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Vegezzi E, Ishiura H, Bragg DC, Pellerin D, Magrinelli F, Currò R, Facchini S, Tucci A, Hardy J, Sharma N, Danzi MC, Zuchner S, Brais B, Reilly MM, Tsuji S, Houlden H, Cortese A. Neurological disorders caused by novel non-coding repeat expansions: clinical features and differential diagnosis. Lancet Neurol 2024; 23:725-739. [PMID: 38876750 DOI: 10.1016/s1474-4422(24)00167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 06/16/2024]
Abstract
Nucleotide repeat expansions in the human genome are a well-known cause of neurological disease. In the past decade, advances in DNA sequencing technologies have led to a better understanding of the role of non-coding DNA, that is, the DNA that is not transcribed into proteins. These techniques have also enabled the identification of pathogenic non-coding repeat expansions that cause neurological disorders. Mounting evidence shows that adult patients with familial or sporadic presentations of epilepsy, cognitive dysfunction, myopathy, neuropathy, ataxia, or movement disorders can be carriers of non-coding repeat expansions. The description of the clinical, epidemiological, and molecular features of these recently identified non-coding repeat expansion disorders should guide clinicians in the diagnosis and management of these patients, and help in the genetic counselling for patients and their families.
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Affiliation(s)
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Pellerin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Riccardo Currò
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefano Facchini
- IRCCS Mondino Foundation, Pavia, Italy; Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Arianna Tucci
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK
| | - John Hardy
- Department of Neurogedengerative Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matt C Danzi
- Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephan Zuchner
- Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Riva A, D'Onofrio G, Ferlazzo E, Pascarella A, Pasini E, Franceschetti S, Panzica F, Canafoglia L, Vignoli A, Coppola A, Badioni V, Beccaria F, Labate A, Gambardella A, Romeo A, Capovilla G, Michelucci R, Striano P, Belcastro V. Myoclonus: Differential diagnosis and current management. Epilepsia Open 2024; 9:486-500. [PMID: 38334331 PMCID: PMC10984309 DOI: 10.1002/epi4.12917] [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] [Received: 10/24/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
Myoclonus classically presents as a brief (10-50 ms duration), non-rhythmic jerk movement. The etiology could vary considerably ranging from self-limited to chronic or even progressive disorders, the latter falling into encephalopathic pictures that need a prompt diagnosis. Beyond the etiological classification, others evaluate myoclonus' body distribution (i.e., clinical classification) or the location of the generator (i.e., neurophysiological classification); particularly, knowing the anatomical source of myoclonus gives inputs on the observable clinical patterns, such as EMG bursts duration or EEG correlate, and guides the therapeutic choices. Among all the chronic disorders, myoclonus often presents itself as a manifestation of epilepsy. In this context, myoclonus has many facets. Myoclonus occurs as one, or the only, seizure manifestation while it can also present as a peculiar type of movement disorder; moreover, its electroclinical features within specific genetically determined epileptic syndromes have seldom been investigated. In this review, following a meeting of recognized experts, we provide an up-to-date overview of the neurophysiology and nosology surrounding myoclonus. Through the dedicated exploration of epileptic syndromes, coupled with pragmatic guidance, we aim to furnish clinicians and researchers alike with practical advice for heightened diagnostic management and refined treatment strategies. PLAIN LANGUAGE SUMMARY: In this work, we described myoclonus, a movement characterized by brief, shock-like jerks. Myoclonus could be present in different diseases and its correct diagnosis helps treatment.
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Affiliation(s)
- Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Edoardo Ferlazzo
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy CentreGreat Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Angelo Pascarella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy CentreGreat Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Elena Pasini
- IRCCS‐Istituto delle Scienze Neurologiche di Bologna, Unit of NeurologyBellaria HospitalBolognaItaly
| | - Silvana Franceschetti
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Ferruccio Panzica
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Laura Canafoglia
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Aglaia Vignoli
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, Health Sciences DepartmentUniversità degli Studi di MilanoMilanoItaly
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatology and Reproductive SciencesFederico II University of NaplesNaplesItaly
| | | | | | - Angelo Labate
- Neurophysiology and Movement Disorders UnitUniversity of MessinaMessinaItaly
| | - Antonio Gambardella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience“Fatebenefratelli e Oftalmico" HospitalMilanoItaly
| | | | - Roberto Michelucci
- IRCCS‐Istituto delle Scienze Neurologiche di Bologna, Unit of NeurologyBellaria HospitalBolognaItaly
| | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
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Hu G, Pan Y, Yuan N, Yang Z, Shi X, Ma S, Li S, Hou X, Liu F, Li D, Bao J, Liu Y. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study. Nat Sci Sleep 2024; 16:207-215. [PMID: 38410526 PMCID: PMC10895986 DOI: 10.2147/nss.s433628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
Background Sleep-related facial mandibular myoclonus (SRFMM) remains rare in clinical practice. The aim of this study was to provide a comprehensive understanding of the electroclinical manner, therapeutic regimen, and prognosis of SRFMM. Methods Twenty-three patients who were diagnosed with SRFMM by clinical manifestation, video-electroencephalography (EEG) and electromyography over bilateral masseter and temporalis muscles were enrolled. Clinical and electrophysiological evaluation as well as follow-up information were recorded and analyzed. Results The cohort involved 4 infants and 19 adults with a mean onset age of 43.5 years for SRFMM, among whom 19 were male. Twenty-one patients complained of tongue injuries and disturbed night-time sleep. SRFMM in 4 patients were ascribed to oral aripiprazole, brainstem ischemia and brain trauma. In 62 SRFMM episodes, 93.5% occurred in NREM sleep and 6.5% in REM sleep, and all events were associated with EEG arousals. In 13 patients with or without clonazepam, the motor events gradually disappeared, and the rest turned to be sporadic. Conclusion SRFMM is a characteristic parasomnia manifested by tongue biting and accompanying facial mandibular myoclonus, leading to disrupted sleep. Besides adults, infants can also experience SRFMM with spontaneous remission. Most patients respond well to clonazepam, eventually with favorable prognosis.
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Affiliation(s)
- Gengyao Hu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Yuanhang Pan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Na Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xiuyu Shi
- Department of Pediatrics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
| | - Sha Ma
- Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China
| | - Shan Li
- Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China
| | - Xiaohua Hou
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Fei Liu
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Dongmei Li
- Department of Dentistry for Special Services, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Junxiang Bao
- Department of Aerospace Hygiene, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
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Van Der Veen S, Tijssen MAJ, Berkovic SF. The Muddle of Myoclonus: Many Guises, 2 Disciplines, Consensus Needed. Neurol Clin Pract 2023; 13:e200187. [PMID: 37664134 PMCID: PMC10473854 DOI: 10.1212/cpj.0000000000200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023]
Abstract
Myoclonus is often approached in different ways by epileptologists and movement disorder specialists, leading to confusion in the literature. Multiplicity and inconsistency over the past 2 centuries resulted in a lack of precision and ambiguity of the terminology. We show that this is a current problem in which one phenomenon has been described with many terms and vice versa. Of more importance, we discuss the conceptualization of myoclonus from perspectives of both fields and focus on the borderland that exists, especially in the spectrum of cortical and epileptic myoclonus. By giving 2 examples, we illustrate the conundrum: the spectrum of progressive myoclonus epilepsies and progressive myoclonic ataxias and "cortical tremor" observed in familial cortical myoclonic tremor with epilepsy or familial adult myoclonic epilepsy. We attempt to facilitate to bridge these subspecialties and form the base for a uniform understanding to take this issue forward toward future classifications, discussions, and scientific research.
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Affiliation(s)
- Sterre Van Der Veen
- Department of Neurology (SVDV, MAJT), University of Groningen, University Medical Centre Groningen; Expertise Centre Movement Disorders Groningen (SVDV, MAJT), University Medical Centre Groningen; and Epilepsy Research Centre (SVDV, SFB), Department of Medicine, University of Melbourne, Austin Health
| | - Marina A J Tijssen
- Department of Neurology (SVDV, MAJT), University of Groningen, University Medical Centre Groningen; Expertise Centre Movement Disorders Groningen (SVDV, MAJT), University Medical Centre Groningen; and Epilepsy Research Centre (SVDV, SFB), Department of Medicine, University of Melbourne, Austin Health
| | - Samuel F Berkovic
- Department of Neurology (SVDV, MAJT), University of Groningen, University Medical Centre Groningen; Expertise Centre Movement Disorders Groningen (SVDV, MAJT), University Medical Centre Groningen; and Epilepsy Research Centre (SVDV, SFB), Department of Medicine, University of Melbourne, Austin Health
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Surillo-Dahdah L, Morfi-Pagán CA. Two-Generation Epsilon-Sarcoglycan Gene (SGCE) Mutation-Associated Myoclonus-Dystonia (DYT-SGCE) Misdiagnosed as Tourette's Syndrome: A Case Series. Cureus 2023; 15:e45289. [PMID: 37846277 PMCID: PMC10576872 DOI: 10.7759/cureus.45289] [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] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
This case series provides a diagnosis of myoclonus-dystonia syndrome (MDS) in two patients whose original presentation was thought to be Tourette's syndrome. The first patient presented with dystonia and myoclonus, which progressively worsened with age, and was diagnosed with an epsilon-sarcoglycan gene (SGCE) mutation. The patient's father, who was diagnosed in his childhood with Tourette's syndrome, also received genetic testing, which proved that to be a misdiagnosis and confirmed that he was the carrier of the SGCE mutation. Both patients were subjected to a levodopa trial, which proved to be an effective treatment. To our knowledge, these are the first reported cases of heterozygous pathogenic mutation of SGCE in Puerto Rico.
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Affiliation(s)
- Laura Surillo-Dahdah
- Department of Neurology, Institute of Neuroscience, Manatí Medical Center, Manatí, PRI
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Xu Y, Zhao L, Dong J, Jiang J, Jin L. Pathogenic SCN5A Mutation and Thyrotoxicosis-Related Neurological Syndrome: Casual or Causal Relationship? Brain Sci 2023; 13:1049. [PMID: 37508981 PMCID: PMC10377684 DOI: 10.3390/brainsci13071049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Various neurologic complications of hyperthyroidism are reported, and most of these complications are reversible with the amelioration of thyrotoxicosis. We report a previously undescribed concurrence of hyperthyroid-associated exercise-induced myalgia and stiffness, pyramidal tract dysfunction, and myoclonic movements that make an initial clinical diagnosis difficult. CASE PRESENTATION A 17-year-old male was hospitalized in the department of neurology, presenting with a 4-year history of severe exercise-induced myalgia and stiffness, weakness of lower limbs, and myoclonic movements. Laboratory investigations unexpectedly revealed hyperthyroidism. MRI of the brain and spine, electrophysiology, and whole exome sequencing were also performed. Antithyroid therapy led to marked improvement of neurologic symptoms, accompanied by a significant improvement of the time-dependent decline in compound muscle action potentials (CMAP) amplitudes after exercise and normalization of the prolonged QTc interval. Genetic analysis identified a rare variant in SCN5A. CONCLUSION This case report provides important insights into the relationship between hyperthyroidism and neurologic/cardiac complications, particularly in those with a genetic predisposition. SCN5A mutation possibly plays a role in the complex neurological syndrome associated with hyperthyroidism. Further studies are warranted to better understand the underlying mechanisms and potential therapeutic options for these complex conditions.
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Affiliation(s)
- Yangqi Xu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Lin Zhao
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Jingjing Jiang
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Lirong Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
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van Noort SAM, van der Veen S, de Koning TJ, de Koning-Tijssen MAJ, Verbeek DS, Sival DA. Early onset ataxia with comorbid myoclonus and epilepsy: A disease spectrum with shared molecular pathways and cortico-thalamo-cerebellar network involvement. Eur J Paediatr Neurol 2023; 45:47-54. [PMID: 37301083 DOI: 10.1016/j.ejpn.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Early onset ataxia (EOA) concerns a heterogeneous disease group, often presenting with other comorbid phenotypes such as myoclonus and epilepsy. Due to genetic and phenotypic heterogeneity, it can be difficult to identify the underlying gene defect from the clinical symptoms. The pathological mechanisms underlying comorbid EOA phenotypes remain largely unknown. The aim of this study is to investigate the key pathological mechanisms in EOA with myoclonus and/or epilepsy. METHODS For 154 EOA-genes we investigated (1) the associated phenotype (2) reported anatomical neuroimaging abnormalities, and (3) functionally enriched biological pathways through in silico analysis. We assessed the validity of our in silico results by outcome comparison to a clinical EOA-cohort (80 patients, 31 genes). RESULTS EOA associated gene mutations cause a spectrum of disorders, including myoclonic and epileptic phenotypes. Cerebellar imaging abnormalities were observed in 73-86% (cohort and in silico respectively) of EOA-genes independently of phenotypic comorbidity. EOA phenotypes with comorbid myoclonus and myoclonus/epilepsy were specifically associated with abnormalities in the cerebello-thalamo-cortical network. EOA, myoclonus and epilepsy genes shared enriched pathways involved in neurotransmission and neurodevelopment both in the in silico and clinical genes. EOA gene subgroups with myoclonus and epilepsy showed specific enrichment for lysosomal and lipid processes. CONCLUSIONS The investigated EOA phenotypes revealed predominantly cerebellar abnormalities, with thalamo-cortical abnormalities in the mixed phenotypes, suggesting anatomical network involvement in EOA pathogenesis. The studied phenotypes exhibit a shared biomolecular pathogenesis, with some specific phenotype-dependent pathways. Mutations in EOA, epilepsy and myoclonus associated genes can all cause heterogeneous ataxia phenotypes, which supports exome sequencing with a movement disorder panel over conventional single gene panel testing in the clinical setting.
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Affiliation(s)
- Suus A M van Noort
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sterre van der Veen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatrics, University Medical Center Groningen, Groningen, the Netherlands; Pediatrics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marina A J de Koning-Tijssen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Dineke S Verbeek
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah A Sival
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands.
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Chen F, Ren A, Wang M, Fu Y, Huo Y, Chen J, Ge R, Wang H. A case report of Parkinson's disease with acute and unmanageable myoclonic dyskinesia. Clin Neurol Neurosurg 2023; 226:107614. [PMID: 36738642 DOI: 10.1016/j.clineuro.2023.107614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/10/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Fang Chen
- Department of Neurology, Binzhou Medical University Hospital, China
| | - Anyan Ren
- Department of Neurology, Binzhou Medical University Hospital, China
| | - Mengdi Wang
- Department of Neurology, Binzhou Medical University Hospital, China
| | - Yong Fu
- Department of Neurology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province 250000, China
| | - Yingqian Huo
- Department of Neurology, Binzhou Medical University Hospital, China
| | - Jinbo Chen
- Department of Neurology, Binzhou Medical University Hospital, China
| | - Ruli Ge
- Department of Neurology, Binzhou Medical University Hospital, China.
| | - Hongcai Wang
- Department of Neurology, Binzhou Medical University Hospital, China.
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Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures. Neurologist 2022:00127893-990000000-00040. [PMID: 36223312 DOI: 10.1097/nrl.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting. REVIEW SUMMARY Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders. CONCLUSIONS Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.
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van der Veen S, Caviness JN, Dreissen YE, Ganos C, Ibrahim A, Koelman JH, Stefani A, Tijssen MA. Myoclonus and other jerky movement disorders. Clin Neurophysiol Pract 2022; 7:285-316. [PMID: 36324989 PMCID: PMC9619152 DOI: 10.1016/j.cnp.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Myoclonus and other jerky movements form a large heterogeneous group of disorders. Clinical neurophysiology studies can have an important contribution to support diagnosis but also to gain insight in the pathophysiology of different kind of jerks. This review focuses on myoclonus, tics, startle disorders, restless legs syndrome, and periodic leg movements during sleep. Myoclonus is defined as brief, shock-like movements, and subtypes can be classified based the anatomical origin. Both the clinical phenotype and the neurophysiological tests support this classification: cortical, cortical-subcortical, subcortical/non-segmental, segmental, peripheral, and functional jerks. The most important techniques used are polymyography and the combination of electromyography-electroencephalography focused on jerk-locked back-averaging, cortico-muscular coherence, and the Bereitschaftspotential. Clinically, the differential diagnosis of myoclonus includes tics, and this diagnosis is mainly based on the history with premonitory urges and the ability to suppress the tic. Electrophysiological tests are mainly applied in a research setting and include the Bereitschaftspotential, local field potentials, transcranial magnetic stimulation, and pre-pulse inhibition. Jerks due to a startling stimulus form the group of startle syndromes. This group includes disorders with an exaggerated startle reflex, such as hyperekplexia and stiff person syndrome, but also neuropsychiatric and stimulus-induced disorders. For these disorders polymyography combined with a startling stimulus can be useful to determine the pattern of muscle activation and thus the diagnosis. Assessment of symptoms in restless legs syndrome and periodic leg movements during sleep can be performed with different validated scoring criteria with the help of electromyography.
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Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - John N. Caviness
- Department of Neurology, Mayo Clinic Arizona, Movement Neurophysiology Laboratory, Scottsdale, AZ, USA
| | - Yasmine E.M. Dreissen
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes H.T.M. Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Corresponding author at: Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Chen LW, Cheng JF, Chang TM, Hsu MH, Huang CC, Chang YC. Prognostic factors for functional recovery in children with moderate to severe acute disseminated encephalomyelitis. Mult Scler Relat Disord 2022; 66:104056. [PMID: 35878513 DOI: 10.1016/j.msard.2022.104056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/25/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is an immune-mediated encephalopathy with heterogeneous disease courses. However, clinical characteristics for a prognostication of functional recovery from acute episodes of ADEM remain limited. The study aims to characterize the clinical presentations and neuroimaging findings of children with poor functional recoveries from acute episodes of moderate to severe ADEM. METHODS The multicenter retrospective cohort study included children under 18 years of age who presented with moderate to severe ADEM (modified Rankin Scale [mRS] ≥ 3 at nadir) from 2002 to 2019. Children were assigned to a good recovery group (mRS ≤ 2) and a poor recovery group (mRS ≥ 3) after mean 4.3 months of follow-up. The clinical presentations and the distribution of brain lesions on magnetic resonance imaging were compared between the two groups by the t-test for numerical variables and Fisher's exact test for categorical variables. Analyses of logistic regression were conducted and significant variables in the multivariate model were examined by the receiver operating characteristic curve for the prediction of functional recovery. RESULTS Among the 73 children with moderate to severe ADEM, 56 (77%) had good functional recoveries and 17 (23%) showed poor functional recoveries. Children with poor recoveries had a lower rate of prodromal headache (12% vs. 39%, p = 0.04), and presented with higher proportions of dystonia (29% vs. 9%, p = 0.046), myoclonus (24% vs. 2%, p = 0.009), and cerebellar lesions on neuroimages (59% vs. 23%, p = 0.01). The multivariate analyses identified that a lack of prodromal headache (OR 0.1, 95% CI 0.005 - 0.7, p = 0.06) and the presentations of myoclonus (OR 21.6, 95% CI 1.7 - 874, p = 0.04) and cerebellar lesions (OR 4.8, 95% CI 1.3 - 19.9, p = 0.02) were associated with poor functional recoveries. These three factors could prognosticate poor outcomes in children with moderate to severe ADEM (area under the receiver operating characteristic curve 0.80, 95% CI 0.68 - 0.93, p = 0.0002). CONCLUSION Nearly one-fourth of children with moderate to severe ADEM had a poor functional recovery from acute episodes, who were characterized by a lack of prodromal headache, the presentation of myoclonus, and the neuroimaging finding of cerebellar lesions. The clinical variables associated with poor functional recoveries could assist in the planning of immunotherapies during hospitalization for a better outcome in moderate to severe ADEM.
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Affiliation(s)
- Li-Wen Chen
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, North District, Tainan, Taiwan
| | - Ju-Fang Cheng
- Department of Pediatrics, Changhua Christian Children's Hospital, 320 Xuguang Road, Changhua City, Changhua County, Taiwan
| | - Tung-Ming Chang
- Department of Pediatrics, Changhua Christian Children's Hospital, 320 Xuguang Road, Changhua City, Changhua County, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, 1001 Daxue Road, East District, Hsinchu, Taiwan
| | - Mei-Hsin Hsu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, North District, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, 50 Wu-Hsing Street, Taipei, Taiwan
| | - Ying-Chao Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan.
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12
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Park KW, Choi N, Oh E, Lyoo CH, Baek MS, Kim HJ, Yoo D, Lee JY, Choi JH, Lee JH, Koh SB, Sung YH, Cho JW, Yang HJ, Park J, Shin HW, Ahn TB, Ryu HS, You S, Choi SM, Kim BJ, Lee SH, Chung SJ. Movement Disorders Associated With Cerebral Artery Stenosis: A Nationwide Study. Front Neurol 2022; 13:939823. [PMID: 35911886 PMCID: PMC9330487 DOI: 10.3389/fneur.2022.939823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Studies of secondary movement disorder (MD) caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from cerebral artery stenosis (CAS) without clinical manifestations of stroke. In this study, we aimed to investigate the clinical characteristics of MD associated with CAS. Materials and Methods A nationwide multicenter retrospective analysis was performed based on the data from patients with CAS-associated MDs from 16 MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the >50% luminal stenosis of the major cerebral arteries. The association between MD and CAS was determined by MD specialists using pre-defined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and MD outcomes. Statistical analyses were performed to identify factors associated with the MD outcomes. Results The data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease (MMD). Relative to patients with atherosclerosis, those with MMD developed MD at a younger age (p < 0.001) and had a more chronic mode of onset (p = 0.001) and less acute ischemic lesion (p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute MD onset had a better outcome than those with subacute-to-chronic MD onset (p = 0.008). Conclusions This study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition.
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Affiliation(s)
- Kye Won Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Nari Choi
- Department of Neurology, Heavenly Hospital, Goyang, South Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Seok Baek
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Han-Joon Kim
- Department of Neurology, Movement Disorder Center, College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dalla Yoo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Ji-Hyun Choi
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
| | - Young Hee Sung
- Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Sun Ju Chung
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13
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Nelson JL, Blume GM, Bansal SK, Kaufman JR, Woods FR, Zhang X, Kattah JC. Postinfectious SARS-CoV-2 Opsoclonus-Myoclonus-Ataxia Syndrome. J Neuroophthalmol 2022; 42:251-255. [PMID: 34974489 DOI: 10.1097/wno.0000000000001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opsoclonus-myoclonus-ataxia syndrome (OMAS) represents a pathophysiology and diagnostic challenge. Although the diverse etiologies likely share a common mechanism to generate ocular, trunk, and limb movements, the underlying cause may be a paraneoplastic syndrome, as the first sign of cancer, or may be a postinfectious complication, and thus, the outcome depends on identifying the trigger mechanism. A recent hypothesis suggests increased GABAA receptor sensitivity in the olivary-oculomotor vermis-fastigial nucleus-premotor saccade burst neuron circuit in the brainstem. Therefore, OMAS management will focus on immunosuppression and modulation of GABAA hypersensitivity with benzodiazepines. METHODS We serially video recorded the eye movements at the bedside of 1 patient with SARS-CoV-2-specific Immunoglobulin G (IgG) serum antibodies, but twice-negative nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR). We tested cerebrospinal fluid (CSF), serum, and nasopharyngeal samples. After brain MRI and chest, abdomen, and pelvis CT scans, we treated our patient with clonazepam and high-dose Solu-MEDROL, followed by a rituximab infusion after her formal eye movement analysis 10 days later. RESULTS The recordings throughout her acute illness demonstrated different eye movement abnormalities. While on high-dose steroids and clonazepam, she initially had macrosaccadic oscillations, followed by brief ocular flutter during convergence the next day; after 10 days, she had bursts of opsoclonus during scotopic conditions with fixation block but otherwise normal eye movements. Concern for a suboptimal response to high-dose Solu-MEDROL motivated an infusion of rituximab, which induced remission. An investigation for a paraneoplastic etiology was negative. CSF testing showed elevated neuron-specific enolase. Serum IgG to Serum SARS-CoV2 IgG was elevated with negative RT-PCR nasopharyngeal testing. CONCLUSION A recent simulation model of macrosaccadic oscillations and OMAS proposes a combined pathology of brainstem and cerebellar because of increased GABAA receptor sensitivity. In this case report, we report 1 patient with elevated CSF neuronal specific enolase, macrosaccadic oscillations, ocular flutter, and OMAS as a SARS-CoV-2 postinfectious complication. Opsoclonus emerged predominantly with fixation block and suppressed with fixation, providing support to modern theories on the mechanism responsible for these ocular oscillations involving cerebellar-brainstem pathogenesis.
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Affiliation(s)
- Jodi L Nelson
- Department of Neurology (JN, GB, FW, XZ, and JK), University of Illinois College of Medicine Peoria, Illinois Neurologic Institute, OSF St. Francis Medical Center, Peoria, Illinois; Department of Neurology (JK and FW), Illinois Neurologic Institute OSF St. Francis Medical Center, Peoria, Illinois; and Department of Internal Medicine (SB), University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, Illinois
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14
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Swinnen BEKS, van Rootselaar AF, Spanjaart AM, de Bie RMA, Kersten MJ, van de Beek D, Brouwer MC, Dijk JM. Cortical myoclonic tremor after chimeric antigen receptor T-cell therapy. J Neurol 2022; 269:5165-5169. [DOI: 10.1007/s00415-022-11127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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15
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Rotter C, Whittaker D, Rusbridge C. Myoclonus in older Cavalier King Charles Spaniels. J Vet Intern Med 2022; 36:1032-1038. [PMID: 35319117 PMCID: PMC9151451 DOI: 10.1111/jvim.16404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/29/2022] Open
Abstract
Background Myoclonus is observed in older Cavalier King Charles Spaniels (CKCS) but a full description is lacking. Objectives The presence, age of onset, characteristics and treatment of myoclonic episodes were retrospectively evaluated in a cohort of CKCS which presented to 1 board‐certified neurologist. Clinical data, imaging studies, presence of seizures and their management, as well as other comorbidities were noted. Animals Thirty‐nine CKCS that were presented to 2 institutions between 2001 and 2018 with signs consistent with myoclonus. Clinical examination, blood sampling, advanced diagnostic imaging, cerebrospinal fluid analysis, and record keeping of other comorbidities was performed. Methods This is a retrospective case series, describing the presence of myoclonus in CKCS. Results Clinical signs reported were spontaneous in onset, lasted a few seconds and consisted of rapid blinking with head nodding and variable extension down the thoracic limbs. Myoclonus occasionally led to stumbling of the thoracic limbs or collapse. Mean age of onset was 8.38 years (SD ±1.96). Thirteen of 39 dogs with myoclonus had paroxysmal events, such as generalized seizures (9/13). Conclusions and Clinical Importance Myoclonus occurs in middle‐aged to older CKCS and seems to be another epiphenomena of this breed. A link to epilepsy might be present.
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Affiliation(s)
- Carina Rotter
- Orthopedics and Neurology, Fitzpatrick Referrals Ltd, Surrey, United Kingdom
| | - Danielle Whittaker
- Orthopedics and Neurology, Fitzpatrick Referrals Ltd, Surrey, United Kingdom
| | - Clare Rusbridge
- Orthopedics and Neurology, Fitzpatrick Referrals Ltd, Surrey, United Kingdom.,School of Veterinary Medicine, University of Surrey, Surrey, United Kingdom
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16
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Everlo CS, Elting JWJ, Tijssen MA, van der Stouwe AM. Electrophysiological testing aids the diagnosis of tremor and myoclonus in clinically challenging patients. Clin Neurophysiol Pract 2022; 7:51-58. [PMID: 35243186 PMCID: PMC8867002 DOI: 10.1016/j.cnp.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 01/01/2023] Open
Abstract
Objective We investigated how clinical neurophysiological testing can help distinguish tremor and myoclonus and their subtypes. Methods We retrospectively analysed clinical and neurophysiological data from patients who had undergone polymyography (EMG + accelerometry) to diagnose suspected tremor or myoclonus. We show a systematic approach, which includes contraction pattern, rhythm regularity, burst duration and evidence of cortical drive. Results We detected 773 patients in our database, of which 556 patients were ultimately diagnosed with tremor (enhanced physiological tremor n = 169, functional tremor n = 140, essential tremor n = 90, parkinsonism associated tremor n = 64, cerebellar tremor n = 19, Holmes tremor n = 12, dystonic tremor n = 8, tremor not further specified n = 9), 140 with myoclonus and 23 with a combination of tremor and myoclonus. Polymyography confirmed the presumptive diagnosis in the majority of the patients and led to a change of diagnosis in 287 patients (37%). Conversions between diagnoses of tremor and myoclonus occurred most frequently between enhanced physiological tremor, essential tremor, functional tremor and cortical myoclonus. Conclusions Neurophysiology is a valuable additional tool in clinical practice to differentiate between tremor and myoclonus, and can guide towards a specific subtype. Significance We show how the stepwise neurophysiological approach used at our medical center aids the diagnosis of tremor versus myoclonus.
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Affiliation(s)
- Cheryl S.J. Everlo
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jan Willem J. Elting
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Marina A.J. Tijssen
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - A.M. Madelein van der Stouwe
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
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17
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Della Corte M, Delehaye C, Savastano E, De Leva MF, Bernardo P, Varone A. Neuropsychiatric syndrome with myoclonus after SARS-CoV-2 infection in a paediatric patient. Clin Neurol Neurosurg 2022; 213:107121. [PMID: 35030418 PMCID: PMC8739821 DOI: 10.1016/j.clineuro.2022.107121] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
We report the case of a 12-years-old patient who subacutely developed a positive and negative myoclonus of limbs and face, drowsiness and memory deficits after getting infected by SARS-CoV-2. On admission, nasopharyngeal swab for SARS-CoV-2, brain and spinal MRI with and without contrast, EEG, chest X-ray and abdominal ultrasound were negative. CSF physical-chemical examination, culture, PCR testing for SARS-CoV-2 and other pathogens, and oligoclonal IgG bands were negative as well. A full panel blood test, including clotting, autoimmunity and paraneoplastic blood studies, did not show any alteration. The neuropsychological examination showed an impairment in memory, visual-motor coordination, inductive reasoning skills, attention, and concentration. The patient was first treated with clonazepam and then with intravenous methylprednisolone for five days, with poor response. For this reason, he then received a cycle of IVIG, thus reaching a gradual and complete recovery. To date, this is the first case of a COVID-19 associated myoclonus affecting a paediatric patient.
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Affiliation(s)
- M Della Corte
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy.
| | - C Delehaye
- Department of Paediatrics, University of Campania "Luigi Vanvitelli", Piazza L. Miraglia, 2, 80138 Naples, Italy
| | - E Savastano
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - M F De Leva
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - P Bernardo
- Department of Neurosciences, Pediatric Psychiatry and Neurology Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - A Varone
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
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18
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Emerging role of clinical neurophysiology in the diagnosis of movement disorders. Clin Neurophysiol Pract 2022; 7:49-50. [PMID: 35243185 PMCID: PMC8867001 DOI: 10.1016/j.cnp.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/20/2022] Open
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19
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Burton MA, Dalrymple WA, Figari R. Assessment and Treatment of Myoclonus: A Review. Neurology 2022. [DOI: 10.17925/usn.2022.18.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Myoclonus is defined as sudden, brief, shock-like contractions of muscles, and it can be a challenging diagnosis for the clinician to face. The number of aetiologies can make it difficult to determine the appropriate diagnostic workup for each individual patient without ordering a broad array of diagnostic studies from the start. As with other neurological conditions, a comprehensive history and physical examination are paramount in generating and ordering the initial differential diagnosis. Neurophysiological classification of myoclonus, using both electroencephalogram and electromyography, can be very helpful in elucidating the underlying aetiology. Treatment of myoclonus is often symptomatic, unless a clear treatable underlying cause can be found. This article aims to help providers navigate the assessment and treatment of myoclonus, focusing on neurophysiological classification as a guide. By the end of this article, providers should have a good understanding of how to approach the workup and treatment of myoclonus of various aetiologies.
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20
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Pollini L, Tijssen MAJ. A diagnosis of progressive myoclonic ataxia guided by blood biomarkers: Expert commentary. Parkinsonism Relat Disord 2021; 94:127-128. [PMID: 34896024 DOI: 10.1016/j.parkreldis.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
Affiliation(s)
- L Pollini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M A J Tijssen
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands.
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Peters L, Depienne C, Klebe S. Familial adult myoclonic epilepsy (FAME): clinical features, molecular characteristics, pathophysiological aspects and diagnostic work-up. MED GENET-BERLIN 2021; 33:311-318. [PMID: 38835431 PMCID: PMC11006339 DOI: 10.1515/medgen-2021-2100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/16/2021] [Indexed: 06/06/2024]
Abstract
Familial adult myoclonic epilepsy (FAME) is a rare autosomal dominant disorder characterized by myoclonus and seizures. The genetic variant underlying FAME is an intronic repeat expansion composed of two different pentamers: an expanded TTTTA, which is the motif originally present at the locus, and an insertion of TTTCA repeats, which is usually located at the 3' end and likely corresponds to the pathogenic part of the expansion. This repeat expansion has been identified so far in six genes located on different chromosomes, which remarkably encode proteins with distinct cellular localizations and functions. Although the exact pathophysiological mechanisms remain to be clarified, it is likely that FAME repeat expansions lead to disease independently of the gene where they occur. We herein review the clinical and molecular characteristics of this singular genetic disorder, which interestingly shares clinical features with other more common neurological disorders whose etiology remains mainly unsolved.
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Affiliation(s)
- Lorenz Peters
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, University Hospital Essen, Essen, Germany
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22
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Abu-Hegazy M, Elmoungi A, Eltantawi E, Esmael A. Electrophysiological characteristics and anatomical differentiation of epileptic and non-epileptic myoclonus. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Electrophysiological techniques have been used for discriminating myoclonus from other hyperkinetic movement disorders and for classifying the myoclonus subtype. This study was carried out on patients with different subtypes of myoclonus to determine the electrophysiological characteristics and the anatomical classification of myoclonus of different etiologies. This study included 20 patients with different subtypes of myoclonus compared with 30 control participants. Electrophysiological study was carried out for all patients by somatosensory evoked potential (SSEP) and electroencephalography (EEG) while the control group underwent SSEP. SSEP was evaluated in patients and control groups by stimulation of right and left median nerves.
Results
This study included 50 cases with myoclonus of different causes with mean age of 39.3 ± 15.7 and consisted of 23 males and 27 females. Twenty-nine (58%) of the patients were epileptics, while 21 (42%) were non-epileptics. Cases were classified anatomically into ten cases with cortical myoclonus (20%), 12 cases with subcortical myoclonus (24%), and 28 cases with cortical–subcortical myoclonus (56%). There was a significant difference regarding the presence of EEG findings in epileptic myoclonic and non-epileptic myoclonic groups (P = 0.005). Also, there were significant differences regarding P24 amplitude, N33 amplitude, P24–N33 peak-to-peak complex amplitude regarding all types of myoclonus. Primary myoclonic epilepsy (PME) demonstrated significant giant response, juvenile myoclonic epilepsy (JME) demonstrated no enhancement compared to controls, while secondary myoclonus demonstrated lower giant response compared to PME.
Conclusion
Somatosensory evoked potential and electroencephalography are important for the diagnosis and anatomical sub-classification of myoclonus and so may help in decision-making regarding to the subsequent management.
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Ser MH, Gündüz A, Demirbilek V, Yalçınkaya C, Nalbantoğlu M, Coşkun T, Kızıltan M. Progression of myoclonus subtypes in subacute sclerosing panencephalitis. Neurophysiol Clin 2021; 51:533-540. [PMID: 34772596 DOI: 10.1016/j.neucli.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Diagnostic criteria of subacute sclerosing panencephalitis (SSPE) include myoclonus, a well-recognized clinical feature. Here, we studied the electrophysiological features of myoclonus with regards to disease staging in SSPE patients. METHODS We included 10 patients diagnosed with SSPE between 2010 and 2018, along with 21 healthy subjects. All participants had detailed electrophysiological evaluation including polymyographic analysis, blink reflex after trigeminal stimulation, auditory startle response, startle response after somatosensory stimuli, F-waves, and long-loop reflexes. Clinical findings were retrieved from the medical records. RESULTS Patients were categorized into Gascon stage 2B (n = 5, 50%), 2A (n = 2, 20%), 3B (n = 2, 20%) and 4A (n = 1, 10%) at the time of electrophysiological evaluation. Two patients had cortical myoclonus, four had possible cortico-subcortical myoclonus, and four had brainstem myoclonus. Patients were categorized into Gascon stages 2a and 2b had possible cortico-subcortical myoclonus (85.7%). However, none of the patients with stage 3b or 4a had possible cortico-subcortical subtype but all had the brainstem subtype. CONCLUSION Association was seen between subtypes of myoclonus and clinical staging in SSPE. This suggests that myoclonus in SSPE may primarily involve the cortex and cortico-subcortical structures such as the thalamus at earlier stages of disease, and then involve more caudal structures as the disease progresses.
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Affiliation(s)
- Merve Hazal Ser
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysi Demirbilek
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cengiz Yalçınkaya
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mecbure Nalbantoğlu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tülin Coşkun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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van der Stouwe AMM, Tuitert I, Giotis I, Calon J, Gannamani R, Dalenberg JR, van der Veen S, Klamer MR, Telea AC, Tijssen MAJ. Next move in movement disorders (NEMO): developing a computer-aided classification tool for hyperkinetic movement disorders. BMJ Open 2021; 11:e055068. [PMID: 34635535 PMCID: PMC8506849 DOI: 10.1136/bmjopen-2021-055068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Our aim is to develop a novel approach to hyperkinetic movement disorder classification, that combines clinical information, electromyography, accelerometry and video in a computer-aided classification tool. We see this as the next step towards rapid and accurate phenotype classification, the cornerstone of both the diagnostic and treatment process. METHODS AND ANALYSIS The Next Move in Movement Disorders (NEMO) study is a cross-sectional study at Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen. It comprises patients with single and mixed phenotype movement disorders. Single phenotype groups will first include dystonia, myoclonus and tremor, and then chorea, tics, ataxia and spasticity. Mixed phenotypes are myoclonus-dystonia, dystonic tremor, myoclonus ataxia and jerky/tremulous functional movement disorders. Groups will contain 20 patients, or 40 healthy participants. The gold standard for inclusion consists of interobserver agreement on the phenotype among three independent clinical experts. Electromyography, accelerometry and three-dimensional video data will be recorded during performance of a set of movement tasks, chosen by a team of specialists to elicit movement disorders. These data will serve as input for the machine learning algorithm. Labels for supervised learning are provided by the expert-based classification, allowing the algorithm to learn to predict what the output label should be when given new input data. Methods using manually engineered features based on existing clinical knowledge will be used, as well as deep learning methods which can detect relevant and possibly new features. Finally, we will employ visual analytics to visualise how the classification algorithm arrives at its decision. ETHICS AND DISSEMINATION Ethical approval has been obtained from the relevant local ethics committee. The NEMO study is designed to pioneer the application of machine learning of movement disorders. We expect to publish articles in multiple related fields of research and patients will be informed of important results via patient associations and press releases.
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Affiliation(s)
- A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge Tuitert
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ioannis Giotis
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Rahul Gannamani
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle R Dalenberg
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sterre van der Veen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Alex C Telea
- Department of Information and Computing Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Rissanen SM, Hyppönen J, Silvennoinen K, Säisänen L, Karjalainen PA, Mervaala E, Kälviäinen R. Wearable monitoring of positive and negative myoclonus in progressive myoclonic epilepsy type 1. Clin Neurophysiol 2021; 132:2464-2472. [PMID: 34454274 DOI: 10.1016/j.clinph.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/25/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop and test wearable monitoring of surface electromyography and motion for detection and quantification of positive and negative myoclonus in patients with progressive myoclonic epilepsy type 1 (EPM1). METHODS Surface electromyography and three-dimensional acceleration were measured from 23 EPM1 patients from the biceps brachii (BB) of the dominant and the extensor digitorum communis (EDC) of the non-dominant arm for 48 hours. The patients self-reported the degree of myoclonus in a diary once an hour. Severity of myoclonus with action was evaluated by using video-recorded Unified Myoclonus Rating Scale (UMRS). Correlations of monitored parameters were quantified with the UMRS scores and the self-reported degrees of myoclonus. RESULTS The monitoring-based myoclonus index correlated significantly (p < 0.001) with the UMRS scores (ρ = 0.883 for BB and ρ = 0.823 for EDC) and with the self-reported myoclonus degrees (ρ = 0.483 for BB and ρ = 0.443 for EDC). Ten patients were assessed as probably having negative myoclonus in UMRS, while our algorithm detected that in twelve patients. CONCLUSIONS Wearable monitoring was able to detect both positive and negative myoclonus in EPM1 patients. SIGNIFICANCE Our method is suitable for quantifying objective, real-life treatment effects at home and progression of myoclonus.
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Affiliation(s)
- Saara M Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Jelena Hyppönen
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katri Silvennoinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Laura Säisänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Pasi A Karjalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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26
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Chandarana M, Saraf U, Divya KP, Krishnan S, Kishore A. Myoclonus- A Review. Ann Indian Acad Neurol 2021; 24:327-338. [PMID: 34446993 PMCID: PMC8370153 DOI: 10.4103/aian.aian_1180_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Myoclonus is a hyperkinetic movement disorder characterized by a sudden, brief, involuntary jerk. Positive myoclonus is caused by abrupt muscle contractions, while negative myoclonus by sudden cessation of ongoing muscular contractions. Myoclonus can be classified in various ways according to body distribution, relation to activity, neurophysiology, and etiology. The neurophysiological classification of myoclonus by means of electrophysiological tests is helpful in guiding the best therapeutic strategy. Given the diverse etiologies of myoclonus, a thorough history and detailed physical examination are key to the evaluation of myoclonus. These along with basic laboratory testing and neurophysiological studies help in narrowing down the clinical possibilities. Though symptomatic treatment is required in the majority of cases, treatment of the underlying etiology should be the primary aim whenever possible. Symptomatic treatment is often not satisfactory, and a combination of different drugs is often required to control the myoclonus. This review addresses the etiology, classification, clinical approach, and management of myoclonus.
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Affiliation(s)
- Mitesh Chandarana
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Udit Saraf
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K P Divya
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Syam Krishnan
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Asha Kishore
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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27
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The diagnostic value of clinical neurophysiology in hyperkinetic movement disorders: A systematic review. Parkinsonism Relat Disord 2021; 89:176-185. [PMID: 34362669 DOI: 10.1016/j.parkreldis.2021.07.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION To guide the neurologist and neurophysiologist with interpretation and implementation of clinical neurophysiological examinations, we aim to provide a systematic review on evidence of electrophysiological features used to differentiate between hyperkinetic movement disorders. METHODS A PRISMA systematic search and QUADAS quality evaluation has been performed in PubMed to identify diagnostic test accuracy studies comparing electromyography and accelerometer features. We included papers focusing on tremor, dystonia, myoclonus, chorea, tics and ataxia and their functional variant. The features were grouped as 1) basic features (e.g., amplitude, frequency), 2) the influence of tasks on basic features (e.g., entrainment, distraction), 3) advanced analyses of multiple signals, 4) and diagnostic tools combining features. RESULTS Thirty-eight cross-sectional articles were included discussing tremor (n = 28), myoclonus (n = 5), dystonia (n = 5) and tics (n = 1). Fifteen were rated as 'high quality'. In tremor, the basic and task-related features showed great overlap between clinical tremor syndromes, apart from rubral and enhanced physiological tremor. Advanced signal analyses were best suited for essential, parkinsonian and functional tremor, and cortical, non-cortical and functional jerks. Combinations of electrodiagnostic features could identify essential, enhanced physiological and functional tremor. CONCLUSION Studies into the diagnostic accuracy of electrophysiological examinations to differentiate between hyperkinetic movement disorders have predominantly been focused on clinical tremor syndromes. No single feature can differentiate between them all; however, a combination of analyses might improve diagnostic accuracy.
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28
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Montano V, Orsucci D, Carelli V, La Morgia C, Valentino ML, Lamperti C, Marchet S, Musumeci O, Toscano A, Primiano G, Santorelli FM, Ticci C, Filosto M, Rubegni A, Mongini T, Tonin P, Servidei S, Ceravolo R, Siciliano G, Mancuso M. Adult-onset mitochondrial movement disorders: a national picture from the Italian Network. J Neurol 2021; 269:1413-1421. [PMID: 34259909 PMCID: PMC8857085 DOI: 10.1007/s00415-021-10697-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023]
Abstract
Introduction Both prevalence and clinical features of the various movement disorders in adults with primary mitochondrial diseases are unknown. Methods Based on the database of the “Nation-wide Italian Collaborative Network of Mitochondrial Diseases”, we reviewed the clinical, genetic, neuroimaging and neurophysiological data of adult patients with primary mitochondrial diseases (n = 764) where ataxia, myoclonus or other movement disorders were part of the clinical phenotype. Results Ataxia, myoclonus and movement disorders were present in 105/764 adults (13.7%), with the onset coinciding or preceding the diagnosis of the mitochondrial disease in 49/105 (46.7%). Ataxia and parkinsonism were the most represented, with an overall prevalence at last follow-up of 59.1% and 30.5%, respectively. Hyperkinetic movement disorders were reported in 15.3% at last follow-up, being the less common reported movement disorders. The pathogenic m.8344A > G and POLG variants were always associated with a movement disorder, while LHON variants and mtDNA single deletions were more commonly found in the subjects who did not present a movement disorder. The most common neuroimaging features were cortical and/or cerebellar atrophy, white matter hyperintensities, basal ganglia abnormalities and nigro-striatal degeneration. Almost 70% of patients with parkinsonism responded to dopaminergic therapy, mainly levodopa, and 50% with myoclonus were successfully treated with levetiracetam. Conclusion Movement disorders, mainly ataxia and parkinsonism, are important findings in adult primary mitochondrial diseases. This study underlies the importance of looking for a mitochondrial etiology in the diagnostic flowchart of a movement disorder and may help direct genetic screening in daily practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10697-1.
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Affiliation(s)
- V Montano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - D Orsucci
- Unit of Neurology, San Luca Hospital, Lucca, Italy
| | - V Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - C La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - M L Valentino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - C Lamperti
- UO Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - S Marchet
- UO Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - O Musumeci
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Primiano
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F M Santorelli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Stella Maris Foundation, Pisa, Italy
| | - C Ticci
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Stella Maris Foundation, Pisa, Italy
| | - M Filosto
- Department of Clinical and Experimental Sciences, ASST Spedali Civili Brescia and NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - A Rubegni
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, IRCCS Stella Maris Foundation, Pisa, Italy
| | - T Mongini
- Department of Neurosciences, University of Torino, Turin, Italy
| | - P Tonin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - S Servidei
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Ceravolo
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - G Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy.
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New-Onset Movement Disorders Associated with COVID-19. Tremor Other Hyperkinet Mov (N Y) 2021; 11:26. [PMID: 34277139 PMCID: PMC8269765 DOI: 10.5334/tohm.595] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Movement disorders are increasingly described in hospitalized and milder cases of SARS-CoV-2 infection, despite a very low prevalence compared to the total patients. Methods We reviewed the scientific literature published in English, spanning from the initial descriptions of COVID-19 until January 25, 2021, in the PubMed/MEDLINE database. Results We identified 93 new-onset movement disorders cases (44 articles) from 200 papers screened in the database or reference lists. Myoclonus was present in 63.4% (n = 59), ataxia in 38.7% (n = 36), action/postural tremor in 10.8% (n = 10), rigid-akinetic syndrome in 5.38% (n = 5), oculomotor abnormalities in 20.4% (n = 19), catatonia in 2.1% (n = 2), dystonia in 1.1% (n = 1), chorea in 1.1% (n = 1), functional (psychogenic) movement disorders in 3.2% (n = 3) of the reported COVID-19 cases with any movement disorder. Encephalopathy was a common association (n = 37, 39.78%). Discussion Comprehensive neurophysiological, clinical, and neuroimaging descriptions of movement disorders in the setting of SARS-CoV-2 infection are still lacking, and their pathophysiology may be related to inflammatory, postinfectious, or even indirect mechanisms not specific to SARS-CoV-2, such as ischemic-hypoxic brain insults, drug effects, sepsis, kidney failure. Cortical/subcortical myoclonus, which the cited secondary mechanisms can largely cause, seems to be the most common hyperkinetic abnormal movement, and it might occur in association with encephalopathy and ataxia. Conclusion This brief review contributes to the clinical description of SARS-CoV-2 potential neurological manifestations, assisting clinical neurologists in identifying features of these uncommon syndromes as a part of COVID-19 symptomatology. Highlights - Movement disorders are probably uncommon neurological manifestations in SARS-CoV-2 infection;- Myoclonus is the most reported movement disorder associated with COVID-19, its clinical complications or pharmacological management;- The pathophysiology is yet not well-understood but can include systemic inflammation, autoimmune mechanisms, or hypoxia.
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30
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Storti B, Gallone A, Paris L, Foresti C. A Rare Case of Atypical Palatal‐Lingual Tremor Associated with Waldenström's Macroglobulinemia. Mov Disord Clin Pract 2021. [DOI: 10.1002/mdc3.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Benedetta Storti
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
- Università Milano Bicocca, San Gerardo Hospital Monza Italy
| | - Annamaria Gallone
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
| | - Laura Paris
- USC Ematologia, ASST Papa Giovanni XXIII Bergamo Italy
| | - Camillo Foresti
- UOS Neurofisiopatologia e UOC Neurologia, ASST Papa Giovanni XXIII Bergamo Italy
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31
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Movement Disorders in Children with a Mitochondrial Disease: A Cross-Sectional Survey from the Nationwide Italian Collaborative Network of Mitochondrial Diseases. J Clin Med 2021; 10:jcm10102063. [PMID: 34065803 PMCID: PMC8151313 DOI: 10.3390/jcm10102063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 12/20/2022] Open
Abstract
Movement disorders are increasingly being recognized as a manifestation of childhood-onset mitochondrial diseases (MDs). However, the spectrum and characteristics of these conditions have not been studied in detail in the context of a well-defined cohort of patients. We retrospectively explored a cohort of individuals with childhood-onset MDs querying the Nationwide Italian Collaborative Network of Mitochondrial Diseases database. Using a customized online questionnaire, we attempted to collect data from the subgroup of patients with movement disorders. Complete information was available for 102 patients. Movement disorder was the presenting feature of MD in 45 individuals, with a mean age at onset of 11 years. Ataxia was the most common movement disorder at onset, followed by dystonia, tremor, hypokinetic disorders, chorea, and myoclonus. During the disease course, most patients (67.7%) encountered a worsening of their movement disorder. Basal ganglia involvement, cerebral white matter changes, and cerebellar atrophy were the most commonly associated neuroradiological patterns. Forty-one patients harbored point mutations in the mitochondrial DNA, 10 carried mitochondrial DNA rearrangements, and 41 cases presented mutations in nuclear-DNA-encoded genes, the latter being associated with an earlier onset and a higher impairment in activities of daily living. Among our patients, 32 individuals received pharmacological treatment; clonazepam and oral baclofen were the most commonly used drugs, whereas levodopa and intrathecal baclofen administration were the most effective. A better delineation of the movement disorders phenotypes starting in childhood may improve our diagnostic workup in MDs, fine tuning management, and treatment of affected patients.
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32
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Sieffien W, Peng P, Dinsmore M. Spinal myoclonus following spinal anaesthesia in a patient with restless legs syndrome. Anaesth Rep 2021; 9:73-75. [PMID: 33898996 DOI: 10.1002/anr3.12113] [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] [Accepted: 03/29/2021] [Indexed: 12/16/2022] Open
Abstract
Myoclonus is defined as involuntary muscle contractions that are self-limiting. The presentation can be diverse, and severe movements may cause significant alarm to both patient and practitioner, with the potential for inappropriate management. Although rare, myoclonus has been associated with intrathecal anaesthetics; however, the exact aetiology remains unclear. In this report, we present a case of delayed spinal myoclonus following the administration of intrathecal bupivacaine to a patient with a known history of restless legs syndrome. The aim of this report is to increase awareness of this rare complication and to contribute to the current body of literature in order that the pathophysiology and potential risk factors may be better understood.
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Affiliation(s)
- W Sieffien
- Faculty of Medicine University of Toronto Toronto ON Canada
| | - P Peng
- Department of Anaesthesia and Pain Medicine Toronto Western Hospital University Health Network Toronto ON Canada.,Department of Anaesthesia and Pain Medicine University of Toronto Toronto ON Canada
| | - M Dinsmore
- Department of Anaesthesia and Pain Medicine Toronto Western Hospital University Health Network Toronto ON Canada.,Department of Anaesthesia and Pain Medicine University of Toronto Toronto ON Canada
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33
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Gannamani R, van der Veen S, van Egmond M, de Koning TJ, Tijssen MAJ. Challenges in Clinicogenetic Correlations: One Phenotype - Many Genes. Mov Disord Clin Pract 2021; 8:311-321. [PMID: 33816658 PMCID: PMC8015914 DOI: 10.1002/mdc3.13163] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/11/2022] Open
Abstract
Background In the field of movement disorders, what you see (phenotype) is seldom what you get (genotype). Whereas 1 phenotype was previously associated to 1 gene, the advent of next‐generation sequencing (NGS) has facilitated an exponential increase in disease‐causing genes and genotype–phenotype correlations, and the “one‐phenotype‐many‐genes” paradigm has become prominent. Objectives To highlight the “one‐phenotype‐many‐genes” paradigm by discussing the main challenges, perspectives on how to address them, and future directions. Methods We performed a scoping review of the various aspects involved in identifying the underlying molecular cause of a movement disorder phenotype. Results The notable challenges are (1) the lack of gold standards, overlap in clinical spectrum of different movement disorders, and variability in the interpretation of classification systems; (2) selecting which patients benefit from genetic tests and the choice of genetic testing; (3) problems in the variant interpretation guidelines; (4) the filtering of variants associated with disease; and (5) the lack of standardized, complete, and up‐to‐date gene lists. Perspectives to address these include (1) deep phenotyping and genotype–phenotype integration, (2) adherence to phenotype‐specific diagnostic algorithms, (3) implementation of current and complementary bioinformatic tools, (4) a clinical‐molecular diagnosis through close collaboration between clinicians and genetic laboratories, and (5) ongoing curation of gene lists and periodic reanalysis of genetic sequencing data. Conclusions Despite the rapidly emerging possibilities of NGS, there are still many steps to take to improve the genetic diagnostic yield. Future directions, including post‐NGS phenotyping and cohort analyses enriched by genotype–phenotype integration and gene networks, ought to be pursued to accelerate identification of disease‐causing genes and further improve our understanding of disease biology.
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Affiliation(s)
- Rahul Gannamani
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Department of Genetics University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Sterre van der Veen
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Martje van Egmond
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Tom J de Koning
- Department of Genetics University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands.,Pediatrics, Department of Clinical Sciences Lund University Lund Sweden
| | - Marina A J Tijssen
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
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Micheli FE, Groppo J, Contartese ML, Baccaglio PG. Spinal myoclonus? Proposal for a new definition. Parkinsonism Relat Disord 2021; 85:29. [PMID: 33677204 DOI: 10.1016/j.parkreldis.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Javier Groppo
- Centro de Parkinson y Trastornos del Movimiento, Ciudad autónoma de Buenos Aires, Argentina
| | - María Laura Contartese
- Centro de Parkinson y Trastornos del Movimiento, Ciudad autónoma de Buenos Aires, Argentina
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Brandsma R, van Egmond ME, Tijssen MAJ. Diagnostic approach to paediatric movement disorders: a clinical practice guide. Dev Med Child Neurol 2021; 63:252-258. [PMID: 33150968 PMCID: PMC7894329 DOI: 10.1111/dmcn.14721] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
Paediatric movement disorders (PMDs) comprise a large group of disorders (tics, myoclonus, tremor, dystonia, chorea, Parkinsonism, ataxia), often with mixed phenotypes. Determination of the underlying aetiology can be difficult given the broad differential diagnosis and the complexity of the genotype-phenotype relationships. This can make the diagnostic process time-consuming and difficult. In this overview, we present a diagnostic approach for PMDs, with emphasis on genetic causes. This approach can serve as a framework to lead the clinician through the diagnostic process in eight consecutive steps, including recognition of the different movement disorders, identification of a clinical syndrome, consideration of acquired causes, genetic testing including next-generation sequencing, post-sequencing phenotyping, and interpretation of test results. The aim of this approach is to increase the recognition and diagnostic yield in PMDs. WHAT THIS PAPER ADDS: An up-to-date description and diagnostic framework for testing of paediatric movement disorders is presented. The framework helps to determine which patients will benefit from next-generation sequencing.
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Affiliation(s)
- Rick Brandsma
- Department of Pediatric NeurologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Martje E van Egmond
- Department of NeurologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Marina A J Tijssen
- Department of NeurologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
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Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review. J Neurol 2021; 268:3517-3548. [PMID: 33616739 PMCID: PMC7897737 DOI: 10.1007/s00415-021-10458-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, neurological manifestations have been recognized as potential complications. Relatively rare movement disorders associated with COVID-19 are increasingly reported in case reports or case series. Here, we present a case and systematic review of myoclonus and cerebellar ataxia associated with COVID-19. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline using the PubMed and Ovid MEDLINE databases, from November 1, 2019 to December 6, 2020. Results 51 cases of myoclonus or ataxia associated with COVID-19, including our case, were identified from 32 publications. The mean age was 59.6 years, ranging from 26 to 88 years, and 21.6% were female. Myoclonus was multifocal or generalized and had an acute onset, usually within 1 month of COVID-19 symptoms. Myoclonus occurred in isolation (46.7%), or with ataxia (40.0%) or cognitive changes (30.0%). Most cases improved within 2 months, and treatment included anti-epileptic medications or immunotherapy. Ataxia had an acute onset, usually within 1 month of COVID-19 symptoms, but could be an initial symptom. Concurrent neurological symptoms included cognitive changes (45.5%), myoclonus (36.4%), or a Miller Fisher syndrome variant (21.2%). Most cases improved within 2 months, either spontaneously or with immunotherapy. Conclusions This systematic review highlights myoclonus and ataxia as rare and treatable post-infectious or para-infectious, immune-mediated phenomena associated with COVID-19. The natural history is unknown and future investigation is needed to further characterize these movement disorders and COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10458-0.
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Hu G, Yuan N, Pan Y, Wang B, Wang X, Wang Z, Chen Z, Liu Y. Electroclinical Features of Sleep-Related Head Jerk. Nat Sci Sleep 2021; 13:2113-2123. [PMID: 34880695 PMCID: PMC8646951 DOI: 10.2147/nss.s331893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVES To evaluate clinical and electrophysiological features of sleep-related head jerk (SRHJ) and electromyographic activity of superficial neck muscles during head jerk. METHODS Totally, 850 cases with video-polysomnography recording were collected, among which 50 presented with SRHJ. In these 50 patients, 15 underwent electromyography (EMG) check on bilateral sternocleidomastoid (SCM) and trapezius muscles as well as chin, while 35 had only chin EMG check. Further, the sensitivity and specificity of the both EMGs were calculated and compared. RESULTS Six among the 50 SRHJ patients had a primary complaint of involuntary head jerks associated with impaired sleep. Approximately 76.1% of head jerks occurred during REM sleep with the median head jerk index of 5.9/h, 64.5% of which were associated with electroencephalogram arousals and 66.4% with body movements. One patient showed SRHJ predominantly in NREM sleep but also in wakefulness. Surface EMG of SCM/trapezius muscles showed a sensitivity of 92% and a specificity of 97.8%, whereas chin EMG had a sensitivity of 14.5% and a specificity of 98.8%. CONCLUSION SRHJ was associated with electroencephalogram arousals and might interfere with sleep. Surface EMG of SCM/trapezius muscles exhibited a good accuracy in the revelation of SRHJ.
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Affiliation(s)
- Gengyao Hu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China.,Department of Neurology, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, 710061, People's Republic of China
| | - Na Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Yuanhang Pan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Bi Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Xiaoli Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Zezhi Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Ze Chen
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, 710032, People's Republic of China
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van de Wardt J, van der Stouwe AMM, Dirkx M, Elting JWJ, Post B, Tijssen MA, Helmich RC. Systematic clinical approach for diagnosing upper limb tremor. J Neurol Neurosurg Psychiatry 2020; 91:822-830. [PMID: 32457087 PMCID: PMC7402459 DOI: 10.1136/jnnp-2019-322676] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.
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Affiliation(s)
- Jaron van de Wardt
- Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands .,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Michiel Dirkx
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Abstract
Background: Myoclonus-dystonia due to SGCE mutations (OMIM: 159900) most commonly presents during childhood with mainly upper body myoclonus, and mild dystonia affecting the neck and arms. Case reports: Herein, we report patients misdiagnosed during childhood with Tourette syndrome and dyskinetic cerebral palsy, and, during adulthood, found to harbor SGCE frameshift mutations. Discussion: Myoclonus-dystonia may be underdiagnosed due to phenotypic misclassification during childhood. SGCE mutations should be included in the differential diagnosis of childhood movement disorders that ostensibly manifest with tics, myoclonus, or abnormal posturing secondary to dystonia and/or spasticity. Highlights: Due to pleiotropy, variable penetrance, broad differential, and hereditary effects of imprinting, the diagnosis of a disorder of childhood onset, myoclonus-dystonia due to SGCE mutations, may be delayed until adulthood, often compromising appropriate clinical management and genetic counseling.
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40
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Hwang J, Bank AM, Mortazavi F, Oakley DH, Frosch MP, Schmahmann JD. Spinal cord α-synuclein deposition associated with myoclonus in patients with MSA-C. Neurology 2020; 93:302-309. [PMID: 31405935 DOI: 10.1212/wnl.0000000000007949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/21/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that myoclonus in patients with multiple system atrophy with predominant cerebellar ataxia (MSA-C) is associated with a heavier burden of α-synuclein deposition in the motor regions of the spinal cord, we compared the degree of α-synuclein deposition in spinal cords of 3 patients with MSA-C with myoclonus and 3 without myoclonus. METHODS All human tissue was obtained by the Massachusetts General Hospital Department of Pathology with support from and according to neuropathology guidelines of the Massachusetts Alzheimer's Disease Research Center. Tissue was stained with Luxol fast blue and hematoxylin & eosin for morphologic evaluation, and with a mouse monoclonal antibody to α-synuclein and Vectastain DAB kit. Images of the spinal cord sections were digitized using a 10× objective lens. Grayscale versions of these images were transferred to ImageJ software for quantitative analysis of 8 different regions of interest (ROIs) in the spinal cord: dorsal column, anterior white column, left and right dorsal horns, left and right anterior horns, and left and right lateral corticospinal tracts. A mixed-effect, multiple linear regression model was constructed to determine if patients with and without myoclonus had significantly different distributions of α-synuclein deposition across the various ROIs. RESULTS Patients with myoclonus had more α-synuclein in the anterior horns (p < 0.001) and lateral corticospinal tracts (p = 0.02) than those without myoclonus. CONCLUSIONS In MSA-C, myoclonus appears to be associated with a higher burden of α-synuclein deposition within spinal cord motor regions. Future studies with more patients will be needed to confirm these findings.
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Affiliation(s)
- Jaeho Hwang
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston
| | - Anna M Bank
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston
| | - Farzad Mortazavi
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston
| | - Derek H Oakley
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston
| | - Matthew P Frosch
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston
| | - Jeremy D Schmahmann
- From Harvard Medical School (J.H., J.D.S.); Harvard T.H. Chan School of Public Health (J.H.), Boston, MA; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Laboratory for Cognitive Neurobiology, Department of Anatomy and Neurobiology (F.M.), Boston University School of Medicine, MA; and Departments of Pathology (D.H.O., M.P.F.) and Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology (J.D.H.), Massachusetts General Hospital, Boston.
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Vochteloo M, Tijssen MAJ, Beudel M. A Clinical Applicable Smartwatch Application for Measuring Hyperkinetic Movement Disorder Severity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5867-5870. [PMID: 31947185 DOI: 10.1109/embc.2019.8857869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Measuring the severity of hyperkinetic movement disorders like tremor and myoclonus is challenging. Although many accelerometers are available to quantify movements, the vast majority lacks real-time analysis and an interface that makes it possible to real-time adjust therapy like deep brain stimulation (DBS). Here, we developed a smartwatch/smartphone application that is capable of real-time analysing movement disorder severity. Movement analysis was realised by integrating acceleration values, to velocity and subsequently to distance. Measured distances were compared with a validated accelerometer already applied for quantifying movement disorders. Further validation was done by quantitative assessment of simulated movement disorders in 10 healthy volunteers. Finally, the approach was tested in two patients treated with DBS to quantify the effect of different DBS settings on myoclonus and tremor severity, respectively. The distance measured with the application had a 96% accuracy. This was non-inferior (p = 0.76) compared to accelerometers already clinically applied. Furthermore, (simulated) movement disorder severity could be classified correctly in 93% of the cases. Finally, the method was capable of distinguishing effective from non-effective DBS parameters in two patients. In summary, with our approach we realised an instantaneous and reliable estimation of the severity of movement disorders which can assist in real time titrating therapy like DBS.
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Abstract
Tremor and myoclonus are two common hyperkinetic movement disorders. Tremor is characterized by rhythmic oscillatory movements while myoclonic jerks are usually arrhythmic. Tremor can be classified into subtypes including the most common types: essential, enhanced physiological, and parkinsonian tremor. Myoclonus classification is based on its anatomic origin: cortical, subcortical, spinal, and peripheral myoclonus. The clinical presentations are unfortunately not always classic and electrophysiologic investigations can be helpful in making a phenotypic diagnosis. Video-polymyography is the main technique to (sub)classify the involuntary movements. In myoclonus, advanced electrophysiologic testing, such as back-averaging, coherence analysis, somatosensory-evoked potentials, and the C-reflex can be of additional value. Recent developments in tremor point toward a role for intermuscular coherence analysis to differentiate between tremor subtypes. Classification of the movement disorder based on clinical and electrophysiologic features is important, as it enables the search for an etiological diagnosis and guides tailored treatment.
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Affiliation(s)
- R Zutt
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - J W Elting
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
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Gündüz A, Kızıltan M, Ser MH, Yeni SN, Özkara Ç, Demirbilek V, Yalçınkaya C, Kızıltan G. The association between causes and electrophysiology in myoclonus: When and why electrophysiology? NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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van der Veen S, Zutt R, Klein C, Marras C, Berkovic SF, Caviness JN, Shibasaki H, de Koning TJ, Tijssen MAJ. Nomenclature of Genetically Determined Myoclonus Syndromes: Recommendations of the International Parkinson and Movement Disorder Society Task Force. Mov Disord 2019; 34:1602-1613. [PMID: 31584223 PMCID: PMC6899848 DOI: 10.1002/mds.27828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022] Open
Abstract
Genetically determined myoclonus disorders are a result of a large number of genes. They have wide clinical variation and no systematic nomenclature. With next-generation sequencing, genetic diagnostics require stringent criteria to associate genes and phenotype. To improve (future) classification and recognition of genetically determined movement disorders, the Movement Disorder Society Task Force for Nomenclature of Genetic Movement Disorders (2012) advocates and renews the naming system of locus symbols. Here, we propose a nomenclature for myoclonus syndromes and related disorders with myoclonic jerks (hyperekplexia and myoclonic epileptic encephalopathies) to guide clinicians in their diagnostic approach to patients with these disorders. Sixty-seven genes were included in the nomenclature. They were divided into 3 subgroups: prominent myoclonus syndromes, 35 genes; prominent myoclonus syndromes combined with another prominent movement disorder, 9 genes; disorders that present usually with other phenotypes but can manifest as a prominent myoclonus syndrome, 23 genes. An additional movement disorder is seen in nearly all myoclonus syndromes: ataxia (n = 41), ataxia and dystonia (n = 6), and dystonia (n = 5). However, no additional movement disorders were seen in related disorders. Cognitive decline and epilepsy are present in the vast majority. The anatomical origin of myoclonus is known in 64% of genetic disorders: cortical (n = 34), noncortical areas (n = 8), and both (n = 1). Cortical myoclonus is commonly seen in association with ataxia, and noncortical myoclonus is often seen with myoclonus-dystonia. This new nomenclature of myoclonus will guide diagnostic testing and phenotype classification. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Rodi Zutt
- Department of Neurology, University Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samuel F Berkovic
- Epilepsy Research Center, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - John N Caviness
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Tom J de Koning
- Department of Neurology, University Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Groningen, University Medical Center Groningen, Groningen, Netherlands
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Jesús S, Latorre A, Vinuela A, Fahn S, Bhatia KP, Balint B. Stimulus Sensitive Foot Myoclonus: A Clue to Coeliac Disease. Mov Disord Clin Pract 2019; 6:320-323. [PMID: 31061841 DOI: 10.1002/mdc3.12753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Coeliac disease (CD) is an autoimmune enteropathy that may feature extraintestinal manifestations including cerebellar ataxia and myoclonus. Methods and Results A descriptive series of five patients with CD who presented with prominent stimulus-sensitive foot myoclonus. Conclusions Stimulus-sensitive foot myoclonus is a distinct clinical sign and may be a useful clue to the diagnosis of CD.
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Affiliation(s)
- Silvia Jesús
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences London United Kingdom.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla Seville Spain.,Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Anna Latorre
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences London United Kingdom.,Department of Human Neurosciences Sapienza University of Rome Italy
| | - Angel Vinuela
- Division of Movement Disorders, Department of Neurology Columbia University Medical Center New York NY USA
| | - Stanley Fahn
- Division of Movement Disorders, Department of Neurology Columbia University Medical Center New York NY USA
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences London United Kingdom
| | - Bettina Balint
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences London United Kingdom.,Department of Neurology University Hospital Heidelberg Heidelberg Germany
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Mondragón JD, Jiménez-Zarazúa O, Vélez-Ramírez LN, Martínez-Rivera MA, Enríquez-Maciel S, González-Guzmán J, Alvarez-Delgado MM, González-Carrillo PL. Paraneoplastic opsoclonus-myoclonus syndrome secondary to melanoma metastasis form occult primary cancer. Case Rep Neurol 2019; 11:66-79. [PMID: 31543788 PMCID: PMC6739717 DOI: 10.1159/000497034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Opsoclonus-myoclonus syndrome (OMS) is an inflammatory neurological disorder, often requiring a prompt medical evaluation. Among the diverse etiologies associated with OMS are autoimmune, infectious, paraneoplastic, and systemic diseases, and drug intoxication. Clinical Summary The case of a 36-year-old female with a disabling holocranial headache, sudden loss of consciousness, aggressive behavior, vertigo, and a personal history of somatoform disorder and major depression is presented here. After hospital admission, the patient developed sudden stereotyped movements in all four extremities and oculogyric crises compatible with OMS. Cerebrospinal fluid analysis, viral and autoimmune assays, as well as blood, urine, and bronchial secretion cultures, drug metabolite urinalysis, and tumor markers were all negative. Furthermore, brain computed tomography (CT) and brain magnetic resonance imaging, along with thoraco-abdominopelvic CT and electroencephalography, were also all negative. The patient suffered type one respiratory insufficiency after 72 h of hospitalization, requiring an endotracheal tube. After 13 days the patient suffered cardiac arrest. Necropsy was performed reporting lymph nodes with a poorly differentiated malignant neoplastic lesion, HMB-45, melan-A, vimentin, and S-100 positive, compatible with melanoma metastasis from an occult primary cancer. Discussion While the incidence of melanoma of unknown primary is between 2.6 and 3.2%, with a median overall survival ranging between 24 and 127 months, when melanoma patients develop OMS their survival is markedly decreased. Although only 5 cases of paraneoplastic OMS secondary to melanoma have been reported in the literature, all had a poor prognosis, dying within 8 months of OMS onset.
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Affiliation(s)
- Jaime D Mondragón
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Alzheimer Research Center Groningen, Groningen, The Netherlands
| | - Omar Jiménez-Zarazúa
- Department of Internal Medicine, Hospital General León, León de los Aldama, Mexico.,Department of Medicine and Nutrition, Universidad de Guanajuato, Guanajuato, Mexico
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van der Veen S, Zutt R, Elting JWJ, Becker CE, de Koning TJ, Tijssen MAJ. Progressive myoclonus ataxia: Time for a new definition? Mov Disord 2018; 33:1281-1286. [PMID: 30145808 PMCID: PMC6175171 DOI: 10.1002/mds.27412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clinical demarcation of the syndrome progressive myoclonus ataxia is unclear, leading to a lack of recognition and difficult differentiation from other neurological syndromes. OBJECTIVES The objective of this study was to apply a refined definition of progressive myoclonus ataxia and describe the clinical characteristics in patients with progressive myoclonus ataxia and with isolated cortical myoclonus. METHODS A retro- and prospective analysis was performed in our tertiary referral center between 1994 and 2014. Inclusion criteria for progressive myoclonus ataxia patients were the presence of myoclonus and ataxia with or without infrequent (all types, treatment responsive) epileptic seizures. Inclusion criteria for isolated cortical myoclonus was the presence of isolated cortical myoclonus. Clinical and electrophysiological characteristics data were systematically scored. RESULTS A total of 14 progressive myoclonus ataxia patients (males, 7; females, 7), median age 14.5 years, and 8 isolated cortical myoclonus patients (males, 2; females, 6), median age 23.5 years, were identified. In 93% of the progressive myoclonus ataxia patients, ataxia started first (median 2 years) followed by myoclonus (4 years) and finally infrequent epilepsy (9.3 years), with a progressive course in 93%. In 64% of the progressive myoclonus ataxia patients, a genetic underlying etiology was identified, including 3 not earlier reported causative progressive myoclonus ataxia genes. In isolated cortical myoclonus patients, myoclonus started at (median) 12 years with progression over time in 63% and a single epileptic seizure in 1 patient. No genetic causes were identified. CONCLUSION Using a refined definition, we could create a rather homogenous progressive myoclonus ataxia group. Patients with isolated cortical myoclonus have a different course and do not appear to evolve in progressive myoclonus ataxia. The refined progressive myoclonus ataxia definition is a successful first step toward creating a separate syndrome for both clinical practice and future genetic research. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sterre van der Veen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Rodi Zutt
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.,Haga Ziekenhuis (Haga Hospital), Department of Neurology, The Hague, The Netherlands
| | - Jan Willem J Elting
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
| | - Charlotte E Becker
- European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Tom J de Koning
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands
| | - Marina A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands
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48
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Les mouvements anormaux : mise au point. Rev Med Interne 2018; 39:641-649. [DOI: 10.1016/j.revmed.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/25/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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49
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Bianchini S, Bellantoni G, Albergati A, Magrassi L. Postsurgical cortical myoclonus responsive to perampanel. Neurol Clin Pract 2018; 8:159-161. [PMID: 29708211 DOI: 10.1212/cpj.0000000000000440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Simonetta Bianchini
- Neurochirurgia, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche (SB, LM), University of Pavia-Fondazione IRCCS Policlinico S. Matteo; S.C. Neurochirurgia (GB), Fondazione IRCCS Policlinico S. Matteo; Unità Operativa di Riabilitazione Neurologica (AA), Istituto di Cura "Città di Pavia"; and Istituto di Genetica Molecolare IGM-CNR (LM), Pavia, Italy
| | - Giuseppe Bellantoni
- Neurochirurgia, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche (SB, LM), University of Pavia-Fondazione IRCCS Policlinico S. Matteo; S.C. Neurochirurgia (GB), Fondazione IRCCS Policlinico S. Matteo; Unità Operativa di Riabilitazione Neurologica (AA), Istituto di Cura "Città di Pavia"; and Istituto di Genetica Molecolare IGM-CNR (LM), Pavia, Italy
| | - Andrea Albergati
- Neurochirurgia, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche (SB, LM), University of Pavia-Fondazione IRCCS Policlinico S. Matteo; S.C. Neurochirurgia (GB), Fondazione IRCCS Policlinico S. Matteo; Unità Operativa di Riabilitazione Neurologica (AA), Istituto di Cura "Città di Pavia"; and Istituto di Genetica Molecolare IGM-CNR (LM), Pavia, Italy
| | - Lorenzo Magrassi
- Neurochirurgia, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche (SB, LM), University of Pavia-Fondazione IRCCS Policlinico S. Matteo; S.C. Neurochirurgia (GB), Fondazione IRCCS Policlinico S. Matteo; Unità Operativa di Riabilitazione Neurologica (AA), Istituto di Cura "Città di Pavia"; and Istituto di Genetica Molecolare IGM-CNR (LM), Pavia, Italy
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50
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van Egmond ME, Eggink H, Kuiper A, Sival DA, Verschuuren-Bemelmans CC, Tijssen MAJ, de Koning TJ. Crossing barriers: a multidisciplinary approach to children and adults with young-onset movement disorders. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2018; 5:3. [PMID: 29636982 PMCID: PMC5887190 DOI: 10.1186/s40734-018-0070-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022]
Abstract
Background Diagnosis of less common young-onset movement disorders is often challenging, requiring a broad spectrum of skills of clinicians regarding phenotyping, normal and abnormal development and the wide range of possible acquired and genetic etiologies. This complexity often leads to considerable diagnostic delays, paralleled by uncertainty for patients and their families. Therefore, we hypothesized that these patients might benefit from a multidisciplinary approach. We report on the first 100 young-onset movement disorders patients who visited our multidisciplinary outpatient clinic. Methods Clinical data were obtained from the medical records of patients with disease-onset before age 18 years. We investigated whether the multidisciplinary team, consisting of a movement disorder specialist, pediatric neurologist, pediatrician for inborn errors of metabolism and clinical geneticist, revised the movement disorder classification, etiological diagnosis, and/or treatment. Results The 100 referred patients (56 males) had a mean age of 12.5 ± 6.3 years and mean disease duration of 9.2 ± 6.3 years. Movement disorder classification was revised in 58/100 patients. Particularly dystonia and myoclonus were recognized frequently and supported by neurophysiological testing in 24/29 patients. Etiological diagnoses were made in 24/71 (34%) formerly undiagnosed patients, predominantly in the genetic domain. Treatment strategy was adjusted in 60 patients, of whom 43 (72%) reported a subjective positive effect. Conclusions This exploratory study demonstrates that a dedicated tertiary multidisciplinary approach to complex young-onset movement disorders may facilitate phenotyping and improve recognition of rare disorders, with a high diagnostic yield and minimal diagnostic delay. Future studies are needed to investigate the cost-benefit ratio of a multidisciplinary approach in comparison to regular subspecialty care.
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Affiliation(s)
- Martje E van Egmond
- 1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Neurology, Ommelander Ziekenhuis Groningen, Delfzijl and Winschoten, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Hendriekje Eggink
- 1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anouk Kuiper
- 1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah A Sival
- 3Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marina A J Tijssen
- 1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- 1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,3Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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