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Couto B, Galosi S, Steel D, Kurian MA, Friedman J, Gorodetsky C, Lang AE. Severe Acute Motor Exacerbations (SAME) across Metabolic, Developmental and Genetic Disorders. Mov Disord 2024. [PMID: 39119747 DOI: 10.1002/mds.29905] [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: 10/02/2023] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 08/10/2024] Open
Abstract
Acute presentation of severe motor disorders is a diagnostic and management challenge. We define severe acute motor exacerbations (SAME) as acute/subacute motor symptoms that persist for hours-to-days with a severity that compromise vital signs (temperature, breath, and heart rate) and bulbar function (swallowing/dysphagia). Phenomenology includes dystonia, choreoathetosis, combined movement disorders, weakness, and hemiplegic attacks. SAME can develop in diverse diseases and can be preceded by triggers or catabolic states. Recent descriptions of SAME in complex neurodevelopmental and epileptic encephalopathies have broadened appreciation of this presentation beyond inborn errors of metabolism. A high degree of clinical suspicion is required to identify appropriately targeted investigations and management. We conducted a comprehensive literature analysis of etiologies. Reported triggers are described and classified as per pathophysiological mechanism. A video of six cases displaying multiple SAME with diverse outcomes is provided. We identified 50 different conditions that manifest SAME, some associated with developmental regression. Etiologies include disorders of metabolism: energy substrate, amino acids, complex molecules, vitamins/cofactors, minerals, and neurotransmitters/synaptic vesicle cycling. Non-metabolic neurodegenerative and genetic disorders that present with movement disorders and epilepsy can additionally manifest SAME. A limited number of triggers are grouped here, together with an approach to investigations and general management strategies. Several neurogenetic and neurometabolic disorders manifest SAME. Identifying triggers can help in certain cases narrow the differential diagnosis and guide the expeditious application of targeted therapies to minimize adverse developmental and neurological consequences. This process may inform pathogenesis and eventually improve our understanding of the mechanisms that lead to the development of SAME. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy PSP Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Instituto de Neurociencia Cognitiva y Traslacional, INECO-Favaloro-CONICET, Buenos Aires, Argentina
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Dora Steel
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Jennifer Friedman
- Departments of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
- Division of Neurology, Rady Children's Hospital; Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Carolina Gorodetsky
- Division of Neurology, Pediatric Deep Brain Stimulation Program, Movement Disorder and Neuromodulation Program at the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy PSP Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Desjardins C, Delorme C, Méneret A, Flamand C, Leveque N, De Sainte Agathe JM, Roze E, Vidailhet M. A Novel Pattern of Dystonia in DYT- VPS16: "Speaking in Tongues". Neurol Genet 2024; 10:e200154. [PMID: 39040918 PMCID: PMC11262712 DOI: 10.1212/nxg.0000000000200154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/18/2024] [Indexed: 07/24/2024]
Abstract
Objectives To expand the phenotype and genotype of VPS16-related dystonia (DYT-VPS16). Methods We report 2 patients with previously unreported VPS16 truncating variants and highlight some distinctive phenomenological characteristics of DYT-VPS16. Results The 2 patients, who were unrelated, presented with early-onset orofacial dystonia with prominent tongue involvement. Case 1, a 37-year-old woman, developed disabling orofacial dystonia, with tongue protrusion (lingual dystonia), orofacial gesticulations, and hyperkinetic dysarthria, responsible for an odd "foreign language" quality. Case 2, a 36-year-old woman, exhibited orofacial dystonia with prominent lingual involvement and orofacial gesticulations. In both patients, orofacial dystonia led to predominant speech impairment with no or discrete swallowing difficulties. Discussion Substantial tongue dystonia may be a distinctive feature of DYT-VPS16. Our cases widen the phenotypic spectrum of DYT-VPS16 and may provide physicians with a new clinical clue for this disease.
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Affiliation(s)
- Clément Desjardins
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Cécile Delorme
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Aurélie Méneret
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Constance Flamand
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Nathalie Leveque
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Jean-Madeleine De Sainte Agathe
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Emmanuel Roze
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
| | - Marie Vidailhet
- From the AP-HP (C. Desjardins, Cécile Delorme, A.M., N.L., E.R., M.V.), Salpetriere Hospital; Sorbonne Université (C. Delorme, A.M., E.R., M.V.), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, DMU Neuroscience 6, Paris; Service de neurologie (C.F.), Centre Hospitalier du Sud Francilien, Corbeil Essonnes; Laboratoire de Phonétique et Phonologie (CNRS/University Sorbonne-Nouvelle) Paris (N.L.); Department of Medical Genetics (J.-M.D.S.A.), Groupe Hospitalo-Universitaire Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France; and Laboratoire de Médecine Génomique Sorbonne Université (J.-M.D.S.A.), Groupement de Coopération Sanitaire SeqOIA
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Bulut E, Johansen PM, Elbualy A, Kalman C, Mayer R, Kato N, Salmeron de Toledo Aguiar R, Pilitsis JG. How Long Does Deep Brain Stimulation Give Patients Benefit? Neuromodulation 2024:S1094-7159(24)00128-4. [PMID: 39001725 DOI: 10.1016/j.neurom.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION One of the most common questions patients ask when they are contemplating deep brain stimulation (DBS) is how long it will last. To guide physicians in answering this query, we performed a scoping review to assess the current state of the literature and to identify the gaps that need to be addressed. MATERIALS AND METHODS The authors performed a MEDLINE search inclusive of articles from January 1987 (advent of DBS literature) to June 2023 including human and modeling studies written in English. For longevity of therapy data, only studies with a mean follow-up of ≥three years were included. Using the Rayyan platform, two reviewers (JP and RM) performed a title screen. Of the 734 articles, 205 were selected by title screen and 109 from abstract review. Ultimately, a total of 122 articles were reviewed. The research questions we explored were 1) how long can the different components of the DBS system maintain functionality? and 2) how long can DBS remain efficacious in treating Parkinson's disease (PD), essential tremor (ET), dystonia, and other disorders? RESULTS We showed that patients with PD, ET, and dystonia maintain a considerable long-term benefit in motor scores seven to ten years after implant, although the percentage improvement decreases over time. Stimulation off scores in PD and ET show worsening, consistent with disease progression. Battery life varies by the disease treated and the programming settings used. There remains a paucity of literature after ten years, and the impact of new device technology has not been classified to date. CONCLUSION We reviewed existing data on DBS longevity. Overall, outcomes data after ten years of therapy are substantially limited in the current literature. We recommend that physicians who have data for patients with DBS exceeding this duration publish their results.
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Affiliation(s)
- Esin Bulut
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - P Mitchell Johansen
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Alya Elbualy
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cheyenne Kalman
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Nicholas Kato
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona, Tucson, AZ, USA.
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Duga V, Giossi R, Romito LM, Stanziano M, Levi V, Panteghini C, Zorzi G, Nardocci N. Long-Term Globus Pallidus Internus Deep Brain Stimulation in Pediatric Non-Degenerative Dystonia: A Cohort Study and a Meta-Analysis. Mov Disord 2024; 39:1131-1144. [PMID: 38646731 DOI: 10.1002/mds.29815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND The evidence in the effectiveness of deep brain stimulation in children with medication-refractory non-degenerative monogenic dystonia is heterogeneous and long-term results are sparse. OBJECTIVES The objective is to describe long-term outcomes in a single-center cohort and compare our results with a meta-analysis cohort form literature. METHODS We performed a retrospective single-center cohort study including consecutive pediatric patients with non-degenerative genetic or idiopathic dystonia treated with globus pallidus internus deep brain stimulation at our center and a systematic review and individual-patient data meta-analysis with the same inclusion criteria. The primary outcome was the change from baseline in the Burke-Fahn-Marsden Dystonia Rating Scale-movement (BFMDRS-M) score. RESULTS The clinical cohort included 25 patients with a mean study follow-up of 11.4 years. The meta-analysis cohort included 224 patients with a mean follow-up of 3 years. Overall, the BFMDRS-M mean improvements at 1 year and at last follow-up were 41% and 33% in the clinical cohort and 58.9% and 57.2% in the meta-analysis cohort, respectively. TOR1A-dystonia showed the greatest and most stable BFMDRS-M improvement in both cohorts at 1 year and at last follow-up (76.3% and 74.3% in the clinical cohort; 69.6% and 67.3% in the meta-analysis cohort), followed by SGCE-dystonia (63% and 63.9% in the meta-analysis cohort). THAP1-dystonia (70.1% and 29.8% in the clinical cohort; 52.3% and 42.0% in the meta-analysis cohort) and KMT2B-dystonia (33.3% and 41.3% in the clinical cohort; 38.0% and 26.7% in the meta-analysis cohort) showed a less pronounced or sustained response. CONCLUSION Globus pallidus deep brain stimulation long-term treatment seems effective with a possible gene-specific differential effect. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Valentina Duga
- Child Neuropsychiatry Unit, Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Riccardo Giossi
- Poison Control Center and Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Luigi Michele Romito
- Movement Disorders Unit, Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Department of Technology and Diagnosis, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Vincenzo Levi
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Celeste Panteghini
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanna Zorzi
- Child Neuropsychiatry Unit, Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Nardo Nardocci
- Child Neuropsychiatry Unit, Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Sorrentino U, Boesch S, Doummar D, Ravelli C, Serranova T, Indelicato E, Winkelmann J, Burglen L, Jech R, Zech M. CHD8-related disorders redefined: an expanding spectrum of dystonic phenotypes. J Neurol 2024; 271:2859-2865. [PMID: 38441608 PMCID: PMC11055771 DOI: 10.1007/s00415-024-12271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Heterozygous loss-of-function variants in CHD8 have been associated with a syndromic neurodevelopmental-disease spectrum, collectively referred to as CHD8-related neurodevelopmental disorders. Several different clinical manifestations, affecting neurodevelopmental and systemic domains, have been described, presenting with highly variable expressivity. Some expressions are well established and comprise autism spectrum disorders, psychomotor delay with cognitive impairment, postnatal overgrowth with macrocephaly, structural brain abnormalities, gastrointestinal disturbances, and behavioral and sleep-pattern problems. However, the complete phenotypic spectrum of CHD8-related disorders is still undefined. In 2021, our group described two singular female patients with CHD8-related neurodevelopmental disorder and striking dystonic manifestations, prompting the suggestion that dystonia should be considered a possible component of this condition. CASE SERIES PRESENTATION We describe three additional unrelated female individuals, each carrying a different CHD8 frameshift variant and whose clinical presentations were primarily characterized by young-onset dystonia. Their dystonic manifestations were remarkably heterogeneous and ranged from focal, exercise-dependent, apparently isolated forms to generalized permanent phenotypes accompanied by spasticity and tremor. Neurocognitive impairment and autistic behaviors, typical of CHD8-related disorders, were virtually absent or at the mild end of the spectrum. CONCLUSIONS This work validates our previous observation that dystonia is part of the phenotypic spectrum of CHD8-related neurodevelopmental disorders with potential female preponderance, raising new challenges and opportunities in the diagnosis and management of this condition. It also highlights the importance of in-depth neurologic phenotyping of patients carrying variants associated with neurodevelopmental disorders, as the connection between neurodevelopmental and movement disorders is proving closer than previously appreciated.
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Affiliation(s)
- Ugo Sorrentino
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany.
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany.
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padua, Italy.
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Diane Doummar
- Sorbonne Université, Service de Neuropédiatrie-Pathologie du Développement, Centre de Référence Neurogénétique, Hôpital Trousseau AP-HP.SU, HU I2D2, Paris, France
| | - Claudia Ravelli
- Sorbonne Université, Service de Neuropédiatrie-Pathologie du Développement, Centre de Référence Neurogénétique, Hôpital Trousseau AP-HP.SU, HU I2D2, Paris, France
| | - Tereza Serranova
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Kateřinská 30, 12 800, Prague, Czech Republic
| | - Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliane Winkelmann
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- DZPG, Deutsches Zentrum Für Psychische Gesundheit, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Lydie Burglen
- Cerebellar Malformations and Congenital Diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP. Sorbonne Université, Paris, France
- Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Kateřinská 30, 12 800, Prague, Czech Republic
| | - Michael Zech
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Munich, Neuherberg, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
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Wu WQ, Li K, Chu LL, Shen TT, Li Y, Xu YY, Zhang QL, Liu CF, Liu J, Zhou XP, Luo WF. Association analyses between the variants of SNAP25, SV2C and ST3GAL2 and the efficacy of botulinum toxin A in the treatment of the primary Meige syndrome. Heliyon 2024; 10:e28543. [PMID: 38628704 PMCID: PMC11019161 DOI: 10.1016/j.heliyon.2024.e28543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Individual differences were observed in the clinical efficacy of Botulinum toxin A (BoNT-A) in the treatment of the primary Meige syndrome. Our study aimed to explore the potential associations between the clinical efficacy of BoNT-A in the treatment of the primary Meige syndrome and variants of SNAP25, SV2C and ST3GAL2, which are involving in the translocation of the BoNT-A in vivo. Methods Patients with the primary Meige syndrome treated with BoNT-A were enrolled. Clinical efficacy was evaluated by the maximum improvement rate of motor symptoms and the duration of efficacy. Variants of SNAP25, SV2C and ST3GAL2 were obtained by Sanger sequencing. Another cohort diagnosed with primary cervical dystonia was also enrolled in the replication stage. Results Among the 104 primary Meige syndrome patients, 80 patients (76.9%) had a good efficacy (the maximum improvement rate of motor symptoms ≥30%) and 24 (23. 1%) had a poor (the maximum improvement rate of motor symptoms <30%). As to the duration of efficacy, 52 patients (50.0%) had a long duration of efficacy (≥4 months), and 52 (50.0%) had a short (<4 months). In terms of primary Meige syndrome, SNAP25 rs6104571 was found associating with the maximum improvement rate of motor symptoms (Genotype: P = 0.02, OR = 0.26; Allele: P = 0.013, OR = 0.29), and SV2C rs31244 was found associating with the duration of efficacy (Genotype: P = 0.024, OR = 0.13; Allele: P = 0.012, OR = 0.13). Besides, we also conducted the association analyses between the variants and BoNT-A-related adverse reactions. Although, there was no statistical difference between the allele of SV2C rs31244 and BoNT-A-related adverse reactions, there was a trend (P = 0.077, OR = 2.56). In the replication stage, we included 39 patients with primary cervical dystonia to further expanding the samples' size. Among the 39 primary cervical dystonia patients, 25 patients (64.1%) had a good efficacy (the maximum improvement rate of motor symptoms ≥50%) and 14 (35.9%) had a poor (the maximum improvement rate of motor symptoms <50%). As to the duration of efficacy, 32 patients (82.1%) had a long duration of efficacy (≥6 months), and 7 (17.9%) had a short (<6 months). Integrating primary Meige syndrome and primary cervical dystonia, SV2C rs31244 was still found associating with the duration of efficacy (Genotype: P = 0.002, OR = 0. 23; Allele: P = 0.001, OR = 0. 25). Conclusion In our study, SNAP25 rs6104571 was associated with the maximum improvement rate of motor symptoms in patients with primary Meige syndrome treated with BoNT-A, and patients carrying this variant had a lower improvement rate of motor symptoms. SV2C rs31244 was associated with duration of treatment in patients with primary Meige syndrome treated with BoNT-A and patients carrying this variant had a shorter duration of treatment. Patients with primary Meige syndrome carrying SV2C rs31244 G allele have an increase likelihood of BoNT-A-related adverse reactions. Involving 39 patients with primary cervical dystonia, the results further verify that SV2C rs31244 was associated with duration of treatment and patients carrying this variant had a shorter duration of treatment.
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Affiliation(s)
- Wen-Qi Wu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
- Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, Jiangsu, China
| | - Kai Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Lu-Lu Chu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Ting-Ting Shen
- Department of Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Yang Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, Zhejiang, China
| | - Ying-Ying Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Qi-Lin Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Jing Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Xu-Ping Zhou
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Wei-Feng Luo
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
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Percetti M, Zini M, Soliveri P, Cogiamanian F, Ferrara M, Orunesu E, Ranghetti A, Ferrarese C, Pezzoli G, Garavaglia B, Isaias IU, Sacilotto G. The Clinical Spectrum of ANO3-Report of a New Family and Literature Review. Mov Disord Clin Pract 2024; 11:289-297. [PMID: 38284143 DOI: 10.1002/mdc3.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Mutations in ANO3 are a rare cause of autosomal dominant isolated or combined dystonia, mainly presenting in adulthood. CASES We extensively characterize a new, large ANO3 family with six affected carriers. The proband is a young girl who had suffered from tremor and painful dystonic movements in her right arm since the age of 11 years. She later developed a diffuse dystonic tremor and mild extrapyramidal signs (ie, rigidity and hypodiadochokinesis) in her right arm. She also suffered from psychomotor delay and learning difficulties. Repeated structural and functional neuroimaging were unremarkable. A dystonic tremor was also present in her two sisters. Her paternal aunt, father, and a third older sister presented episodic postural tremor in the arms. The father and one sister also presented learning difficulties. The heterozygous p.G6V variant in ANO3 was identified in all affected subjects. LITERATURE REVIEW Stratification by age at onset divided ANO3 cases into two major groups, where younger patients displayed a more severe phenotype, probably due to variants near the scrambling domain. CONCLUSIONS We describe the phenotype of a new ANO3 family and highlight the need for functional studies to explore the impact of ANO3 variants on its phospholipid scrambling activity.
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Affiliation(s)
- Marco Percetti
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy
- Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Michela Zini
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
| | | | - Filippo Cogiamanian
- Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarosa Ferrara
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Orunesu
- Nuclear Medicine Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy
- Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit, National Neurological Institute Carlo Besta, Milan, Italy
| | - Ioannis Ugo Isaias
- Parkinson Institute, ASST G. Pini-CTO, Milan, Italy
- University Hospital of Würzburg, Würzburg, Germany
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8
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Dhar D, Holla VV, Kumari R, Yadav R, Kamble N, Muthusamy B, Pal PK. Clinical and genetic profile of patients with dystonia: An experience from a tertiary neurology center from India. Parkinsonism Relat Disord 2024; 120:105986. [PMID: 38219528 DOI: 10.1016/j.parkreldis.2023.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The genetics of dystonia have varied across different ethnicities worldwide. Its significance has become more apparent with the advent of deep brain stimulation. OBJECTIVE To study the clinico-genetic profile of patients with probable genetic dystonia using whole exome sequencing (WES). METHODS A prospective, cross-sectional study was conducted from May 2021 to September 2022, enrolling patients with dystonia of presumed genetic etiology for WES. The study compared genetically-determined cases harboring pathogenic/likely-pathogenic variants (P/LP subgroup) with the presumed idiopathic or unsolved cases. RESULTS We recruited 65 patients (males, 69.2%) whose mean age of onset (AAO) and assessment were 25.0 ± 16.6 and 31.7 ± 15.2 years, respectively. Fifteen had pathogenic/likely-pathogenic variants (yield = 23.1%), 16 (24.6%) had variants of uncertain significance (VUS), 2 were heterozygous carriers while the remaining 32 cases tested negative (presumed idiopathic group). The P/LP subgroup had a significantly younger AAO (16.8 ± 12.3 vs 31.3 ± 17.0 years, p = 0.009), longer duration of illness (10.9 ± 10.3 vs 4.8 ± 4.3 years, p = 0.006), higher prevalence of generalized dystonia (n = 12, 80.0% vs n = 10, 31.3%, p = 0.004), lower-limb onset (n = 5, 33.3% vs n = 1, 3.1%, p = 0.009), higher motor (p = 0.035) and disability scores (p = 0.042). The classical DYT genes with pathogenic/likely pathogenic variants included 3 cases each of TOR1A, and KMT2B, and single cases each of SGCE, EIF2AK2, and VPS16. Non-DYT pathogenic/likely-pathogenic cases included PINK1, PANK2, CTSF, POLG, MICU1, and TSPOAP1. CONCLUSIONS The yield of WES was 23.1% among cases of probable genetic dystonia. Pathogenic or likely pathogenic variants in TOR1A, KMT2B, and SGCE genes were commoner. The absence of family history emphasizes the importance of accurate assessment of clinical predictors before genetic testing.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Riyanka Kumari
- Institute of Bioinformatics, International Technology Park, Bengaluru 560066, India; Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Babylakshmi Muthusamy
- Institute of Bioinformatics, International Technology Park, Bengaluru 560066, India; Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
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9
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Bouhamdani N, McConkey H, Leblanc A, Sadikovic B, Amor MB. Diagnostic utility of DNA methylation episignature analysis for early diagnosis of KMT2B-related disorders: case report. Front Genet 2024; 15:1346044. [PMID: 38425714 PMCID: PMC10902455 DOI: 10.3389/fgene.2024.1346044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
The lysine methyltransferase 2B (KMT2B) gene product is important for epigenetic modifications associated with active gene transcription in normal development and in maintaining proper neural function. Pathogenic variants in KMT2B have been associated with childhood-onset Dystonia-28 and Intellectual developmental disorder, autosomal dominant 68 (MRD 68) for cases of neurodevelopmental impairment without dystonia (DYT28; OMIM 617284 and MRD68; OMIM 619934, respectively). Since its first description in 2016, approximately one hundred KMT2B genetic variants have been reported with heterogeneous phenotypes, including atypical patterns of dystonia evolution and non-dystonic neurodevelopmental phenotypes. KMT2B-related disorders share many overlapping phenotypic characteristics with other neurodevelopmental disorders and delayed dystonia, that can appear later in childhood, often delaying clinical diagnosis. Furthermore, conventional genetic testing may not always provide actionable information (e.g., gene panel selection based on early clinical presentation or variants of uncertain significance), which prevents patients and families from obtaining early access to treatments and support. Herein, we describe the early diagnosis of KMT2B-related neurodevelopmental disorder by DNA methylation episignature testing in a 4-year-old patient without features of dystonia at diagnosis, which is reported to develop in more than 80% of KMT2B-related disorder cases. The proband, a 4-year-old female of Jewish-Israeli descent, presented with speech delay, microcephaly, poor weight gain, attention-deficit and hyperactivity disorder, dysmorphism, intellectual disabilities and joint hyperlaxity, but presented no signs of dystonia at initial evaluation. Episignature screening in this pre-symptomatic patient enabled accurate genetic diagnosis and timely and actionable intervention earlier in the natural history of Childhood-onset Dystonia-28.
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Affiliation(s)
- Nadia Bouhamdani
- Vitalité Health Network, Moncton, NB, Canada
- Faculty of medicine and health sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
| | - Haley McConkey
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, ON, Canada
| | - Amélie Leblanc
- Vitalité Health Network, Moncton, NB, Canada
- Faculty of medicine and health sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
| | - Bekim Sadikovic
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, ON, Canada
| | - Mouna Ben Amor
- Vitalité Health Network, Moncton, NB, Canada
- Faculty of medicine and health sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
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10
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Sugeno N, Hasegawa T, Haginoya K, Kubota T, Ikeda K, Nakamura T, Ishiyama S, Sato K, Yoshida S, Koshimizu E, Uematsu M, Miyatake S, Matsumoto N, Aoki M. Detection of Modified Histones from Oral Mucosa of a Patient with DYT- KMT2B Dystonia. Mol Syndromol 2023; 14:461-468. [PMID: 38108041 PMCID: PMC10722472 DOI: 10.1159/000530625] [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: 03/16/2023] [Accepted: 04/07/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction DYT-KMT2B is a rare childhood-onset, hereditary movement disorder typically characterized by lower-limb dystonia and subsequently spreads into the craniocervical and laryngeal muscles. Recently, KMT2B-encoding lysine (K)-specific histone methyltransferase 2B was identified as the causative gene for DYT-KMT2B, also known as DYT28. In addition to the fact that many physicians do not have sufficient experience or knowledge of hereditary dystonia, the clinical features of DYT-KMT2B overlap with those of other hereditary dystonia, and limited clinical biomarkers make the diagnosis difficult. Methods Histone proteins were purified from the oral mucosa of patients with de novo KMT2B mutation causing premature stop codon, and then trimethylated fourth lysine residue of histone H3 (H3K4me3) which was catalyzed by KMT2B was analyzed by immunoblotting with specific antibody. We further analyzed the significance of H3K4me3 in patients with DYT-KMT2B using publicly available datasets. Results H3K4me3 histone mark was markedly lower in the patient than in the control group. Additionally, a reanalysis of publicly available datasets concerning DNA methylation also demonstrated that KMT2B remained inactive in DYT-KMT2B. Discussion Although only one case was studied due to the rarity of the disease, the reduction of H3K4me3 in the patient's biological sample supports the dysfunction of KMT2B in DYT-KMT2B. Together with informatics approaches, our results suggest that KMT2B haploinsufficiency contributes to the DYT-KMT2B pathogenic process.
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Affiliation(s)
- Naoto Sugeno
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
- Department of Pediatric Neurology, Miyagi Children’s Hospital, Sendai, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaaki Nakamura
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Ishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Yoshida
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Department of Clinical Genetics, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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11
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Vogt LM, Yan H, Santyr B, Breitbart S, Anderson M, Germann J, Lizarraga KJ, Hewitt AL, Fasano A, Ibrahim GM, Gorodetsky C. Deep Brain Stimulation for Refractory Status Dystonicus in Children: Multicenter Case Series and Systematic Review. Ann Neurol 2023. [PMID: 37714824 DOI: 10.1002/ana.26799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE We sought to better understand the workflow, outcomes, and complications of deep brain stimulation (DBS) for pediatric status dystonicus (SD). We present a systematic review, alongside a multicenter case series of pediatric patients with SD treated with DBS. METHODS We collected individual data regarding treatment, stimulation parameters, and dystonia severity for a multicenter case series (n = 8) and all previously published cases (n = 77). Data for case series were used to create probabilistic voxelwise maps of stimulated tissue associated with dystonia improvement. RESULTS In our institutional series, DBS was implanted a mean of 25 days after SD onset. Programming began a mean of 1.6 days after surgery. All 8 patients in our case series and 73 of 74 reported patients in the systematic review had resolution of their SD with DBS, most within 2 to 4 weeks of surgery. Mean follow-up for patients in the case series was 16 months. DBS target for all patients in the case series and 68 of 77 in our systematic review was the globus pallidus pars interna (GPi). In our case series, stimulation of the posterior-ventrolateral GPi was associated with improved dystonia. Mean dystonia improvement was 32% and 51% in our institutional series and systematic review, respectively. Mortality was 4% in the review, which is lower than reported for treatment with pharmacotherapy alone (10-12.5%). INTERPRETATION DBS is a feasible intervention with potential to reverse refractory pediatric SD and improve survival. More work is needed to increase awareness of DBS in this setting, so that it can be implemented in a timely manner. ANN NEUROL 2023.
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Affiliation(s)
- Lindsey M Vogt
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brendan Santyr
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Sara Breitbart
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Anderson
- Library Services, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Karlo J Lizarraga
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Angela L Hewitt
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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12
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Heiser H, Smith K, Duis J, Forbes E. Generalized Dystonia Due to KMT2B Mutation in a Patient with a Previous Diagnosis of Russell Silver Syndrome. Mov Disord Clin Pract 2023; 10:S51-S53. [PMID: 37636227 PMCID: PMC10448616 DOI: 10.1002/mdc3.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/08/2023] [Accepted: 05/03/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Heather Heiser
- Department of NeurologyUniversity of ColoradoAuroraColoradoUSA
| | - Kaitlin Smith
- Department of NeurologyUniversity of ColoradoAuroraColoradoUSA
| | - Jessica Duis
- Department of PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
| | - Emily Forbes
- Department of NeurologyUniversity of ColoradoAuroraColoradoUSA
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13
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Salamon A, Nagy ZF, Pál M, Szabó M, Csősz Á, Szpisjak L, Gárdián G, Zádori D, Széll M, Klivényi P. Genetic Screening of a Hungarian Cohort with Focal Dystonia Identified Several Novel Putative Pathogenic Gene Variants. Int J Mol Sci 2023; 24:10745. [PMID: 37445923 DOI: 10.3390/ijms241310745] [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: 06/01/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Dystonia is a rare movement disorder which is characterized by sustained or intermittent muscle contractions causing abnormal and often repetitive movements, postures, or both. The two most common forms of adult-onset focal dystonia are cervical dystonia (CD) and benign essential blepharospasm (BSP). A total of 121 patients (CD, 74; BSP, 47) were included in the study. The average age of the patients was 64 years. For the next-generation sequencing (NGS) approach, 30 genes were selected on the basis of a thorough search of the scientific literature. Assessment of 30 CD- and BSP-associated genes from 121 patients revealed a total of 209 different heterozygous variants in 24 genes. Established clinical and genetic validity was determined for nine heterozygous variations (three likely pathogenic and six variants of uncertain significance). Detailed genetic examination is an important part of the work-up for focal dystonia forms. To our knowledge, our investigation is the first such study to be carried out in the Middle-European region.
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Affiliation(s)
- András Salamon
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - Zsófia Flóra Nagy
- Department of Medical Genetics, University of Szeged, 4, Somogyi Béla Str., H-6720 Szeged, Hungary
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, 78/b, Üllői Str., H-1083 Budapest, Hungary
| | - Margit Pál
- Department of Medical Genetics, University of Szeged, 4, Somogyi Béla Str., H-6720 Szeged, Hungary
- ELKH-SZTE Functional Clinical Genetics Research Group, Eötvös Loránd Research Network, 4, Somogyi Béla Str., H-6720 Szeged, Hungary
| | - Máté Szabó
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - Ádám Csősz
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - László Szpisjak
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - Gabriella Gárdián
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - Dénes Zádori
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
| | - Márta Széll
- Department of Medical Genetics, University of Szeged, 4, Somogyi Béla Str., H-6720 Szeged, Hungary
- ELKH-SZTE Functional Clinical Genetics Research Group, Eötvös Loránd Research Network, 4, Somogyi Béla Str., H-6720 Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, 6, Semmelweis Str., H-6725 Szeged, Hungary
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14
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Tsagkaris S, Yau EKC, McClelland V, Papandreou A, Siddiqui A, Lumsden DE, Kaminska M, Guedj E, Hammers A, Lin JP. Metabolic patterns in brain 18F-fluorodeoxyglucose PET relate to aetiology in paediatric dystonia. Brain 2023; 146:2512-2523. [PMID: 36445406 PMCID: PMC10232264 DOI: 10.1093/brain/awac439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/09/2023] Open
Abstract
There is a lack of imaging markers revealing the functional characteristics of different brain regions in paediatric dystonia. In this observational study, we assessed the utility of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in understanding dystonia pathophysiology by revealing specific resting awake brain glucose metabolism patterns in different childhood dystonia subgroups. PET scans from 267 children with dystonia being evaluated for possible deep brain stimulation surgery between September 2007 and February 2018 at Evelina London Children's Hospital (ELCH), UK, were examined. Scans without gross anatomical abnormality (e.g. large cysts, significant ventriculomegaly; n = 240) were analysed with Statistical Parametric Mapping (SPM12). Glucose metabolism patterns were examined in the 144/240 (60%) cases with the 10 commonest childhood-onset dystonias, focusing on nine anatomical regions. A group of 39 adult controls was used for comparisons. The genetic dystonias were associated with the following genes: TOR1A, THAP1, SGCE, KMT2B, HPRT1 (Lesch Nyhan disease), PANK2 and GCDH (Glutaric Aciduria type 1). The acquired cerebral palsy (CP) cases were divided into those related to prematurity (CP-Preterm), neonatal jaundice/kernicterus (CP-Kernicterus) and hypoxic-ischaemic encephalopathy (CP-Term). Each dystonia subgroup had distinct patterns of altered FDG-PET uptake. Focal glucose hypometabolism of the pallidi, putamina or both, was the commonest finding, except in PANK2, where basal ganglia metabolism appeared normal. HPRT1 uniquely showed glucose hypometabolism across all nine cerebral regions. Temporal lobe glucose hypometabolism was found in KMT2B, HPRT1 and CP-Kernicterus. Frontal lobe hypometabolism was found in SGCE, HPRT1 and PANK2. Thalamic and brainstem hypometabolism were seen only in HPRT1, CP-Preterm and CP-term dystonia cases. The combination of frontal and parietal lobe hypermetabolism was uniquely found in CP-term cases. PANK2 cases showed a distinct combination of parietal hypermetabolism with cerebellar hypometabolism but intact putaminal-pallidal glucose metabolism. HPRT1, PANK2, CP-kernicterus and CP-preterm cases had cerebellar and insula glucose hypometabolism as well as parietal glucose hypermetabolism. The study findings offer insights into the pathophysiology of dystonia and support the network theory for dystonia pathogenesis. 'Signature' patterns for each dystonia subgroup could be a useful biomarker to guide differential diagnosis and inform personalized management strategies.
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Affiliation(s)
- Stavros Tsagkaris
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
- King’s College London & Guy’s and St Thomas’ PET Centre, Division of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Eric K C Yau
- Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Verity McClelland
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Apostolos Papandreou
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London WC1N 1DZ, UK
| | - Ata Siddiqui
- Neuroradiology Department, Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
| | - Daniel E Lumsden
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
- Perinatal Imaging, Division of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Margaret Kaminska
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
| | - Eric Guedj
- CERIMED, Nuclear Medicine Department, Aix Marseille Universite, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, 13397 Marseille, France
| | - Alexander Hammers
- King’s College London & Guy’s and St Thomas’ PET Centre, Division of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jean-Pierre Lin
- Children’s Neurosciences, Complex Motor Disorders Service (CMDS), Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), London SE1 7EH, UK
- Women and Children’s Health Institute Faculty of Life Sciences & Medicine, Kings Health Partners, King’s College London, London SE1 7EH, UK
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15
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Marie V. What have we learned about the biology of dystonia from deep brain stimulation? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:481-491. [PMID: 37482401 DOI: 10.1016/bs.irn.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Deep brain stimulation has dramatically changed the management of patients with dystonia, therapeutic approach of dystonia with marked improvement of dystonia and functional disability. However, despite decades of experience and identification of good prognosis factors, prediction of beneficial effect at the individual level is still a challenge. There is inter-individual variability in therapeutic outcome. Genetic factors are identified but subgroups of patients still have relapse or worsening of dystonia in short or long term. Possible "biological factors" underlying such a difference among patients are discussed, including structural or functional differences including altered plasticity.
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Affiliation(s)
- Vidailhet Marie
- Sorbonne Université, Paris Brain Institute - ICM, Inserm CNRS, Paris, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France.
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16
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Lumsden DE, Cif L, Capuano A, Allen NM. The changing face of reported status dystonicus - A systematic review. Parkinsonism Relat Disord 2023:105438. [PMID: 37268557 DOI: 10.1016/j.parkreldis.2023.105438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Status Dystonicus (SD) represents the most severe end of the spectrum of dystonia. We aimed to explore whether reported features of cases of SD have changed over time. METHODS A systematic review of cases of SD reported from 2017 to 2023 and comparison of features to data extracted from 2 previous literature reviews (epochs 2012-2017 and pre-2012). RESULTS From 53 papers, a total 206 SD episodes in 168 patients were identified from 2017 to 2023. Combining data from all 3 epochs, a total of 339 SD episodes were reported from 277 patients. SD episodes occurred mostly in children, with a trigger identified in 63.4% of episodes, most commonly infection/inflammation. Most reported underlying aetiologies were genetic (e.g. 49.5% between 2017 and 2023), including new associated aetiologies in each epoch. Deep Brain Stimulation (DBS)-related SD increased over time. Neurosurgical interventions were more frequently reported in later epochs. Across the epochs, return to or improvement post SD episode, compared to baseline was reported above 70%. Reported mortality was 4.9% most recently, compared to 11.4% and 7.9%, previously. CONCLUSIONS SD episodes reported have more than doubled in the last 5 years. Reports of medication change-induced SD have become less frequent, whilst episodes of DBS-related SD have become more frequent. More dystonia aetiologies, including novel aetiologies have been reported in recent cohorts, reflecting advances in genetic diagnosis. Neurosurgical interventions are increasingly reported in the management of SD episodes, including novel use of intraventricular baclofen. Overall outcomes from SD remain largely unchanged over time. No prospective epidemiological studies of SD were identified.
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Affiliation(s)
- Daniel E Lumsden
- Complex Motor Disorder Service, Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; Perinatal Imaging, Imaging Sciences and Biomedical Engineering, King's College London, UK.
| | - Laura Cif
- Department of Neurosurgery, University Hospital Montpellier, France
| | - Alessandro Capuano
- Department of Neuroscience, Bambino Gesù Children' Hospital, Rome, Italy; Cerebral Palsy Center -NeuropsychiatricUnit - ASL Viterbo, Viterbo, Italy
| | - Nicholas M Allen
- Department of Paediatrics (Neurology), University of Galway, Ireland
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17
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Reid KM, Steel D, Nair S, Bhate S, Biassoni L, Sudhakar S, Heys M, Burke E, Kamsteeg EJ, Hameed B, Zech M, Mencacci NE, Barwick K, Topf M, Kurian MA. Loss-of-Function Variants in DRD1 in Infantile Parkinsonism-Dystonia. Cells 2023; 12:cells12071046. [PMID: 37048120 PMCID: PMC10093404 DOI: 10.3390/cells12071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
The human dopaminergic system is vital for a broad range of neurological processes, including the control of voluntary movement. Here we report a proband presenting with clinical features of dopamine deficiency: severe infantile parkinsonism-dystonia, characterised by frequent oculogyric crises, dysautonomia and global neurodevelopmental impairment. CSF neurotransmitter analysis was unexpectedly normal. Triome whole-genome sequencing revealed a homozygous variant (c.110C>A, (p.T37K)) in DRD1, encoding the most abundant dopamine receptor (D1) in the central nervous system, most highly expressed in the striatum. This variant was absent from gnomAD, with a CADD score of 27.5. Using an in vitro heterologous expression system, we determined that DRD1-T37K results in loss of protein function. Structure-function modelling studies predicted reduced substrate binding, which was confirmed in vitro. Exposure of mutant protein to the selective D1 agonist Chloro APB resulted in significantly reduced cyclic AMP levels. Numerous D1 agonists failed to rescue the cellular defect, reflected clinically in the patient, who had no benefit from dopaminergic therapy. Our study identifies DRD1 as a new disease-associated gene, suggesting a crucial role for the D1 receptor in motor control.
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18
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Stephen CD, Dy-Hollins M, Gusmao CMD, Qahtani XA, Sharma N. Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing. Semin Neurol 2023; 43:17-34. [PMID: 36972613 DOI: 10.1055/s-0043-1764292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system eatures. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.
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Affiliation(s)
| | - Marisela Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Xena Al Qahtani
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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19
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Ritchie FD, Lizarraga SB. The role of histone methyltransferases in neurocognitive disorders associated with brain size abnormalities. Front Neurosci 2023; 17:989109. [PMID: 36845425 PMCID: PMC9950662 DOI: 10.3389/fnins.2023.989109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Brain size is controlled by several factors during neuronal development, including neural progenitor proliferation, neuronal arborization, gliogenesis, cell death, and synaptogenesis. Multiple neurodevelopmental disorders have co-morbid brain size abnormalities, such as microcephaly and macrocephaly. Mutations in histone methyltransferases that modify histone H3 on Lysine 36 and Lysine 4 (H3K36 and H3K4) have been identified in neurodevelopmental disorders involving both microcephaly and macrocephaly. H3K36 and H3K4 methylation are both associated with transcriptional activation and are proposed to sterically hinder the repressive activity of the Polycomb Repressor Complex 2 (PRC2). During neuronal development, tri-methylation of H3K27 (H3K27me3) by PRC2 leads to genome wide transcriptional repression of genes that regulate cell fate transitions and neuronal arborization. Here we provide a review of neurodevelopmental processes and disorders associated with H3K36 and H3K4 histone methyltransferases, with emphasis on processes that contribute to brain size abnormalities. Additionally, we discuss how the counteracting activities of H3K36 and H3K4 modifying enzymes vs. PRC2 could contribute to brain size abnormalities which is an underexplored mechanism in relation to brain size control.
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20
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Akter H, Rahman MM, Sarker S, Basiruzzaman M, Islam MM, Rahaman MA, Rahaman MA, Eshaque TB, Dity NJ, Sarker S, Amin MR, Hossain MM, Lopa M, Jahan N, Hossain S, Islam A, Mondol A, Faruk MO, Saha N, Kundu GK, Kanta SI, Kazal RK, Fatema K, Rahman MA, Hasan M, Hossain Mollah MA, Hosen MI, Karuvantevida N, Begum G, Zehra B, Nassir N, Nabi AHMN, Uddin KMF, Uddin M. Construction of copy number variation landscape and characterization of associated genes in a Bangladeshi cohort of neurodevelopmental disorders. Front Genet 2023; 14:955631. [PMID: 36959829 PMCID: PMC10028086 DOI: 10.3389/fgene.2023.955631] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., "Critical-Exon Genes (CEGs)"] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package. Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients' pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.
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Affiliation(s)
- Hosneara Akter
- Genetics and Genomic Medicine Centre, NeuroGen Healthcare, Dhaka, Bangladesh
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Muhammad Mizanur Rahman
- Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shaoli Sarker
- Department of Child Neurology, NeuroGen Healthcare, Dhaka, Bangladesh
- Department of Paediatric Neuroscience, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mohammed Basiruzzaman
- Department of Child Neurology, NeuroGen Healthcare, Dhaka, Bangladesh
- Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Md. Mazharul Islam
- Department of Child Neurology, NeuroGen Healthcare, Dhaka, Bangladesh
- Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Md. Atikur Rahaman
- Genetics and Genomic Medicine Centre, NeuroGen Healthcare, Dhaka, Bangladesh
| | | | | | - Nushrat Jahan Dity
- Genetics and Genomic Medicine Centre, NeuroGen Healthcare, Dhaka, Bangladesh
| | - Shouvik Sarker
- Institute of Plant Genetics, Department of Plant Biotechnology, Leibniz University Hannover, Hanover, Germany
| | - Md. Robed Amin
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Mohammad Monir Hossain
- Department of Paediatric Neurology, National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Maksuda Lopa
- Centre for Precision Therapeutics, NeuroGen Healthcare, Dhaka, Bangladesh
| | - Nargis Jahan
- Centre for Precision Therapeutics, NeuroGen Healthcare, Dhaka, Bangladesh
| | - Shafaat Hossain
- Department of Biology and Biochemistry, University of Houston, Houston, TX, United States
| | - Amirul Islam
- Genetics and Genomic Medicine Centre, NeuroGen Healthcare, Dhaka, Bangladesh
- Cellular Intelligence Lab, GenomeArc Inc, Toronto, ON, Canada
| | | | - Md Omar Faruk
- Centre for Precision Therapeutics, NeuroGen Healthcare, Dhaka, Bangladesh
| | - Narayan Saha
- Department of Paediatric Neurology, National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Gopen kumar Kundu
- Department of Child Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shayla Imam Kanta
- Department of Paediatric Neuroscience, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Rezaul Karim Kazal
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kanij Fatema
- Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md. Ashrafur Rahman
- Department of Pharmaceutical Sciences, Wilkes University, Pennsylvania, PA, United States
| | - Maruf Hasan
- Department of Biomedical Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh
| | | | - Md. Ismail Hosen
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Noushad Karuvantevida
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ghausia Begum
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Binte Zehra
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nasna Nassir
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - A. H. M. Nurun Nabi
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - K. M. Furkan Uddin
- Genetics and Genomic Medicine Centre, NeuroGen Healthcare, Dhaka, Bangladesh
- Department of Biochemistry, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | - Mohammed Uddin
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Cellular Intelligence (Ci) Lab, GenomeArc Inc, Toronto, ON, Canada
- *Correspondence: Mohammed Uddin,
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21
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Roth C, Kilpinen H, Kurian MA, Barral S. Histone lysine methyltransferase-related neurodevelopmental disorders: current knowledge and saRNA future therapies. Front Cell Dev Biol 2023; 11:1090046. [PMID: 36923252 PMCID: PMC10009263 DOI: 10.3389/fcell.2023.1090046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
Neurodevelopmental disorders encompass a group of debilitating diseases presenting with motor and cognitive dysfunction, with variable age of onset and disease severity. Advances in genetic diagnostic tools have facilitated the identification of several monogenic chromatin remodeling diseases that cause Neurodevelopmental disorders. Chromatin remodelers play a key role in the neuro-epigenetic landscape and regulation of brain development; it is therefore not surprising that mutations, leading to loss of protein function, result in aberrant neurodevelopment. Heterozygous, usually de novo mutations in histone lysine methyltransferases have been described in patients leading to haploinsufficiency, dysregulated protein levels and impaired protein function. Studies in animal models and patient-derived cell lines, have highlighted the role of histone lysine methyltransferases in the regulation of cell self-renewal, cell fate specification and apoptosis. To date, in depth studies of histone lysine methyltransferases in oncology have provided strong evidence of histone lysine methyltransferase dysregulation as a determinant of cancer progression and drug resistance. As a result, histone lysine methyltransferases have become an important therapeutic target for the treatment of different cancer forms. Despite recent advances, we still lack knowledge about the role of histone lysine methyltransferases in neuronal development. This has hampered both the study and development of precision therapies for histone lysine methyltransferases-related Neurodevelopmental disorders. In this review, we will discuss the current knowledge of the role of histone lysine methyltransferases in neuronal development and disease progression. We will also discuss how RNA-based technologies using small-activating RNAs could potentially provide a novel therapeutic approach for the future treatment of histone lysine methyltransferase haploinsufficiency in these Neurodevelopmental disorders, and how they could be first tested in state-of-the-art patient-derived neuronal models.
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Affiliation(s)
- Charlotte Roth
- Molecular Neurosciences, Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Helena Kilpinen
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Serena Barral
- Molecular Neurosciences, Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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22
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Chudy D, Raguž M, Vuletić V, Rački V, Papić E, Nenadić Baranašić N, Barišić N. GPi DBS treatment outcome in children with monogenic dystonia: a case series and review of the literature. Front Neurol 2023; 14:1151900. [PMID: 37168666 PMCID: PMC10166204 DOI: 10.3389/fneur.2023.1151900] [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: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Dystonia is the third most common pediatric movement disorder and is often difficult to treat. Deep brain stimulation (DBS) of the internal pallidum (GPi) has been demonstrated as a safe and effective treatment for genetic dystonia in adolescents and adults. The results of DBS in children are limited to individual cases or case series, although it has been proven to be an effective procedure in carefully selected pediatric cohorts. The aim of our study was to present the treatment outcome for 7- to 9-year-old pediatric patients with disabling monogenic isolated generalized DYT-THAP1 and DYT-KMT2B dystonia after bilateral GPi-DBS. Patients and results We present three boys aged <10 years; two siblings with disabling generalized DYT-THAP1 dystonia and a boy with monogenic-complex DYT-KMT2B. Dystonia onset occurred between the ages of 3 and 6. Significantly disabled children were mostly dependent on their parents. Pharmacotherapy was inefficient and patients underwent bilateral GPi-DBS. Clinical signs of dystonia improved significantly in the first month after the implantation and continued to maintain improved motor functions, which were found to have improved further at follow-up. These patients were ambulant without support and included in everyday activities. All patients had significantly lower Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) values, indicating >25% improvement over the first 15 months. However, there was a decline in speech and upper limb function, manifesting with bradylalia, bradykinesia, and dysphonia, which decreased after treatment with trihexyphenidyl. Conclusion Although reports of patients with monogenic dystonia, particularly DYT-THAP1, treated with DBS are still scarce, DBS should be considered as an efficient treatment approach in children with pharmacoresistent dystonia, especially with generalized monogenic dystonia and to prevent severe and disabling symptoms that reduce the quality of life, including emotional and social aspects. Patients require an individual approach and parents should be properly informed about expectations and possible outcomes, including relapses and impairments, in addition to DBS responsiveness and related improvements. Furthermore, early genetic diagnosis and the provision of appropriate treatments, including DBS, are mandatory for preventing severe neurologic impairments.
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Affiliation(s)
- Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
- *Correspondence: Marina Raguž
| | - Vladimira Vuletić
- Department of Neurology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Valentino Rački
- Department of Neurology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Eliša Papić
- Department of Neurology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nataša Nenadić Baranašić
- Department of Pediatrics, University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nina Barišić
- Department of Pediatrics, University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
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Hara K, Ouchi H, Hamanaka K, Miyatake S, Matsumoto N. [A case of generalized dystonia DYT28 with a novel de novo mutation in the KMT2B gene]. Rinsho Shinkeigaku 2022; 62:856-859. [PMID: 36288966 DOI: 10.5692/clinicalneurol.cn-001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The patient exhibited plantarflexion during walking at the age of five. He then developed writer's cramp at the age of six, dysphonia at 15 years, and action-induced dystonia with left knee elevation and trunk swinging when walking at 16 years, which subsequently spread to the right leg at 19 years. Levodopa therapy was ineffective for dystonia. Brain MRI showed no abnormalities. He was diagnosed with DYT28 after detecting a novel heterozygous mutation (c.433C>T, p.Arg145*) in the KMT2B gene using whole-exome sequencing at age 39. Furthermore, the patient's parents exhibited normal alleles, confirming the de novo status of KMT2B gene mutation. We should consider DYT28 in addition to DYT1 and DYT5 in patients who developed leg dystonia in childhood.
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Affiliation(s)
- Kenju Hara
- Department of Neurology, Akita Red Cross Hospital
| | - Haruka Ouchi
- Department of Neurology, Akita Red Cross Hospital
| | - Kohei Hamanaka
- Department of Human Genetics, Yokohama City University Graduate School of Medicine
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine
- Clinical Genetics Department, Yokohama City University Hospital
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine
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Neurophysiological Basis of Deep Brain Stimulation and Botulinum Neurotoxin Injection for Treating Oromandibular Dystonia. Toxins (Basel) 2022; 14:toxins14110751. [PMID: 36356002 PMCID: PMC9694803 DOI: 10.3390/toxins14110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Oromandibular dystonia (OMD) induces severe motor impairments, such as masticatory disturbances, dysphagia, and dysarthria, resulting in a serious decline in quality of life. Non-invasive brain-imaging techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) are powerful approaches that can elucidate human cortical activity with high temporal resolution. Previous studies with EEG and MEG have revealed that movements in the stomatognathic system are regulated by the bilateral central cortex. Recently, in addition to the standard therapy of botulinum neurotoxin (BoNT) injection into the affected muscles, bilateral deep brain stimulation (DBS) has been applied for the treatment of OMD. However, some patients' OMD symptoms do not improve sufficiently after DBS, and they require additional BoNT therapy. In this review, we provide an overview of the unique central spatiotemporal processing mechanisms in these regions in the bilateral cortex using EEG and MEG, as they relate to the sensorimotor functions of the stomatognathic system. Increased knowledge regarding the neurophysiological underpinnings of the stomatognathic system will improve our understanding of OMD and other movement disorders, as well as aid the development of potential novel approaches such as combination treatment with BoNT injection and DBS or non-invasive cortical current stimulation therapies.
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25
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Tai CH, Chou SC, Lin CH, Lee WT, Wu RM, Tseng SH. Long-Term Outcomes of Idiopathic and Acquired Dystonia After Pallidal Deep Brain Stimulation: A Case Series. World Neurosurg 2022; 167:e575-e582. [PMID: 35995355 DOI: 10.1016/j.wneu.2022.08.053] [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: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among dystonia patients receiving globus pallidus internus (GPi) deep brain stimulation (DBS), long-term outcomes remain to be established. To report the long-term outcomes of GPi DBS in a patient cohort with idiopathic and acquired dystonia. METHODS In this long-term follow-up cohort, there were 4 patients with idiopathic dystonia and 2 patients with acquired dystonia. The Burke-Fahn-Marsden Dystonia Rating Scale was used to evaluate 6 consecutive patients preoperatively and at 6 months, 12 months, and the last follow-up. The relationship between etiology and clinical improvement was analyzed. Stimulation parameters were evaluated for similarities and differences among these patients. RESULTS The mean follow-up of our cohort was 65.3 months (median 40.5 months). The average improvement in the Burke-Fahn-Marsden Dystonia Rating Scale (mean ± SEM) were 56% ± 7.6, 67% ± 6.8 and 66% ± 9.7 at 6 months, 12 months, and the last follow-up, respectively. There was greater improvement during the long-term follow-up in the 4 patients with idiopathic dystonia than in the 2 patients with acquired dystonia. The 2 most ventral electrodes (contact 0 and 1) were activated in all 11 leads in this cohort. The average stimulation intensity, pulse width and frequency were 2.0 ± 0.24 mA, 252 ± 43 μs, and 99 ± 6.0 Hz, respectively. CONCLUSIONS Isolated dystonia, either monogenic or idiopathic, usually responds better to GPi DBS than to acquired dystonia. Selection of patients by dystonia etiology, accurate placement of DBS leads in GPi targets, and proper stimulation programming are crucial to achieve better long-term outcomes.
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Affiliation(s)
- Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Che Chou
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Hong Tseng
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Gelineau-Morel R, Kruer MC, Garris JF, Libdeh AA, Barbosa DAN, Coffman KA, Moon D, Barton C, Vera AZ, Bruce AB, Larsh T, Wu SW, Gilbert DL, O’Malley JA. Deep Brain Stimulation for Pediatric Dystonia: A Review of the Literature and Suggested Programming Algorithm. J Child Neurol 2022; 37:813-824. [PMID: 36053123 PMCID: PMC9912476 DOI: 10.1177/08830738221115248] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Deep brain stimulation (DBS) is an established intervention for use in pediatric movement disorders, especially dystonia. Although multiple publications have provided guidelines for deep brain stimulation patient selection and programming in adults, there are no evidence-based or consensus statements published for pediatrics. The result is lack of standardized care and underutilization of this effective treatment. To this end, we assembled a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric deep brain stimulation to review recent literature and current practices and propose a standardized approach to candidate selection, implantation target site selection, and programming algorithms. For pediatric dystonia, we provide algorithms for (1) programming for initial session and follow-up sessions, and (2) troubleshooting side effects encountered during programming. We discuss common side effects, how they present, and recommendations for management. This topical review serves as a resource for movement disorders specialists interested in using deep brain stimulation for pediatric dystonia.
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Affiliation(s)
- Rose Gelineau-Morel
- Division of Neurology, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, Missouri, 64108
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital & University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85016
| | - Jordan F Garris
- Division of Pediatric Neurology, Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908−0394
| | - Amal Abu Libdeh
- Division of Pediatric Neurology, Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908−0394
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, 94305
| | - Keith A Coffman
- Division of Neurology, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, Missouri, 64108
| | - David Moon
- Department of Child Neurology, Division of Neurosciences, Helen DeVos Children’s Hospital, 100 Michigan St NE, Grand Rapids, MI 49503
| | - Christopher Barton
- Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky; Division of Child Neurology, Norton Children’s Medical Group, 231 E Chestnut St, Louisville, KY 40202
| | - Alonso Zea Vera
- Department of Neurology, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC, 20010
| | - Adrienne B Bruce
- Division of Pediatric Neurology, Department of Pediatrics, Prisma Health, 200 Patewood Drive A350, Greenville, SC, USA 29615; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605
| | - Travis Larsh
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Steve W Wu
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Jennifer A O’Malley
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, 750 Welch Road, Suite 317, Palo Alto, California, 94304
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Montano C, Cassini T, Ziegler SG, Boehm M, Nicoli ER, Mindell JA, Soldatos AG, Manoli I, Wolfe L, Macnamara EF, Malicdan MCV, Adams DR, Tifft CJ, Toro C, Gahl WA. Diagnosis and discovery: Insights from the NIH Undiagnosed Diseases Program. J Inherit Metab Dis 2022; 45:907-918. [PMID: 35490291 DOI: 10.1002/jimd.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022]
Abstract
Living with an undiagnosed medical condition places a tremendous burden on patients, their families, and their healthcare providers. The Undiagnosed Diseases Program (UDP) was established at the National Institutes of Health (NIH) in 2008 with the primary goals of providing a diagnosis for patients with mysterious conditions and advancing medical knowledge about rare and common diseases. The program reviews applications from referring clinicians for cases that are considered undiagnosed despite a thorough evaluation. Those that are accepted receive clinical evaluations involving deep phenotyping and genetic testing that includes exome and genomic sequencing. Selected candidate gene variants are evaluated by collaborators using functional assays. Since its inception, the UDP has received more than 4500 applications and has completed evaluations on nearly 1300 individuals. Here we present six cases that exemplify the discovery of novel disease mechanisms, the importance of deep phenotyping for rare diseases, and how genetic diagnoses have led to appropriate treatment. The creation of the Undiagnosed Diseases Network (UDN) in 2014 has substantially increased the number of patients evaluated and allowed for greater opportunities for data sharing. Expansion to the Undiagnosed Diseases Network International (UDNI) has the possibility to extend this reach even farther. Together, networks of undiagnosed diseases programs are powerful tools to advance our knowledge of pathophysiology, accelerate accurate diagnoses, and improve patient care for patients with rare conditions.
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Affiliation(s)
- Carolina Montano
- Medical Genetics & Genomic Medicine Training Program, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
| | - Thomas Cassini
- Medical Genetics & Genomic Medicine Training Program, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
| | - Shira G Ziegler
- Departments of Pediatrics and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Manfred Boehm
- Laboratory of Cardiovascular Regenerative Medicine, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | - Elena-Raluca Nicoli
- Glycosphingolipid and Glycoprotein Disorders Unit, Medical Genetics Branch, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
| | - Joseph A Mindell
- Membrane Transport Biophysics Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, Maryland, USA
| | - Ariane G Soldatos
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, Maryland, USA
| | - Irini Manoli
- Organic Acid Research Section, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
| | - Lynne Wolfe
- Office of the Clinical Director, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
| | - Ellen F Macnamara
- NIH Undiagnosed Diseases Program, Common Fund, NIH, Bethesda, Maryland, USA
| | | | - David R Adams
- Office of the Clinical Director, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
- NIH Undiagnosed Diseases Program, Common Fund, NIH, Bethesda, Maryland, USA
| | - Cynthia J Tifft
- Glycosphingolipid and Glycoprotein Disorders Unit, Medical Genetics Branch, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
- Office of the Clinical Director, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
- NIH Undiagnosed Diseases Program, Common Fund, NIH, Bethesda, Maryland, USA
| | - Camilo Toro
- NIH Undiagnosed Diseases Program, Common Fund, NIH, Bethesda, Maryland, USA
| | - William A Gahl
- Office of the Clinical Director, National Human Genome Research Institute (NHGRI), NIH, Bethesda, Maryland, USA
- NIH Undiagnosed Diseases Program, Common Fund, NIH, Bethesda, Maryland, USA
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28
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Dzinovic I, Winkelmann J, Zech M. Genetic intersection between dystonia and neurodevelopmental disorders: Insights from genomic sequencing. Parkinsonism Relat Disord 2022; 102:131-140. [DOI: 10.1016/j.parkreldis.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
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Cif L, Demailly D, Vasques X, Verbizier DD, Coubes P, Gorman K, Kurian MA. Freezing of gait as a complication of pallidal deep brain stimulation in
DYT‐
KMT2B
patients with evidence of striatonigral degeneration. Mov Disord Clin Pract 2022; 9:992-996. [PMID: 36247903 PMCID: PMC9547127 DOI: 10.1002/mdc3.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac Centre Hospitalier Universitaire Montpellier Montpellier France
| | - Diane Demailly
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac Centre Hospitalier Universitaire Montpellier Montpellier France
| | - Xavier Vasques
- Laboratoire de Recherche en Neurosciences Cliniques Montpellier France
- IBM Technology France
| | - Delphine de Verbizier
- Département de Médecine Nucléaire Hôpital Gui de Chauliac, Centre Hospitalier Universitaire Montpellier Montpellier France
| | - Philippe Coubes
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac Centre Hospitalier Universitaire Montpellier Montpellier France
| | - Kathleen Gorman
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children London WC1N 1DZ UK
- Department of Neurology Great Ormond Street Hospital London UK
| | - Manju A. Kurian
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children London WC1N 1DZ UK
- Department of Neurology Great Ormond Street Hospital London UK
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30
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Deep brain stimulation in dystonia: factors contributing to variability in outcome in short and long term follow-up. Curr Opin Neurol 2022; 35:510-517. [PMID: 35787538 DOI: 10.1097/wco.0000000000001072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is currently the most effective treatment for medically refractory dystonia with globus pallidus internus (GPi) usually the preferred target. Despite the overall success of DBS in dystonia, there remains variability in treatment outcome in both short and long-term follow-up, due to various factors. Factors contributing to variability in outcome comprise 'Dystonia Related' including dystonia classification, semiology, duration, body distribution, orthopaedic deformity, aetiology and genetic cause. The majority of these factors are identifiable from clinical assessment, brain MRI and genetic testing, and therefore merit careful preoperative consideration. 'DBS related' factors include brain target, accuracy of lead placement, stimulation parameters, time allowed for response, neurostimulation technology employed and DBS induced side-effects. In this review, factors contributing to variability in short and long-term dystonia DBS outcome are reviewed and discussed. RECENT FINDINGS The recognition of differential DBS benefit in monogenic dystonia, increasing experience with subthalamic nucleus (STN) DBS and in DBS for Meige syndrome, elucidation of DBS side effects and novel neurophysiological and imaging techniques to assist in predicting clinical outcome. SUMMARY Improved understanding of factors contributing to variability of DBS outcome in dystonia may assist in patient selection and predicting surgical outcomes.
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31
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Buzo EL, De la Casa-Fages B, Sánchez MG, Sánchez JP, Carballal CF, Vidorreta JG, Sierra OM, Chicote AC, Grandas F. Pallidal deep brain stimulation response in two siblings with atypical adult-onset dystonia related to a KMT2B variant. J Neurol Sci 2022; 438:120295. [DOI: 10.1016/j.jns.2022.120295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/05/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022]
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Wirth T, Garone G, Kurian MA, Piton A, Millan F, Telegrafi A, Drouot N, Rudolf G, Chelly J, Marks W, Burglen L, Demailly D, Coubes P, Castro‐Jimenez M, Joriot S, Ghoumid J, Belin J, Faucheux J, Blumkin L, Hull M, Parnes M, Ravelli C, Poulen G, Calmels N, Nemeth AH, Smith M, Barnicoat A, Ewenczyk C, Méneret A, Roze E, Keren B, Mignot C, Beroud C, Acosta F, Nowak C, Wilson WG, Steel D, Capuano A, Vidailhet M, Lin J, Tranchant C, Cif L, Doummar D, Anheim M. Highlighting the Dystonic Phenotype Related to GNAO1. Mov Disord 2022; 37:1547-1554. [PMID: 35722775 PMCID: PMC9545634 DOI: 10.1002/mds.29074] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Most reported patients carrying GNAO1 mutations showed a severe phenotype characterized by early-onset epileptic encephalopathy and/or chorea. OBJECTIVE The aim was to characterize the clinical and genetic features of patients with mild GNAO1-related phenotype with prominent movement disorders. METHODS We included patients diagnosed with GNAO1-related movement disorders of delayed onset (>2 years). Patients experiencing either severe or profound intellectual disability or early-onset epileptic encephalopathy were excluded. RESULTS Twenty-four patients and 1 asymptomatic subject were included. All patients showed dystonia as prominent movement disorder. Dystonia was focal in 1, segmental in 6, multifocal in 4, and generalized in 13. Six patients showed adolescence or adulthood-onset dystonia. Seven patients presented with parkinsonism and 3 with myoclonus. Dysarthria was observed in 19 patients. Mild and moderate ID were present in 10 and 2 patients, respectively. CONCLUSION We highlighted a mild GNAO1-related phenotype, including adolescent-onset dystonia, broadening the clinical spectrum of this condition. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Wirth
- Département de Neurologie, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourg,Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance
| | - Giacomo Garone
- University Hospital Pediatric Department, IRCCS Bambino Gesù Children's HospitalUniversity of Rome Tor VergataRomeItaly,Movement Disorders Clinic, Department of NeurosciencesBambino Gesù Children's HospitalRomeItaly
| | - Manju A. Kurian
- Molecular Neurosciences, Developmental NeurosciencesUCL Great Ormond Street Institute of Child HealthLondonUnited Kingdom
| | - Amélie Piton
- Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance,Laboratoire de diagnostic génétique, Nouvel Hôpital CivilHôpitaux universitaires de StrasbourgStrasbourgFrance
| | | | | | - Nathalie Drouot
- Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance
| | - Gabrielle Rudolf
- Département de Neurologie, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourg,Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance
| | - Jamel Chelly
- Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance,Laboratoire de diagnostic génétique, Nouvel Hôpital CivilHôpitaux universitaires de StrasbourgStrasbourgFrance
| | - Warren Marks
- Cook Children's Medical CentreFort WorthTexasUSA
| | - Lydie Burglen
- Centre de Référence des Malformations et Maladies Congénitales du Cervelet, Département de Génétique et Embryologie MédicaleAPHP, Hôpital TrousseauParisFrance
| | - Diane Demailly
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements AnormauxHôpital Gui de Chauliac, Centre Hospitalier Régional MontpellierMontpellierFrance
| | - Phillipe Coubes
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements AnormauxHôpital Gui de Chauliac, Centre Hospitalier Régional MontpellierMontpellierFrance
| | - Mayte Castro‐Jimenez
- Service de Neurologie, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland
| | - Sylvie Joriot
- Department of Paediatric NeurologyUniversity Hospital of LilleLilleFrance
| | - Jamal Ghoumid
- Univ. Lille, ULR7364 RADEME, CHU Lille, Clinique de Génétique Guy FontaineLilleFrance
| | | | | | - Lubov Blumkin
- Pediatric Movement Disorders Clinic, Pediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Mariam Hull
- Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Section of Pediatric Neurology and Developmental NeuroscienceTexas Children's HospitalHoustonTexasUSA
| | - Mered Parnes
- Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Section of Pediatric Neurology and Developmental NeuroscienceTexas Children's HospitalHoustonTexasUSA
| | - Claudia Ravelli
- Sorbonne Université, Service de Neuropédiatrie‐Pathologie du développement, centre de référence neurogénétiqueHôpital Trousseau AP‐HP.SU, FHU I2D2ParisFrance
| | - Gaëtan Poulen
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements AnormauxHôpital Gui de Chauliac, Centre Hospitalier Régional MontpellierMontpellierFrance
| | - Nadège Calmels
- Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance,Laboratoire de diagnostic génétique, Nouvel Hôpital CivilHôpitaux universitaires de StrasbourgStrasbourgFrance
| | - Andrea H. Nemeth
- Oxford University Hospitals National Health Service Foundation Trust and University of OxfordOxfordUnited Kingdom
| | - Martin Smith
- Oxford University Hospitals National Health Service Foundation Trust and University of OxfordOxfordUnited Kingdom
| | - Angela Barnicoat
- Department of Clinical GeneticsGreat Ormond Street HospitalLondonUnited Kingdom
| | - Claire Ewenczyk
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Aurélie Méneret
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Emmanuel Roze
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Boris Keren
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Cyril Mignot
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Christophe Beroud
- Aix Marseille Université, INSERM, MMG, Bioinformatics & GeneticsMarseilleFrance
| | | | - Catherine Nowak
- The Feingold Center for Children, Division of Genetics and GenomicsBoston Children's HospitalBostonMassachusettsUSA
| | - William G. Wilson
- Department of PediatricsUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Dora Steel
- Molecular Neurosciences, Developmental NeurosciencesUCL Great Ormond Street Institute of Child HealthLondonUnited Kingdom
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of NeurosciencesBambino Gesù Children's HospitalRomeItaly
| | - Marie Vidailhet
- Sorbonne Université/Inserm U1127/CNRS UMR 7225/Institut du CerveauParisFrance,Service de neurologie, Hôpital la Pitié SalpêtrièreSorbonne UniversitéParisFrance
| | - Jean‐Pierre Lin
- Children's Neurosciences Department, Evelina London Children's HospitalGuy's and St Thomas NHS Foundation TrustLondonUnited Kingdom
| | - Christine Tranchant
- Département de Neurologie, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourg,Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance
| | - Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements AnormauxHôpital Gui de Chauliac, Centre Hospitalier Régional MontpellierMontpellierFrance
| | - Diane Doummar
- Sorbonne Université, Service de Neuropédiatrie‐Pathologie du développement, centre de référence neurogénétiqueHôpital Trousseau AP‐HP.SU, FHU I2D2ParisFrance
| | - Mathieu Anheim
- Département de Neurologie, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourg,Fédération de Médecine Translationnelle de Strasbourg (FMTS)Université de StrasbourgStrasbourgFrance,Institut de Génétique et de Biologie Moléculaire et CellulaireIllkirchFrance
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Ojaimi MA, Banimortada BJ, Othman A, Riedhammer KM, Almannai M, El-Hattab AW. Disorders of histone methylation: molecular basis and clinical syndromes. Clin Genet 2022; 102:169-181. [PMID: 35713103 DOI: 10.1111/cge.14181] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
Epigenetic modifications of DNA and histone tails are essential for gene expression regulation. They play an essential role in neurodevelopment as nervous system development is a complex process requiring a dynamic pattern of gene expression. Histone methylation is one of the vital epigenetic regulators and mostly occurs on lysine residues of histones H3 and H4. Histone methylation is catalyzed by two sets of enzymes: histone lysine methyltransferases (KMTs) and histone lysine demethylases (KDMs). KMT2 enzymes form a distinct multi-subunit complex known as COMPASS to enhance their catalytic activity and diversify their biologic functions. Several neurodevelopmental syndromes result from defects of histone methylation which can be caused by deficiencies in histone methyltransferases and demethylases, loss of the histone methyltransferase activator TASP1, or derangements in COMPASS formation. In this review article, the molecular mechanism of histone methylation is discussed followed by summarizing clinical syndromes caused by monogenic defects in histone methylation.
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Affiliation(s)
- Mode Al Ojaimi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Amna Othman
- Genetics and Genomic Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Korbinian M Riedhammer
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Mohammed Almannai
- Genetics and Precision Medicine Department, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Ayman W El-Hattab
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Pediatrics Department, University Hospital Sharjah, Sharjah, United Arab Emirates.,Genetics and Metabolic Department, KidsHeart Medical Center, Abu Dhabi, United Arab Emirates
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34
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The Patho-Neurophysiological Basis and Treatment of Focal Laryngeal Dystonia: A Narrative Review and Two Case Reports Applying TMS over the Laryngeal Motor Cortex. J Clin Med 2022; 11:jcm11123453. [PMID: 35743523 PMCID: PMC9224879 DOI: 10.3390/jcm11123453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/10/2022] Open
Abstract
Focal laryngeal dystonia (LD) is a rare, idiopathic disease affecting the laryngeal musculature with an unknown cause and clinically presented as adductor LD or rarely as abductor LD. The most effective treatment options include the injection of botulinum toxin (BoNT) into the affected laryngeal muscle. The aim of this narrative review is to summarize the patho-neuro-physiological and genetic background of LD, as well as the standard recommended therapy (BoNT) and pharmacological treatment options, and to discuss possible treatment perspectives using neuro-modulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and vibrotactile stimulation. The review will present two LD cases, patients with adductor and abductor LD, standard diagnostic procedure, treatments and achievement, and the results of cortical excitability mapping the primary motor cortex for the representation of the laryngeal muscles in the assessment of corticospinal and corticobulbar excitability.
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35
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Lee S, Ochoa E, Barwick K, Cif L, Rodger F, Docquier F, Pérez-Dueñas B, Clark G, Martin E, Banka S, Kurian MA, Maher ER. Comparison of methylation episignatures in KMT2B- and KMT2D-related human disorders. Epigenomics 2022; 14:537-547. [PMID: 35506254 DOI: 10.2217/epi-2021-0521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim & methods: To investigate peripheral blood methylation episignatures in KMT2B-related dystonia (DYT-KMT2B), the authors undertook genome-wide methylation profiling of ∼2 M CpGs using a next-generation sequencing-based assay and compared the findings with those in controls and patients with KMT2D-related Kabuki syndrome type 1 (KS1). Results: A total of 1812 significantly differentially methylated CpG positions (false discovery rate < 0.05) were detected in DYT-KMT2B samples compared with controls. Multi-dimensional scaling analysis showed that the 10 DYT-KMT2B samples clustered together and separately from 29 controls and 10 with pathogenic variants in KMT2D. The authors found that most differentially methylated CpG positions were specific to one disorder and that all (DYT-KMT2B) and most (Kabuki syndrome type 1) methylation alterations in CpG islands were gain of methylation events. Conclusion: Using sensitive methylation profiling methodology, the authors replicated recent reports of a methylation episignature for DYT-KMT2B. These findings will facilitate the development of episignature-based assays to improve diagnostic accuracy.
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Affiliation(s)
- Sunwoo Lee
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Eguzkine Ochoa
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Katy Barwick
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, WC1N 1DZ, UK
| | - Laura Cif
- Departement de Neurochirurgie, Unite des Pathologies Cerebrales Resistantes, Unite de Recherche sur les Comportements et Mouvements Anormaux, Hopital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France, & Faculte de Medecine, Universite de Montpellier, France
| | - Fay Rodger
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK.,Stratified Medicine Core Laboratory NGS Hub, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - France Docquier
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK.,Stratified Medicine Core Laboratory NGS Hub, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Belén Pérez-Dueñas
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, WC1N 1DZ, UK
| | - Graeme Clark
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK.,Stratified Medicine Core Laboratory NGS Hub, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ezequiel Martin
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK.,Stratified Medicine Core Laboratory NGS Hub, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Siddharth Banka
- Division of Evolution, Infection & Genomics, School of Biological Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK, & Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University Foundation NHS Trust, Health Innovation Manchester, Manchester, M13 9WL, UK
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, WC1N 1DZ, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge, CB2 0QQ, UK
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36
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Grosz BR, Tisch S, Tchan MC, Fung VSC, Darveniza P, Fellner A, Kurian MA, McLean A, Tomlinson SE, Smyth R, Devery S, Wu KHC, Kennerson ML, Kumar KR. A novel synonymous KMT2B variant in a patient with dystonia causes aberrant splicing. Mol Genet Genomic Med 2022; 10:e1923. [PMID: 35293157 PMCID: PMC9034664 DOI: 10.1002/mgg3.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Heterozygous KMT2B variants are a common cause of dystonia. A novel synonymous KMT2B variant, c.5073C>T (p.Gly1691=) was identified in an individual with childhood‐onset progressive dystonia. Methods The splicing impact of c.5073C>T was assessed using an in vitro exon‐trapping assay. The genomic region of KMT2B exons 23–26 was cloned into the pSpliceExpress plasmid between exon 2 and 3 of the rat Ins2 gene. The c.5073C>T variant was then introduced through site‐directed mutagenesis. The KMT2B wild‐type and c.5073C>T plasmids were transfected separately into HeLa cells and RNA was extracted 48 hours after transfection. The RNA was reverse transcribed to produce cDNA, which was PCR amplified using primers annealing to the flanking rat Ins2 sequences. Results Sanger sequencing of the PCR products revealed that c.5073C>T caused a novel splice donor site and therefore a 5‐bp deletion of KMT2B exon 23 in mature mRNA, leading to a coding frameshift and premature stop codon (p.Lys1692AsnfsTer7). Conclusion To our knowledge, this is the first report of a KMT2B synonymous variant associated with dystonia. Reassessment of synonymous variants may increase diagnostic yield for inherited disorders including monogenic dystonia. This is of clinical importance, given the generally favourable response to deep brain stimulation for KMT2B‐related dystonia.
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Affiliation(s)
- Bianca R Grosz
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michel C Tchan
- Clinical Genomics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Department of Genetic Medicine, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Victor S C Fung
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Paul Darveniza
- Department of Neurology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Avi Fellner
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Manju A Kurian
- Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, London, UK
| | - Alison McLean
- Clinical Genomics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Susan E Tomlinson
- Department of Neurology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Renee Smyth
- Clinical Genomics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Sophie Devery
- Clinical Genomics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Kathy H C Wu
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Clinical Genomics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Marina L Kennerson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Kishore R Kumar
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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37
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Yellajoshyula D, Pappas SS, Dauer WT. Oligodendrocyte and Extracellular Matrix Contributions to Central Nervous System Motor Function: Implications for Dystonia. Mov Disord 2022; 37:456-463. [PMID: 34989453 PMCID: PMC11152458 DOI: 10.1002/mds.28892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/18/2022] Open
Abstract
The quest to elucidate nervous system function and dysfunction in disease has focused largely on neurons and neural circuits. However, fundamental aspects of nervous system development, function, and plasticity are regulated by nonneuronal elements, including glial cells and the extracellular matrix (ECM). The rapid rise of genomics and neuroimaging techniques in recent decades has highlighted neuronal-glial interactions and ECM as a key component of nervous system development, plasticity, and function. Abnormalities of neuronal-glial interactions have been understudied but are increasingly recognized to play a key role in many neurodevelopmental disorders. In this report, we consider the role of myelination and the ECM in the development and function of central nervous system motor circuits and the neurodevelopmental disease dystonia. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Samuel S Pappas
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William T Dauer
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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38
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Rajan R, Garg K, Saini A, Radhakrishnan DM, Carecchio M, Bk B, Singh M, Srivastava AK. GPi-DBS for KMT2B-Associated Dystonia: Systematic Review and Meta-Analysis. Mov Disord Clin Pract 2022; 9:31-37. [PMID: 35005062 DOI: 10.1002/mdc3.13374] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/11/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022] Open
Abstract
Background Early evidence suggests good response to pallidal deep brain stimulation (DBS) in DYT-KMT2B. Objectives We aimed to conduct a systematic review and meta-analysis to assess outcomes and identify predictors of good outcome following GPi-DBS in DYT-KMT2B. Methods We searched MEDLINE, Cochrane and MDS-abstracts databases using the MeSH terms "KMT2B and DYT28". We included studies that reported objective outcomes following GPi-DBS in DYT-KMT2B. The BFMDRS-M (Burke-Fahn-Marsden Dystonia Rating Scale- Movement) total scores pre- and post-surgery were used to quantify outcomes. We calculated pooled effects using a random effects meta-analysis and used meta-regression to identify potential effect modifiers. Multiple linear regression using individual patient data was used to identify predictors of good outcome (>50% improvement from baseline on BFMDRS-M). Results Initial searches screened 132 abstracts of which 34 full-text articles were identified to be of potential interest. Ten studies reporting 42 individual patients, met the inclusion/exclusion criteria and were included in the final review. The mean age at onset was 6.4 ± 5.7 years and 40% were male. The median follow-up was 12 months (range: 1-264 months). GPi-DBS resulted in median BFMDRS-M improvement of 42.7% (range: -103.5% to 95.9%) postoperatively. Pooled proportion of patients experiencing clinical improvement >50% on BFMDRS-M was 41% (95% CI: 27%-57%). Male gender [β: 22.6, 95% CI: 8.0-37.3, P = 0.004), and higher pre-operative BFMDRS-M score [β: 0.62, 95% CI: 0.36-0.87, P < 0.001) were independently associated with better outcome. Conclusion KMT2B-associated dystonia responds effectively to pallidal stimulation. The outcome is better in males and those with more severe dystonia at baseline.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Kanwaljeet Garg
- Department of Neurosurgery All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Arti Saini
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Divya M Radhakrishnan
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Miryam Carecchio
- Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy
| | - Binukumar Bk
- CSIR-Institute of Genomics and Integrative Biology New Delhi India
| | - Manmohan Singh
- Department of Neurosurgery All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Achal K Srivastava
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
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39
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Trenado C, Cif L, Pedroarena-Leal N, Ruge D. Electrophysiological Signature and the Prediction of Deep Brain Stimulation Withdrawal and Insertion Effects. Front Neurol 2021; 12:754701. [PMID: 34917015 PMCID: PMC8669963 DOI: 10.3389/fneur.2021.754701] [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: 08/06/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
Deep brain stimulation (DBS) serves as a treatment for neurological and psychiatric disorders, such as Parkinson's disease (PD), essential tremor, dystonia, Tourette Syndrome (GTS), Huntington's disease, and obsessive-compulsive disorder (OCD). There is broad experience with the short-term effects of DBS in individual diseases and their signs/symptoms. However, even in acute treatment and for the same disorder or a given disorder, a prediction of effect is not perfect. Even further, the factors that influence the long-term effect of DBS and its withdrawal are hardly characterized. In this work, we aim to shed light on an important topic, the question of “DBS dependency.” To address this, we make use of the Kuramoto model of phase synchronization (oscillation feature) endowed with neuroplasticity to study the effects of DBS under successive withdrawals and renewals of neuromodulation as well as influence of treatment duration in de novo DBS “patients.” The results of our simulation show that the characteristics of neuroplasticity have a profound effect on the stability and mutability of oscillation synchronization patterns across successive withdrawal and renewal of DBS in chronic “patients” and also in de novo DBS “patients” with varying duration of treatment (here referred to as the “number of iterations”). Importantly, the results demonstrate the strong effect of the individual neuroplasticity makeup on the behavior of synchrony of oscillatory activity that promotes certain disorder/disease states or symptoms. The effect of DBS-mediated neuromodulation and withdrawal is highly dependent on the makeup of the neuroplastic signature of a disorder or an individual.
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Affiliation(s)
- Carlos Trenado
- Laboratoire de Recherche en Neurosciences Cliniques, LRENC, Montpellier, France
| | - Laura Cif
- Département de Neurochirurgie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Diane Ruge
- Laboratoire de Recherche en Neurosciences Cliniques, LRENC, Montpellier, France
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40
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Towards Precision Therapies for Inherited Disorders of Neurodegeneration with Brain Iron Accumulation. Tremor Other Hyperkinet Mov (N Y) 2021; 11:51. [PMID: 34909266 PMCID: PMC8641530 DOI: 10.5334/tohm.661] [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: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Neurodegeneration with brain iron accumulation (NBIA) disorders comprise a group of rare but devastating inherited neurological diseases with unifying features of progressive cognitive and motor decline, and increased iron deposition in the basal ganglia. Although at present there are no proven disease-modifying treatments, the severe nature of these monogenic disorders lends to consideration of personalized medicine strategies, including targeted gene therapy. In this review we summarize the progress and future direction towards precision therapies for NBIA disorders. Methods: This review considered all relevant publications up to April 2021 using a systematic search strategy of PubMed and clinical trials databases. Results: We review what is currently known about the underlying pathophysiology of NBIA disorders, common NBIA disease pathways, and how this knowledge has influenced current management strategies and clinical trial design. The safety profile, efficacy and clinical outcome of clinical studies are reviewed. Furthermore, the potential for future therapeutic approaches is also discussed. Discussion: Therapeutic options in NBIAs remain very limited, with no proven disease-modifying treatments at present. However, a number of different approaches are currently under development with increasing focus on targeted precision therapies. Recent advances in the field give hope that novel strategies, such as gene therapy, gene editing and substrate replacement therapies are both scientifically and financially feasible for these conditions. Highlights This article provides an up-to-date review of the current literature about Neurodegeneration with Brain Iron Accumulation (NBIA), with a focus on disease pathophysiology, current and previously trialed therapies, and future treatments in development, including consideration of potential genetic therapy approaches.
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41
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Aksoy A, Yayıcı Köken Ö, Ceylan AC, Toptaş Dedeoğlu Ö. KMT2B-Related Dystonia: Challenges in Diagnosis and Treatment. Mol Syndromol 2021; 13:159-164. [DOI: 10.1159/000518974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
In this study, we report the first known Turkish case of a novel nonsense mutation c.2453dupT (p.M818fs*28) in the <i>KMT2B</i> (NM_014727.2) gene diagnosed in a male patient with <i>KMT2B</i>-related dystonia (DYT-<i>KMT2B</i>, DYT-28, Dystonia*-28), which is a complex, childhood-onset, progressive, hereditary dystonia. The patient, who is followed up from 9 to 13 years of age, had dysmorphic features, developmental delay, short stature, and microcephaly, in addition to focal dystonia and hemichorea (in the right and left lower extremities). Generalized dystonia involving bulbar and cervical muscles, in addition to dystonic cramps, myoclonus, and hemiballismus, were also observed during the course of the follow-up. While he was able to perform basic functions like eating, climbing stairs, walking, and writing with the aid of levodopa and trihexyphenidyl treatment, his clinical status gradually deteriorated secondary to progressive generalized dystonia in the 4-year follow-up. Deep brain stimulation has been shown to be effective in several patients which could be the next preferred treatment for the patient.
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42
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Siegert S, Mindler GT, Brücke C, Kranzl A, Patsch J, Ritter M, Janecke AR, Vodopiutz J. Expanding the Phenotype of the FAM149B1-Related Ciliopathy and Identification of Three Neurogenetic Disorders in a Single Family. Genes (Basel) 2021; 12:genes12111648. [PMID: 34828254 PMCID: PMC8622907 DOI: 10.3390/genes12111648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Biallelic truncating FAM149B1 variants result in cilia dysfunction and have been reported in four infants with Joubert syndrome and orofaciodigital syndrome type VI, respectively. We report here on three adult siblings, 18 to 40 years of age, homozygous for the known FAM149B1 c.354_357delinsCACTC (p.Gln118Hisfs*20) variant. Detailed clinical examinations were performed including ocular and gait analyses, skeletal- and neuroimaging. All three patients presented with neurological and oculomotor symptoms since birth and mild skeletal dysplasia in infancy resulting in characteristic gait abnormalities. We document mild skeletal dysplasia, abnormal gait with increased hip rotation and increased external foot rotation, ataxia, variable polydactyly, ocular Duane syndrome, progressive ophthalmoplegia, nystagmus, situs inversus of the retinal vessels, olfactory bulb aplasia, and corpus callosal dysgenesis as novel features in FAM149B1-ciliopathy. We show that intellectual disability is mild to moderate and retinal, renal and liver function is normal in these affected adults. Our study thus expands the FAM149B1-related Joubert syndrome to a mainly neurological and skeletal ciliopathy phenotype with predominant oculomotor dysfunction but otherwise stable outcome in adults. Diagnosis of FAM149B1-related disorder was impeded by segregation of multiple neurogenetic disorders in the same family, highlighting the importance of extended clinical and genetic studies in families with complex phenotypes.
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Affiliation(s)
- Sandy Siegert
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gabriel T. Mindler
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, 1130 Vienna, Austria; (G.T.M.); (A.K.)
- Vienna Bone and Growth Center, 1090 Vienna, Austria;
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Andreas Kranzl
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, 1130 Vienna, Austria; (G.T.M.); (A.K.)
- Vienna Bone and Growth Center, 1090 Vienna, Austria;
- Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Speising, 1130 Vienna, Austria
| | - Janina Patsch
- Vienna Bone and Growth Center, 1090 Vienna, Austria;
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Ritter
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Andreas R. Janecke
- Department of Pediatrics I, Medical University of Innsbruck, 6020 Innsbruck, Austria;
- Division of Human Genetics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julia Vodopiutz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
- Vienna Bone and Growth Center, 1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40400-31880
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43
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Mirza-Schreiber N, Zech M, Wilson R, Brunet T, Wagner M, Jech R, Boesch S, Škorvánek M, Necpál J, Weise D, Weber S, Mollenhauer B, Trenkwalder C, Maier EM, Borggraefe I, Vill K, Hackenberg A, Pilshofer V, Kotzaeridou U, Schwaibold EMC, Hoefele J, Waldenberger M, Gieger C, Peters A, Meitinger T, Schormair B, Winkelmann J, Oexle K. Blood DNA methylation provides an accurate biomarker of KMT2B-related dystonia and predicts onset. Brain 2021; 145:644-654. [PMID: 34590685 DOI: 10.1093/brain/awab360] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/13/2022] Open
Abstract
Dystonia is a prevalent, heterogeneous movement disorder characterized by involuntarily abnormal postures. Biomarkers of dystonia are notoriously lacking. Here, a biomarker is reported for histone lysine methyltransferase (KMT2B)-deficient dystonia, a leading subtype among the individually rare monogenic dystonias. It was derived by applying a support vector machine to an episignature of 113 DNA CpG sites which, in blood cells, showed significant epigenome-wide association with KMT2B deficiency and at least 1x log-fold change of methylation. This classifier was accurate both when tested on the general population and on samples with various other deficiencies of the epigenetic machinery, thus allowing for definitive evaluation of variants of uncertain significance and identifying patients who may profit from deep brain stimulation, a highly successful treatment in KMT2B-deficient dystonia. Methylation was increased in KMT2B deficiency at all 113 CpG sites. The coefficients of variation of the normalized methylation levels at these sites also perfectly classified the samples with KMT2B-deficient dystonia. Moreover, the mean of the normalized methylation levels correlated well with the age at onset of dystonia (p = 0.003) - being lower in samples with late or incomplete penetrance-thus serving as a predictor of disease onset and severity. Similarly, it may also function in monitoring the recently envisioned treatment of KMT2B deficiency by inhibition of DNA methylation.
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Affiliation(s)
- Nazanin Mirza-Schreiber
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Neurogenetic Systems Analysis Group, Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Michael Zech
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Rory Wilson
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Theresa Brunet
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Matias Wagner
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Sylvia Boesch
- Department of Neurology, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Matej Škorvánek
- Department of Neurology, P. J. Safarik University, 04011 Kosice, Slovakia.,Department of Neurology, University Hospital L. Pasteur, 04011 Kosice, Slovakia
| | - Ján Necpál
- Department of Neurology, Zvolen Hospital, 96001 Zvolen, Slovakia
| | - David Weise
- Department of Neurology, Asklepios Fachklinikum Stadtroda, 07646 Stadtroda, Germany.,Department of Neurology, University of Leipzig, 04103 Leipzig, Germany
| | - Sandrina Weber
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,University Medical Center Goettingen, Department of Neurology and Paracelsus-Elena-Klinik, 34128 Kassel, Germany
| | - Brit Mollenhauer
- University Medical Center Goettingen, Department of Neurology and Paracelsus-Elena-Klinik, 34128 Kassel, Germany
| | - Claudia Trenkwalder
- University Medical Center Goettingen, Department of Neurology and Paracelsus-Elena-Klinik, 34128 Kassel, Germany
| | - Esther M Maier
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Ingo Borggraefe
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Katharina Vill
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, 8032 Zürich, Switzerland
| | | | - Urania Kotzaeridou
- Department of Child Neurology and Metabolic Medicine, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Julia Hoefele
- Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
| | - Barbara Schormair
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, 80337 Munich, Germany
| | - Juliane Winkelmann
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany.,Chair of Neurogenetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Konrad Oexle
- Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Neurogenetic Systems Analysis Group, Institute of Neurogenomics (ING), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, School of Medicine, 81675 Munich, Germany
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44
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Damásio J, Santos M, Samões R, Araújo M, Macedo M, Sardoeira A, Cavaco S, Freitas J, Barros J, Oliveira J, Sequeiros J. Novel KMT2B mutation causes cerebellar ataxia: Expanding the clinical phenotype. Clin Genet 2021; 100:743-747. [PMID: 34477219 DOI: 10.1111/cge.14055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/25/2023]
Abstract
Hereditary cerebellar ataxias comprise a heterogeneous group of neurodegenerative disorders affecting the cerebellum and/or cerebellar pathways. Next-generation sequencing techniques have contributed substantially to the expansion of ataxia-causing genes, including genes classically described in alternative phenotypes. Herein, we describe a patient with adult-onset cerebellar ataxia, minor dystonia, neuropathy, seizure and ophthalmological pathology, who bears a novel variant in KMT2B (NM_014727.2:c.3334 + 1G > A). Bioinformatic analysis suggested this variant completely abolished the splice-site at exon 8/intron 8, which was confirmed through analysis of mRNA extracted from fibroblasts. Exon 8 skipping would ultimately translate as an in-frame deletion at the protein level, corresponding to the loss of 91 aminoacids [p.(Gly1020_Asn1111del)]. So far, KMT2B disease causing variants have been described in patients with dystonia or neurodevelopmental delay, with no reports of a cerebellar predominant phenotype. Our findings highlight the possible role of KMT2B as a gene involved in hereditary cerebellar ataxias.
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Affiliation(s)
- Joana Damásio
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,UnIGENe, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Mariana Santos
- UnIGENe, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria Araújo
- Ophtalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mafalda Macedo
- Ophtalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Sardoeira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sara Cavaco
- Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joel Freitas
- Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Barros
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
| | - Jorge Oliveira
- UnIGENe, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Jorge Sequeiros
- UnIGENe, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal.,ICBAS School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal
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45
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Doummar D, Treven M, Qebibo L, Devos D, Ghoumid J, Ravelli C, Kranz G, Krenn M, Demailly D, Cif L, Davion JB, Zimprich F, Burglen L, Zech M. Childhood-onset progressive dystonia associated with pathogenic truncating variants in CHD8. Ann Clin Transl Neurol 2021; 8:1986-1990. [PMID: 34415117 PMCID: PMC8528468 DOI: 10.1002/acn3.51444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022] Open
Abstract
Originally described as a risk factor for autism, CHD8 loss‐of‐function variants have recently been associated with a wider spectrum of neurodevelopmental abnormalities. We further expand the CHD8‐related phenotype with the description of two unrelated patients who presented with childhood‐onset progressive dystonia. Whole‐exome sequencing conducted in two independent laboratories revealed a CHD8 nonsense variant in one patient and a frameshift variant in the second. The patients had strongly overlapping phenotypes characterized by generalized dystonia with mild‐to‐moderate neurodevelopmental comorbidity. Deep brain stimulation led to clinical improvement in both cases. We suggest that CHD8 should be added to the growing list of neurodevelopmental disorder‐associated genes whose mutations can also result in dystonia‐dominant phenotypes.
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Affiliation(s)
- Diane Doummar
- Pediatric Neurology Department, Movement Disorders Center, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, 3400, Austria
| | - Leila Qebibo
- Cerebellar Malformations and Congenital diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | - David Devos
- Université de Lille, INSERM, U1172, CHU-Lille, Lille, France.,Neuroscience Cognition Research Centre, Lille, France.,Neurology and Movement Disorders Department, CHU Lille, Licend, Lille, 59000, France
| | - Jamal Ghoumid
- CHU Lille, University of Lille, ULR7364 RADEME, Lille, France
| | - Claudia Ravelli
- Pediatric Neurology Department, Movement Disorders Center, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France
| | | | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,School of Medicine, Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Diane Demailly
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | - Laura Cif
- Département de Neurochirurgie, Unité des Pathologies Cérébrales Résistantes, Unité de Recherche sur les Comportements et Mouvements Anormaux, Hôpital Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France.,Faculté de médecine, Université de Montpellier, France
| | | | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lydie Burglen
- Cerebellar Malformations and Congenital diseases Reference Center and Neurogenetics Lab, Department of Genetics, Armand Trousseau Hospital, AP-HP.Sorbonne Université, Paris, France.,Developmental Brain Disorders Laboratory, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Michael Zech
- School of Medicine, Institute of Human Genetics, Technical University of Munich, Munich, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
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46
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Ciolfi A, Foroutan A, Capuano A, Pedace L, Travaglini L, Pizzi S, Andreani M, Miele E, Invernizzi F, Reale C, Panteghini C, Iascone M, Niceta M, Gavrilova RH, Schultz-Rogers L, Agolini E, Bedeschi MF, Prontera P, Garibaldi M, Galosi S, Leuzzi V, Soliveri P, Olson RJ, Zorzi GS, Garavaglia BM, Tartaglia M, Sadikovic B. Childhood-onset dystonia-causing KMT2B variants result in a distinctive genomic hypermethylation profile. Clin Epigenetics 2021; 13:157. [PMID: 34380541 PMCID: PMC8359374 DOI: 10.1186/s13148-021-01145-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Dystonia is a clinically and genetically heterogeneous movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements and/or postures. Heterozygous variants in lysine methyltransferase 2B (KMT2B), encoding a histone H3 methyltransferase, have been associated with a childhood-onset, progressive and complex form of dystonia (dystonia 28, DYT28). Since 2016, more than one hundred rare KMT2B variants have been reported, including frameshift, nonsense, splice site, missense and other in-frame changes, many having an uncertain clinical impact. Results We characterize the genome-wide peripheral blood DNA methylation profiles of a cohort of 18 patients with pathogenic and unclassified KMT2B variants. We resolve the “episignature” associated with KMT2B haploinsufficiency, proving that this approach is robust in diagnosing clinically unsolved cases, properly classifying them with respect to other partially overlapping dystonic phenotypes, other rare neurodevelopmental disorders and healthy controls. Notably, defective KMT2B function in DYT28 causes a non-random DNA hypermethylation across the genome, selectively involving promoters and other regulatory regions positively controlling gene expression. Conclusions We demonstrate a distinctive DNA hypermethylation pattern associated with DYT28, provide an epigenetic signature for this disorder enabling accurate diagnosis and reclassification of ambiguous genetic findings and suggest potential therapeutic approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01145-y.
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Affiliation(s)
- Andrea Ciolfi
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146, Rome, Italy
| | - Aidin Foroutan
- Department of Pathology and Laboratory Medicine, Western University, London, ON, N6A 3K7, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Canada
| | - Alessandro Capuano
- Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Lucia Pedace
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Lorena Travaglini
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146, Rome, Italy
| | - Simone Pizzi
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146, Rome, Italy
| | - Marco Andreani
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Federica Invernizzi
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Chiara Reale
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Celeste Panteghini
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Maria Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146, Rome, Italy
| | | | | | - Emanuele Agolini
- Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paolo Prontera
- Maternal-Infantile Department, University Hospital of Perugia, Perugia, Italy
| | - Matteo Garibaldi
- Department of Neuroscience, NESMOS, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, Child Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Child Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Paola Soliveri
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Rory J Olson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Giovanna S Zorzi
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Barbara M Garavaglia
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146, Rome, Italy.
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, ON, N6A 3K7, Canada. .,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Canada. .,Molecular Diagnostics Division, London Health Sciences Centre, London, Canada.
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47
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Larsh T, Wu SW, Vadivelu S, Grant GA, O'Malley JA. Deep Brain Stimulation for Pediatric Dystonia. Semin Pediatr Neurol 2021; 38:100896. [PMID: 34183138 DOI: 10.1016/j.spen.2021.100896] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Dystonia is one of the most common pediatric movement disorders and can have a profound impact on the lives of children and their caregivers. Response to pharmacologic treatment is often unsatisfactory. Deep brain stimulation (DBS) has emerged as a promising treatment option for children with medically refractory dystonia. In this review we highlight the relevant literature related to DBS for pediatric dystonia, with emphasis on the background, indications, prognostic factors, challenges, and future directions of pediatric DBS.
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Affiliation(s)
- Travis Larsh
- Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Sudhakar Vadivelu
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gerald A Grant
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Stanford University School of Medicine, Palo Alto, CA
| | - Jennifer A O'Malley
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA.
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48
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Rajan R, Garg K, Saini A, Kumar M, Binukumar BK, Scaria V, Aggarwal R, Gupta A, Vishnu VY, Garg A, Singh MB, Bhatia R, Srivastava AK, Padma Srivastava M, Singh M. Pallidal Deep Brain Stimulation for KMT2B Related Dystonia in An Indian Patient. Ann Indian Acad Neurol 2021; 24:586-588. [PMID: 34728955 PMCID: PMC8513985 DOI: 10.4103/aian.aian_1316_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/11/2021] [Accepted: 01/27/2021] [Indexed: 12/01/2022] Open
Abstract
Outcomes of pallidal stimulation in KMT2B dystonia have been infrequently reported prospectively. We report the six-month outcomes of bilateral GPi DBS in an Asian Indian patient with early-onset generalized dystonia associated with a novel heterozygous variant in the KMT2B gene.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Saini
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Kumar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - BK Binukumar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Vinod Scaria
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Rajeev Aggarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - VY Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K. Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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49
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Mulroy E, Vijiaratnam N, De Roquemaurel A, Bhatia KP, Zrinzo L, Foltynie T, Limousin P. A practical guide to troubleshooting pallidal deep brain stimulation issues in patients with dystonia. Parkinsonism Relat Disord 2021; 87:142-154. [PMID: 34074583 DOI: 10.1016/j.parkreldis.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
High frequency deep brain stimulation (DBS) of the internal portion of the globus pallidus has, in the last two decades, become a mainstream therapy for the management of medically-refractory dystonia syndromes. Such increasing uptake places an onus on movement disorder physicians to become familiar with this treatment modality, in particular optimal patient selection for the procedure and how to troubleshoot problems relating to sub-optimal efficacy and therapy-related side effects. Deep brain stimulation for dystonic conditions presents some unique challenges. For example, the frequent lack of immediate change in clinical status following stimulation alterations means that programming often relies on personal experience and local practice rather than real-time indicators of efficacy. Further, dystonia is a highly heterogeneous disorder, making the development of unifying guidelines and programming algorithms for DBS in this population difficult. Consequently, physicians may feel less confident in managing DBS for dystonia as compared to other indications e.g. Parkinson's disease. In this review, we integrate our years of personal experience of the programming of DBS systems for dystonia with a critical appraisal of the literature to produce a practical guide for troubleshooting common issues encountered in patients with dystonia treated with DBS, in the hope of improving the care for these patients.
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Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alexis De Roquemaurel
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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50
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Abel M, Pfister R, Hussein I, Alsalloum F, Onyinzo C, Kappl S, Zech M, Demmel W, Staudt M, Kudernatsch M, Berweck S. Deep Brain Stimulation in KMT2B-Related Dystonia: Case Report and Review of the Literature With Special Emphasis on Dysarthria and Speech. Front Neurol 2021; 12:662910. [PMID: 34054706 PMCID: PMC8160374 DOI: 10.3389/fneur.2021.662910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: KMT2B-related dystonia is a progressive childhood-onset movement disorder, evolving from lower-limb focal dystonia into generalized dystonia. With increasing age, children frequently show prominent laryngeal or facial dystonia manifesting in dysarthria. Bilateral deep brain stimulation of the globus pallidus internus (GPi-DBS) is reported to be an efficient therapeutic option. Especially improvement of dystonia and regaining of independent mobility is commonly described, but detailed information about the impact of GPi-DBS on dysarthria and speech is scarce. Methods: We report the 16-months outcome after bilateral GPi-DBS in an 8-year-old child with KMT2B-related dystonia caused by a de-novo c.3043C>T (p.Arg1015*) non-sense variant with special emphasis on dysarthria and speech. We compare the outcome of our patient with 59 patients identified through a PubMed literature search. Results: A remarkable improvement of voice, articulation, respiration and prosodic characteristics was seen 16 months after GPi-DBS. The patients' speech intelligibility improved. His speech became much more comprehensible not only for his parents, but also for others. Furthermore, his vocabulary and the possibility to express his feelings and wants expanded considerably. Conclusion: A positive outcome of GPi-DBS on speech and dysarthria is rarely described in the literature. This might be due to disease progression, non-effectiveness of DBS or due to inadvertent spreading of the electrical current to the corticobulbar tract causing stimulation induced dysarthria. This highlights the importance of optimal lead placement, the possibility of horizontal steering of the electrical field by applying directional stimulation with segmented leads as well as the use of the lowest possible effective stimulation intensity.
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Affiliation(s)
- Maria Abel
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Robert Pfister
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Iman Hussein
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Fahd Alsalloum
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Christina Onyinzo
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Simon Kappl
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Michael Zech
- Helmholtz Centre Munich, Institute of Neurogenomics, Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Walter Demmel
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Martin Staudt
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany.,Research Institute Rehabilitation, Transition, Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Steffen Berweck
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany.,Dr. Von Hauner Children's Hospital, Ludwig-Maximilians- University Munich, Munich, Germany
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