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Wagle Shukla A. Basis of movement control in dystonia and why botulinum toxin should influence it? Toxicon 2024; 237:107251. [PMID: 37574115 DOI: 10.1016/j.toxicon.2023.107251] [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: 05/23/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
Dystonia is a network disorder involving multiple brain regions, such as the motor cortex, sensory cortex, basal ganglia, and cerebellum. Botulinum toxin (BoNT) is the first-line therapy for treating focal dystonia and is a potent molecule that blocks the release of acetylcholine at the peripheral neuromuscular junction. However, the clinical benefits of BoNT are not solely related to peripheral muscle relaxation or modulation of afferent input from the muscle spindle. An increasing body of evidence, albeit in smaller cohorts, has shown that BoNT leads to distant modulation of the pathological brain substrates implicated in dystonia. A single treatment session of BoNT has been observed to reduce excessive motor excitability and improve sensory processing. Furthermore, owing to plasticity effects that are induced by botulinum, neural reorganization of pathological networks occurs, presumably leading to defective motor programs of dystonia replaced with normal movement patterns. However, longitudinal studies investigating the effects of multiple treatment sessions in large, well-characterized homogenous cohorts of dystonia will provide further compelling evidence supporting central botulinum mechanisms.
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Affiliation(s)
- Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, 3009 Williston Road, Gainesville, 32608, Florida, United States.
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2
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MacIver CL, Tax CMW, Jones DK, Peall KJ. Structural magnetic resonance imaging in dystonia: A systematic review of methodological approaches and findings. Eur J Neurol 2022; 29:3418-3448. [PMID: 35785410 PMCID: PMC9796340 DOI: 10.1111/ene.15483] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Structural magnetic resonance techniques have been widely applied in neurological disorders to better understand tissue changes, probing characteristics such as volume, iron deposition and diffusion. Dystonia is a hyperkinetic movement disorder, resulting in abnormal postures and pain. Its pathophysiology is poorly understood, with normal routine clinical imaging in idiopathic forms. More advanced tools provide an opportunity to identify smaller scale structural changes which may underpin pathophysiology. This review aims to provide an overview of methodological approaches undertaken in structural brain imaging of dystonia cohorts, and to identify commonly identified pathways, networks or regions that are implicated in pathogenesis. METHODS Structural magnetic resonance imaging studies of idiopathic and genetic forms of dystonia were systematically reviewed. Adhering to strict inclusion and exclusion criteria, PubMed and Embase databases were searched up to January 2022, with studies reviewed for methodological quality and key findings. RESULTS Seventy-seven studies were included, involving 1945 participants. The majority of studies employed diffusion tensor imaging (DTI) (n = 45) or volumetric analyses (n = 37), with frequently implicated areas of abnormality in the brainstem, cerebellum, basal ganglia and sensorimotor cortex and their interconnecting white matter pathways. Genotypic and motor phenotypic variation emerged, for example fewer cerebello-thalamic tractography streamlines in genetic forms than idiopathic and higher grey matter volumes in task-specific than non-task-specific dystonias. DISCUSSION Work to date suggests microstructural brain changes in those diagnosed with dystonia, although the underlying nature of these changes remains undetermined. Employment of techniques such as multiple diffusion weightings or multi-exponential relaxometry has the potential to enhance understanding of these differences.
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Affiliation(s)
- Claire L. MacIver
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK,Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Chantal M. W. Tax
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK,Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Derek K. Jones
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK
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3
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O'Flynn LC, Simonyan K. Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia. Neurology 2022; 99:e1178-e1190. [PMID: 35764404 PMCID: PMC9536744 DOI: 10.1212/wnl.0000000000200850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laryngeal dystonia (LD) is isolated task-specific focal dystonia selectively impairing speech production. The first choice of LD treatment is botulinum neurotoxin (BoNT) injections into the affected laryngeal muscles. However, whether BoNT has a lasting therapeutic effect on disorder pathophysiology is unknown. We investigated short-term and long-term effects of BoNT treatment on brain function in patients with LD. METHODS A total of 161 participants were included in the functional MRI study. Statistical analyses examined central BoNT effects in patients with LD who were stratified based on the effectiveness and duration of treatment. RESULTS Patients with LD who were treated and benefited from BoNT injections had reduced activity in the left precuneus compared with BoNT-naive and treatment nonbenefiting patients. In addition, BoNT-treated patients with adductor LD had decreased activity in the right thalamus, whereas BoNT-treated abductor patients with LD had reduced activity in the left inferior frontal cortex. No statistically significant differences in brain activity were found between patients with shorter (1-5 years) and longer (13-28 years) treatment durations. However, patients with intermediate treatment duration of 6-12 years showed reduced activity in the right cerebellum compared with patients with both shorter and longer treatment durations and reduced activity in the right prefrontal cortex compared with patients with shorter treatment duration. DISCUSSION Our findings suggest that the left precuneus is the site of short-term BoNT central action in patients with LD, whereas the prefrontal-cerebellar axis is engaged in the BoNT response in patients with intermediate treatment duration of 6-12 years. Involvement of these structures points to indirect action of BoNT treatment on the dystonic sensorimotor network through modulation of motor sequence planning and coordination.
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Affiliation(s)
- Lena C O'Flynn
- From the Department of Otolaryngology-Head and Neck Surgery (L.C.O., K.S.), Massachusetts Eye and Ear and Harvard Medical School; Program in Speech Hearing Bioscience and Technology (L.C.O., K.S.), Harvard University; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston
| | - Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (L.C.O., K.S.), Massachusetts Eye and Ear and Harvard Medical School; Program in Speech Hearing Bioscience and Technology (L.C.O., K.S.), Harvard University; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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4
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Yellajoshyula D, Rogers AE, Kim AJ, Kim S, Pappas SS, Dauer WT. A pathogenic DYT-THAP1 dystonia mutation causes hypomyelination and loss of YY1 binding. Hum Mol Genet 2022; 31:1096-1104. [PMID: 34686877 PMCID: PMC8976427 DOI: 10.1093/hmg/ddab310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Dystonia is a disabling disease that manifests as prolonged involuntary twisting movements. DYT-THAP1 is an inherited form of isolated dystonia caused by mutations in THAP1 encoding the transcription factor THAP1. The phe81leu (F81L) missense mutation is representative of a category of poorly understood mutations that do not occur on residues critical for DNA binding. Here, we demonstrate that the F81L mutation (THAP1F81L) impairs THAP1 transcriptional activity and disrupts CNS myelination. Strikingly, THAP1F81L exhibits normal DNA binding but causes a significantly reduced DNA binding of YY1, its transcriptional partner that also has an established role in oligodendrocyte lineage progression. Our results suggest a model of molecular pathogenesis whereby THAP1F81L normally binds DNA but is unable to efficiently organize an active transcription complex.
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Affiliation(s)
| | - Abigail E Rogers
- Molecular Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Audrey J Kim
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sumin Kim
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Cellular and Molecular Biology Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Samuel S Pappas
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - William T Dauer
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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5
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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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6
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Pontillo G, Castagna A, Vola EA, Macerollo A, Peluso S, Russo C, Baglio F, Manganelli F, Brunetti A, Cocozza S, Esposito M. The cerebellum in idiopathic cervical dystonia: A specific pattern of structural abnormalities? Parkinsonism Relat Disord 2020; 80:152-157. [DOI: 10.1016/j.parkreldis.2020.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/17/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022]
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7
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Boonstra FMC, Evans A, Noffs G, Perera T, Jokubaitis V, Stankovich J, Vogel AP, Moffat BA, Butzkueven H, Kolbe SC, van der Walt A. OnabotulinumtoxinA treatment for MS-tremor modifies fMRI tremor response in central sensory-motor integration areas. Mult Scler Relat Disord 2020; 40:101984. [PMID: 32062446 DOI: 10.1016/j.msard.2020.101984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/21/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment of tremor in MS is an unmet need. OnabotulinumtoxinA (BoNT-A) has shown promising results; however, little is known regarding its effects on the brain. The clinical presentation of tremor MS is shown to depend on subcortical neural damage and cortical neural plasticity. This study aimed to identify effects of onabotulinumtoxinA (BoNT-A) on brain activation in MS and upper-limb tremor using functional MRI. METHODS Forty-three MS participants with tremor were randomized to receive intramuscular injections of placebo (n = 22) or BoNT-A (n = 21). Tremor was quantified using the Bain score (0-10) for severity, handwriting and Archimedes drawing at baseline, 6 weeks and 12 weeks. Functional MRI activation within two previously identified clusters, ipsilateral inferior parietal cortex (IPL) and premotor/supplementary motor cortex (SMC) of compensatory activity, was measured at baseline and 6 weeks. RESULTS Treatment with BoNT-A resulted in improved handwriting tremor at 6 weeks (p = 0.049) and 12 weeks (p = 0.014), and tremor severity -0.79 (p = 0.007) at 12 weeks. Furthermore, the patients that received BoNT-A showed a reduction in activation within the IPL (p = 0.034), but not in the SMC. The change in IPL activation correlated with the reduction in tremor severity from baseline to 12 weeks (β = 0.608; p = 0.015) in the BoNT-A group. No tremor and fMRI changes were seen in the placebo treated group. CONCLUSION We have shown that reduction in MS-tremor severity after intramuscular injection with BoNT-A is associated with changes in brain activity in sensorimotor integration regions.
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Affiliation(s)
- Frederique M C Boonstra
- Department of Medicine and Radiology, University of Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia.
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Australia; The Bionics Institute, Australia
| | - Gustavo Noffs
- Department of Neurology, Royal Melbourne Hospital, Australia; Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
| | - Thushara Perera
- The Bionics Institute, Australia; Department of Medical Bionics, University of Melbourne, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia; The Bionics Institute, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; Redenlab, Victoria, Australia
| | - Bradford A Moffat
- Department of Medicine and Radiology, University of Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Scott C Kolbe
- Department of Medicine and Radiology, University of Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Florey Institute of Neuroscience and Mental Health, Australia
| | - Anneke van der Walt
- Department of Neurology, Royal Melbourne Hospital, Australia; The Bionics Institute, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia
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8
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Blood AJ, Kuster JK, Waugh JL, Levenstein JM, Multhaupt-Buell TJ, Sudarsky LR, Breiter HC, Sharma N. White Matter Changes in Cervical Dystonia Relate to Clinical Effectiveness of Botulinum Toxin Treatment. Front Neurol 2019; 10:265. [PMID: 31019484 PMCID: PMC6459077 DOI: 10.3389/fneur.2019.00265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 12/27/2022] Open
Abstract
In a previous report showing white matter microstructural hemispheric asymmetries medial to the pallidum in focal dystonias, we showed preliminary evidence that this abnormality was reduced 4 weeks after botulinum toxin (BTX) injections. In the current study we report the completed treatment study in a full-size cohort of CD patients (n = 14). In addition to showing a shift toward normalization of the hemispheric asymmetry, we evaluated clinical relevance of these findings by relating white matter changes to degree of symptom improvement. We also evaluated whether the magnitude of the white matter asymmetry before treatment was related to severity, laterality, duration of dystonia, and/or number of previous BTX injections. Our results confirm the findings of our preliminary report: we observed significant fractional anisotropy (FA) changes medial to the pallidum 4 weeks after BTX in CD participants that were not observed in controls scanned at the same interval. There was a significant relationship between magnitude of hemispheric asymmetry and dystonia symptom improvement, as measured by percent reduction in dystonia scale scores. There was also a trend toward a relationship between magnitude of pre-injection white matter asymmetry and symptom severity, but not symptom laterality, disorder duration, or number of previous BTX injections. Post-hoc analyses suggested the FA changes at least partially reflected changes in pathophysiology, but a dissociation between patient perception of benefit from injections and FA changes suggested the changes did not reflect changes to the primary "driver" of the dystonia. In contrast, there were no changes or group differences in DTI diffusivity measures, suggesting the hemispheric asymmetry in CD does not reflect irreversible white matter tissue loss. These findings support the hypothesis that central nervous system white matter changes are involved in the mechanism by which BTX exerts clinical benefit.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, United States.,Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - John K Kuster
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, United States.,Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Jeff L Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Division of Child Neurology, Boston Children's Hospital, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jacob M Levenstein
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | | | - Lewis R Sudarsky
- Department of Neurology, Harvard Medical School, Boston, MA, United States.,Department Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Hans C Breiter
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, United States.,Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States.,Department Neurology, Brigham and Women's Hospital, Boston, MA, United States
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9
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Central Effects of Botulinum Neurotoxin-Evidence from Human Studies. Toxins (Basel) 2019; 11:toxins11010021. [PMID: 30621330 PMCID: PMC6356587 DOI: 10.3390/toxins11010021] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/25/2018] [Accepted: 12/31/2018] [Indexed: 11/24/2022] Open
Abstract
For more than three decades, Botulinum neurotoxin (BoNT) has been used to treat a variety of clinical conditions such as spastic or dystonic disorders by inducing a temporary paralysis of the injected muscle as the desired clinical effect. BoNT is known to primarily act at the neuromuscular junction resulting in a biochemical denervation of the treated muscle. However, recent evidence suggests that BoNT’s pharmacological properties may not only be limited to local muscular denervation at the injection site but may also include additional central effects. In this review, we report and discuss the current evidence for BoNT’s central effects based on clinical observations, neurophysiological investigations and neuroimaging studies in humans. Collectively, these data strongly point to indirect mechanisms via changes to sensory afferents that may be primarily responsible for the marked plastic effects of BoNT on the central nervous system. Importantly, BoNT-related central effects and consecutive modulation and/or reorganization of the brain may not solely be considered “side-effects” but rather an additional therapeutic impact responsible for a number of clinical observations that cannot be explained by merely peripheral actions.
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10
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Waugh JL, Kuster JK, Makhlouf ML, Levenstein JM, Multhaupt-Buell TJ, Warfield SK, Sharma N, Blood AJ. A registration method for improving quantitative assessment in probabilistic diffusion tractography. Neuroimage 2019; 189:288-306. [PMID: 30611874 DOI: 10.1016/j.neuroimage.2018.12.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/07/2023] Open
Abstract
Diffusion MRI-based probabilistic tractography is a powerful tool for non-invasively investigating normal brain architecture and alterations in structural connectivity associated with disease states. Both voxelwise and region-of-interest methods of analysis are capable of integrating population differences in tract amplitude (streamline count or density), given proper alignment of the tracts of interest. However, quantification of tract differences (between groups, or longitudinally within individuals) has been hampered by two related features of white matter. First, it is unknown to what extent healthy individuals differ in the precise location of white matter tracts, and to what extent experimental factors influence perceived tract location. Second, white matter lacks the gross neuroanatomical features (e.g., gyri, histological subtyping) that make parcellation of grey matter plausible - determining where tracts "should" lie within larger white matter structures is difficult. Accurately quantifying tractographic connectivity between individuals is thus inherently linked to the difficulty of identifying and aligning precise tract location. Tractography is often utilized to study neurological diseases in which the precise structural and connectivity abnormalities are unknown, underscoring the importance of accounting for individual differences in tract location when evaluating the strength of structural connectivity. We set out to quantify spatial variance in tracts aligned through a standard, whole-brain registration method, and to assess the impact of location mismatch on groupwise assessments of tract amplitude. We then developed a method for tract alignment that enhances the existing standard whole brain registration, and then tested whether this method improved the reliability of groupwise contrasts. Specifically, we conducted seed-based probabilistic diffusion tractography from primary motor, supplementary motor, and visual cortices, projecting through the corpus callosum. Streamline counts decreased rapidly with movement from the tract center (-35% per millimeter); tract misalignment of a few millimeters caused substantial compromise of amplitude comparisons. Alignment of tracts "peak-to-peak" is essential for accurate amplitude comparisons. However, for all transcallosal tracts registered through the whole-brain method, the mean separation distance between an individual subject's tract and the average tract (3.2 mm) precluded accurate comparison: at this separation, tract amplitudes were reduced by 74% from peak value. In contrast, alignment of subcortical tracts (thalamo-putaminal, pallido-rubral) was substantially better than alignment for cortical tracts; whole-brain registration was sufficient for these subcortical tracts. We demonstrated that location mismatches in cortical tractography were sufficient to produce false positive and false negative amplitude estimates in both groupwise and longitudinal comparisons. We then showed that our new tract alignment method substantially reduced location mismatch and improved both reliability and statistical power of subsequent quantitative comparisons.
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Affiliation(s)
- J L Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States; Dept. of Neurology, Massachusetts General Hospital, Boston, MA, United States; Division of Child Neurology, Boston Children's Hospital, United States; Harvard Medical School, Boston, MA, United States; Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States.
| | - J K Kuster
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States; Dept. Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States.
| | - M L Makhlouf
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States; Dept. Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard-MIT HST Program, United States; Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States.
| | - J M Levenstein
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States; Dept. Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States.
| | - T J Multhaupt-Buell
- Dept. of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| | - S K Warfield
- Department of Radiology, Boston Children's Hospital, United States; Harvard Medical School, Boston, MA, United States.
| | - N Sharma
- Dept. of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - A J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States; Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States; Dept. Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States.
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11
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Abstract
Dystonias are characterized by involuntary muscle contractions, twisting movements, abnormal postures, and often tremor in various body regions. However, in the last decade several studies have demonstrated that dystonias are also characterized by sensory abnormalities. While botulinum toxin is the gold standard therapy for focal dystonia, exactly how it improves this disorder is not entirely understood. Neurophysiological studies in animals and humans have clearly demonstrated that botulinum toxin improves dystonic motor manifestations by inducing chemodenervation, therefore weakening the injected muscles. In addition, neurophysiological and neuroimaging evidence also suggests that botulinum toxin modulates the activity of various neural structures in the CNS distant from the injected site, particularly cortical motor and sensory areas. Concordantly, recent studies have shown that in patients with focal dystonias botulinum toxin ameliorates sensory disturbances, including reduced spatial discrimination acuity and pain. Overall, these observations suggest that in these patients botulinum toxin-induced effects encompass complex mechanisms beyond chemodenervation of the injected muscles.
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Affiliation(s)
- Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
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12
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13
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Abstract
Dystonia can be seen in a number of different phenotypes that may arise from different etiologies. The pathophysiological substrate of dystonia is related to three lines of research. The first postulate a loss of inhibition which may account for the excess of movement and for the overflow phenomena. A second abnormality is sensory dysfunction which is related to the mild sensory complaints in patients with focal dystonias and may be responsible for some of the motor dysfunction. Finally, there are strong pieces of evidence from animal and human studies suggesting that alterations of synaptic plasticity characterized by a disruption of homeostatic plasticity, with a prevailing facilitation of synaptic potentiation may play a pivotal role in primary dystonia. These working hypotheses have been generalized in all form of dystonia. On the other hand, several pieces of evidence now suggest that the pathophysiology may be slightly different in the different types of dystonia. Therefore, in the present review, we would like to discuss the neural mechanisms underlying the different forms of dystonia to disentangle the different weight and role of environmental and predisposing factors.
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Affiliation(s)
- Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Diane Ruge
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
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Dynamic causal modeling revealed dysfunctional effective connectivity in both, the cortico-basal-ganglia and the cerebello-cortical motor network in writers' cramp. NEUROIMAGE-CLINICAL 2018; 18:149-159. [PMID: 29868443 PMCID: PMC5984595 DOI: 10.1016/j.nicl.2018.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 12/25/2022]
Abstract
Writer's cramp (WC) is a focal task-specific dystonia characterized by sustained or intermittent muscle contractions while writing, particularly with the dominant hand. Since structural lesions rarely cause WC, it has been assumed that the disease might be caused by a functional maladaptation within the sensory-motor system. Therefore, our objective was to examine the differences between patients suffering from WC and a healthy control (HC) group with regard to the effective connectivity that describes causal influences one brain region exerts over another within the motor network. The effective connectivity within a network including contralateral motor cortex (M1), supplementary motor area (SMA), globus pallidus (GP), putamen (PU) and ipsilateral cerebellum (CB) was investigated using dynamic causal modeling (DCM) for fMRI. Eight connectivity models of functional motor systems were compared. Fifteen WC patients and 18 age-matched HC performed a sequential, five-element finger-tapping task with the non-dominant and non-affected left hand within a 3 T MRI-scanner as quickly and accurately as possible. The task was conducted in a fixed block design repeated 15 times and included 30 s of tapping followed by 30 s of rest. DCM identified the same model in WC and HC as superior for reflecting basal ganglia and cerebellar motor circuits of healthy subjects. The M1-PU, as well as M1-CB connectivity, was more strongly influenced by tapping in WC, but the intracortical M1-SMA connection was more facilitating in controls. Inhibiting influences originating from GP to M1 were stronger in controls compared to WC patients whereby facilitating influences the PU exerts over CB and CB exerts over M1 were not as strong. Although the same model structure explains the given data best, DCM confirms previous research demonstrating a malfunction in effective connectivity intracortically (M1-SMA) and in the cortico-basal ganglia circuitry in WC. In addition, DCM analysis demonstrates abnormal reciprocal excitatory connectivity in the cortico-cerebellar circuitry. These results highlight the dysfunctional cerebello-cortical as well as basalganglio-cortical interaction in WC. Effective connectivity in writer`s cramp differs under sequential finger movements. We found a deficient inhibitory pallido-cortical connectivity in writer`s cramp. We found a diverging effective connectivity in the cortico-cerebellar loop. We found a diverging effective connectivity in the cortico-basal ganglia pathway. Pathophysiological interaction between the cerebellum and the basal ganglia.
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15
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Blood AJ, Waugh JL, Münte TF, Heldmann M, Domingo A, Klein C, Breiter HC, Lee LV, Rosales RL, Brüggemann N. Increased insula-putamen connectivity in X-linked dystonia-parkinsonism. NEUROIMAGE-CLINICAL 2017. [PMID: 29527488 PMCID: PMC5842648 DOI: 10.1016/j.nicl.2017.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Preliminary evidence from postmortem studies of X-linked dystonia-parkinsonism (XDP) suggests tissue loss may occur first and/or most severely in the striatal striosome compartment, followed later by cell loss in the matrix compartment. However, little is known about how this relates to pathogenesis and pathophysiology. While MRI cannot visualize these striatal compartments directly in humans, differences in relative gradients of afferent cortical connectivity across compartments (weighted toward paralimbic versus sensorimotor cortex, respectively) can be used to infer potential selective loss in vivo. In the current study we evaluated relative connectivity of paralimbic versus sensorimotor cortex with the caudate and putamen in 17 individuals with XDP and 17 matched controls. Although caudate and putamen volumes were reduced in XDP, there were no significant reductions in either “matrix-weighted”, or “striosome-weighted” connectivity. In fact, paralimbic connectivity with the putamen was elevated, rather than reduced, in XDP. This was driven most strongly by elevated putamen connectivity with the anterior insula. There was no relationship of these findings to disease duration or striatal volume, suggesting insula and/or paralimbic connectivity in XDP may develop abnormally and/or increase in the years before symptom onset. Previous work suggested striosomes might degenerate preferentially in early XDP. We developed a DTI tractography method to assess striosome and matrix integrity. Striosomal afferents to putamen were elevated in XDP, despite reduced putamen volume. Connectivity was particularly elevated from the insula (two to three-fold). Striosome connectivity strength was not associated with disease duration.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, USA; Laboratory of Neuroimaging and Genetics, MGH, Charlestown, MA, USA; Depts. of Neurology, MGH, Boston, MA, USA; Psychiatry, MGH, Boston, MA, USA; Martinos Center for Biomedical Imaging, Dept. of Radiology, MGH, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Jeff L Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, USA; Depts. of Neurology, MGH, Boston, MA, USA; Martinos Center for Biomedical Imaging, Dept. of Radiology, MGH, Charlestown, MA, USA; Division of Child Neurology, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Aloysius Domingo
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Hans C Breiter
- Mood and Motor Control Laboratory, Massachusetts General Hospital (MGH), Charlestown, MA, USA; Laboratory of Neuroimaging and Genetics, MGH, Charlestown, MA, USA; Psychiatry, MGH, Boston, MA, USA; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lillian V Lee
- XDP Study Group, Philippine Children's Medical Center, Quezon City, Philippines
| | - Raymond L Rosales
- XDP Study Group, Philippine Children's Medical Center, Quezon City, Philippines; Department of Neurology and Psychiatry, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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Jinnah HA, Neychev V, Hess EJ. The Anatomical Basis for Dystonia: The Motor Network Model. Tremor Other Hyperkinet Mov (N Y) 2017; 7:506. [PMID: 29123945 PMCID: PMC5673689 DOI: 10.7916/d8v69x3s] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/25/2017] [Indexed: 01/27/2023] Open
Abstract
Background The dystonias include a clinically and etiologically very diverse group of disorders. There are both degenerative and non-degenerative subtypes resulting from genetic or acquired causes. Traditionally, all dystonias have been viewed as disorders of the basal ganglia. However, there has been increasing appreciation for involvement of other brain regions including the cerebellum, thalamus, midbrain, and cortex. Much of the early evidence for these other brain regions has come from studies of animals, but multiple recent studies have been done with humans, in an effort to confirm or refute involvement of these other regions. The purpose of this article is to review the new evidence from animals and humans regarding the motor network model, and to address the issues important to translational neuroscience. Methods The English literature was reviewed for articles relating to the neuroanatomical basis for various types of dystonia in both animals and humans. Results There is evidence from both animals and humans that multiple brain regions play an important role in various types of dystonia. The most direct evidence for specific brain regions comes from animal studies using pharmacological, lesion, or genetic methods. In these studies, experimental manipulations of specific brain regions provide direct evidence for involvement of the basal ganglia, cerebellum, thalamus and other regions. Additional evidence also comes from human studies using neuropathological, neuroimaging, non-invasive brain stimulation, and surgical interventions. In these studies, the evidence is less conclusive, because discriminating the regions that cause dystonia from those that reflect secondary responses to abnormal movements is more challenging. Discussion Overall, the evidence from both animals and humans suggests that different regions may play important roles in different subtypes of dystonia. The evidence so far provides strong support for the motor network model. There are obvious challenges, but also advantages, of attempting to translate knowledge gained from animals into a more complete understanding of human dystonia and novel therapeutic strategies.
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Affiliation(s)
- H. A. Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Vladimir Neychev
- Department of Surgery, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Medical University of Sofia, Sofia, Bulgaria
| | - Ellen J. Hess
- Departments of Pharmacology and Neurology, Emory University, Atlanta, GA, USA
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17
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Király A, Szabó N, Párdutz Á, Tóth E, Tajti J, Csete G, Faragó P, Bodnár P, Szok D, Tuka B, Pálinkás É, Ertsey C, Vécsei L, Kincses ZT. Macro- and microstructural alterations of the subcortical structures in episodic cluster headache. Cephalalgia 2017; 38:662-673. [PMID: 28425325 DOI: 10.1177/0333102417703762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Previous functional and structural imaging studies have revealed that subcortical structures play a key a role in pain processing. The recurring painful episodes might trigger maladaptive plasticity or alternatively degenerative processes that might be detected by MRI as changes in size or microstructure. In the current investigation, we aimed to identify the macro- and microstructural alterations of the subcortical structures in episodic cluster headache. Methods High-resolution T1-weighted and diffusion-weighted MRI images with 60 gradient directions were acquired from 22 patients with cluster headache and 94 healthy controls. Surface-based segmentation analysis was used to measure the volume of the subcortical nuclei, and mean diffusion parameters (fractional anisotropy, mean, radial and axial diffusivity) were determined for these structures. In order to understand whether the size and diffusion parameters could be investigated in a headache lateralised manner, first the asymmetry of the size and diffusion parameters of the subcortical structures was analysed. Volumes and diffusion parameters were compared between groups and correlated with the cumulative number of headache days. To account for the different size of the patient and control group, a bootstrap approach was used to investigate the stability of the findings. Results A significant lateralisation of the size (caudate, putamen and thalamus) and the diffusion parameters of the subcortical structures were found in normal controls. In cluster headache patients, the mean fractional anisotropy of the right amygdalae, the mean axial and mean diffusivity of the right caudate nucleus and the radial diffusivity of the right pallidum were higher. The mean anisotropy of the right pallidum was lower in patients. Conclusion The analysis of the pathology in the subcortical structures in episodic cluster headache reveals important features of the disease, which might allow a deeper insight into the pathomechanism of the pain processing in this headache condition.
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Affiliation(s)
- András Király
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,2 International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Árpád Párdutz
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - János Tajti
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gergő Csete
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Bodnár
- 3 Department of Image Processing and Computer Graphics, Faculty of Science and Informatics, Szeged, Hungary
| | - Délia Szok
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bernadett Tuka
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,4 MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Éva Pálinkás
- 5 Bacs-Kiskun County Hospital, Kecskemét, Hungary
| | - Csaba Ertsey
- 6 Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Vécsei
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,4 MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- 1 Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,2 International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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18
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Waugh JL, Kuster JK, Levenstein JM, Makris N, Multhaupt-Buell TJ, Sudarsky LR, Breiter HC, Sharma N, Blood AJ. Thalamic Volume Is Reduced in Cervical and Laryngeal Dystonias. PLoS One 2016; 11:e0155302. [PMID: 27171035 PMCID: PMC4865047 DOI: 10.1371/journal.pone.0155302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dystonia, a debilitating movement disorder characterized by abnormal fixed positions and/or twisting postures, is associated with dysfunction of motor control networks. While gross brain lesions can produce secondary dystonias, advanced neuroimaging techniques have been required to identify network abnormalities in primary dystonias. Prior neuroimaging studies have provided valuable insights into the pathophysiology of dystonia, but few directly assessed the gross volume of motor control regions, and to our knowledge, none identified abnormalities common to multiple types of idiopathic focal dystonia. METHODS We used two gross volumetric segmentation techniques and one voxelwise volumetric technique (voxel based morphometry, VBM) to compare regional volume between matched healthy controls and patients with idiopathic primary focal dystonia (cervical, n = 17, laryngeal, n = 7). We used (1) automated gross volume measures of eight motor control regions using the FreeSurfer analysis package; (2) blinded, anatomist-supervised manual segmentation of the whole thalamus (also gross volume); and (3) voxel based morphometry, which measures local T1-weighted signal intensity and estimates gray matter density or volume at the level of single voxels, for both whole-brain and thalamus. RESULTS Using both automated and manual gross volumetry, we found a significant volume decrease only in the thalamus in two focal dystonias. Decreases in whole-thalamic volume were independent of head and brain size, laterality of symptoms, and duration. VBM measures did not differ between dystonia and control groups in any motor control region. CONCLUSIONS Reduced thalamic gross volume, detected in two independent analyses, suggests a common anatomical abnormality in cervical dystonia and spasmodic dysphonia. Defining the structural underpinnings of dystonia may require such complementary approaches.
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Affiliation(s)
- Jeff L. Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Child Neurology, Boston Children’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
- * E-mail:
| | - John K. Kuster
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Jacob M. Levenstein
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nikos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | | | - Lewis R. Sudarsky
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Hans C. Breiter
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Anne J. Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
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19
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Pavese N, Tai YF. Genetic and degenerative disorders primarily causing other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:507-523. [PMID: 27432681 DOI: 10.1016/b978-0-444-53485-9.00025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter, we will discuss the contributions of structural and functional imaging to the diagnosis and management of genetic and degenerative diseases that lead to the occurrence of movement disorders. We will mainly focus on Huntington's disease, Wilson's disease, dystonia, and neurodegeneration with brain iron accumulation, as they are the more commonly encountered clinical conditions within this group.
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Affiliation(s)
- Nicola Pavese
- Division of Brain Sciences, Imperial College London, UK; Aarhus University, Denmark.
| | - Yen F Tai
- Division of Brain Sciences, Imperial College London, UK
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20
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Pinheiro GLS, Guimarães RP, Piovesana LG, Campos BM, Campos LS, Azevedo PC, Torres FR, Amato-Filho AC, França MC, Lopes-Cendes I, Cendes F, D'Abreu A. White Matter Microstructure in Idiopathic Craniocervical Dystonia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5. [PMID: 26056610 PMCID: PMC4454992 DOI: 10.7916/d86972h6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/28/2015] [Indexed: 12/01/2022]
Abstract
Background Dystonias are hyperkinetic movement disorders characterized by involuntary muscle contractions resulting in abnormal torsional movements and postures. Recent neuroimaging studies in idiopathic craniocervical dystonia (CCD) have uncovered the involvement of multiple areas, including cortical ones. Our goal was to evaluate white matter (WM) microstructure in subjects with CCD using diffusion tensor imaging (DTI) analysis. Methods We compared 40 patients with 40 healthy controls. Patients were then divided into subgroups: cervical dystonia, blepharospasm, blepharospasm + oromandibular dystonia, blepharospasm + oromandibular dystonia + cervical dystonia, using tract-based spatial statistics. We performed a region of interest-based analysis and tractography as confirmatory tests. Results There was no significant difference in the mean fractional anisotropy (FA) and mean diffusivity (MD) between the groups in any analysis. Discussion The lack of DTI changes in CCD suggests that the WM tracts are not primarily affected.
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Affiliation(s)
- Giordanna L S Pinheiro
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rachel P Guimarães
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Luiza G Piovesana
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Brunno M Campos
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lidiane S Campos
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Paula C Azevedo
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fabio R Torres
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Augusto C Amato-Filho
- Department of Radiology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marcondes C França
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil ; Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Iscia Lopes-Cendes
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil ; Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Anelyssa D'Abreu
- Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, Brazil ; Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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22
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Delnooz CCS, Pasman JW, van de Warrenburg BPC. Dynamic cortical gray matter volume changes after botulinum toxin in cervical dystonia. Neurobiol Dis 2014; 73:327-33. [PMID: 25447226 DOI: 10.1016/j.nbd.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/15/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Previous electrophysiological and functional imaging studies in focal dystonia have reported on cerebral reorganization after botulinum toxin (BoNT) injections. With the exception of microstructural changes, alterations in gray matter volume after BoNT have not been explored. In this study, we sought to determine whether BoNT influences gray matter volume in a group of cervical dystonia (CD) patients. We analyzed whole brain gray matter volume in a sample of CD patients with VBM analysis. In patients, scans were repeated immediately before and some weeks after BoNT injections; controls were only scanned once. We analyzed 1) BoNT-related gray matter volume changes within patients; 2) gray matter volume differences between patients and controls; and 3) correlations between gray matter volume and disease duration and disease severity. The pre- and post-BoNT treatment analysis revealed an increase of gray matter volume within the right precentral sulcus, at the lateral border of the premotor cortex. In comparison to healthy controls, CD patients had reduced gray matter volume in area 45 functionally corresponding to the left ventral premotor cortex. No gray matter volume increase was found for CD patients in comparison to controls. Gray matter volume of the left supramarginal gyrus and left premotor cortex correlated positively with disease duration, and that of the right inferior parietal lobule correlated negatively with disease severity. We have identified structural, yet dynamic gray matter volume changes in CD. There were specific gray matter volume changes related to BoNT injections, illustrating indirect central consequences of modified peripheral sensory input. As differences were exclusively seen in higher order motor areas relevant to motor planning and spatial cognition, these observations support the hypothesis that deficits in these cognitive processes are crucial in the pathophysiology of CD.
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Affiliation(s)
- Cathérine C S Delnooz
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - Jaco W Pasman
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - Bart P C van de Warrenburg
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands.
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Yang J, Luo C, Song W, Guo X, Zhao B, Chen X, Huang X, Gong Q, Shang HF. Diffusion tensor imaging in blepharospasm and blepharospasm-oromandibular dystonia. J Neurol 2014; 261:1413-24. [PMID: 24792726 DOI: 10.1007/s00415-014-7359-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/16/2014] [Accepted: 04/18/2014] [Indexed: 02/05/2023]
Abstract
Patterns of white matter (WM) abnormalities and correlation with clinical features in patients with blepharospasm (BSP) and patients with blepharospasm-oromandibular dystonia (BOM) remain unknown. Using voxel-based analysis, diffusion behaviors of WM including fractional anisotropy (FA), mean diffusivity (MD) and eigenvalues were compared between 20 BSP patients vs. 11 healthy controls (HCs) and 11 patients with BOM vs. 11 HCs. Correlation analyses were performed to assess possible association between diffusion behaviors of significantly different areas and clinical measures. Compared with HCs, BSP patients showed significant FA reductions in the left anterior lobe of cerebellum. Significant increases of MD and radial diffusivity (RD) were detected in right lentiform nucleus and thalamus. Significantly decreased FA in the right precuneus of parietal lobe, increased MD in the right lentiform nucleus and insula, and increased axial diffusivity in the right insula were observed in BOM patients. The FA values in the WM of left cerebellum negatively correlated with disease severity in BSP patients measured by JRS (r = -0.655, p = 0.002). The FA values in the right parietal WM negatively correlated with disease duration in BOM patients (r = -0.745, p = 0.008). Both BSP and BOM are related to microstructural abnormalities of WM in the basal ganglia. WM changes outside the basal ganglia may present trait features that are specific for individual dystonia phenotype. The correlation between FA abnormalities and symptom severity suggests that DTI parameters might be of clinical value in assessing and following disability in BSP patients.
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Affiliation(s)
- Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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Lehéricy S, Tijssen MAJ, Vidailhet M, Kaji R, Meunier S. The anatomical basis of dystonia: current view using neuroimaging. Mov Disord 2014; 28:944-57. [PMID: 23893451 DOI: 10.1002/mds.25527] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 04/06/2013] [Accepted: 05/02/2013] [Indexed: 12/15/2022] Open
Abstract
This review will consider the knowledge that neuroimaging studies have provided to the understanding of the anatomy of dystonia. Major advances have occurred in the use of neuroimaging for dystonia in the past 2 decades. At present, the most developed imaging approaches include whole-brain or region-specific studies of structural or diffusion changes, functional imaging using fMRI or positron emission tomography (PET), and metabolic imaging using fluorodeoxyglucose PET. These techniques have provided evidence that regions other than the basal ganglia are involved in dystonia. In particular, there is increasing evidence that primary dystonia can be viewed as a circuit disorder, involving the basal ganglia-thalamo-cortical and cerebello-thalamo-cortical pathways. This suggests that a better understanding of the dysfunction in each region in the network and their interactions are important topics to address. Current views of interpretation of imaging data as cause or consequence of dystonia, and the postmortem correlates of imaging data are presented. The application of imaging as a tool to monitor therapy and its use as an outcome measure will be discussed. © 2013 Movement Disorder Society.
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Affiliation(s)
- Stéphane Lehéricy
- Institut du Cerveau et de la Moelle (ICM) epiniere, Centre de NeuroImagerie de Recherche (CENIR), Paris, France.
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Hess CW, Ofori E, Akbar U, Okun MS, Vaillancourt DE. The evolving role of diffusion magnetic resonance imaging in movement disorders. Curr Neurol Neurosci Rep 2013; 13:400. [PMID: 24046183 PMCID: PMC3824956 DOI: 10.1007/s11910-013-0400-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Significant advances have allowed diffusion magnetic resonance imaging (MRI) to evolve into a powerful tool in the field of movement disorders that can be used to study disease states and connectivity between brain regions. Diffusion MRI is a promising potential biomarker for Parkinson's disease and other forms of parkinsonism, and may allow the distinction of different forms of parkinsonism. Techniques such as tractography have contributed to our current thinking regarding the pathophysiology of dystonia and possible mechanisms of penetrance. Diffusion MRI measures could potentially assist in monitoring disease progression in Huntington's disease, and in uncovering the nature of the processes and structures involved the development of essential tremor. The ability to represent structural connectivity in vivo also makes diffusion MRI an ideal adjunctive tool for the surgical treatment of movement disorders. We review recent studies using diffusion MRI in movement disorders research and present the current state of the science as well as future directions.
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Affiliation(s)
- Christopher W. Hess
- Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
- University of Florida Center for Movement Disorders & Neurorestoration, Gainesville, FL, USA
- Neurology Service, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Edward Ofori
- Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - Umer Akbar
- University of Florida Center for Movement Disorders & Neurorestoration, Gainesville, FL, USA
| | - Michael S. Okun
- University of Florida Center for Movement Disorders & Neurorestoration, Gainesville, FL, USA
| | - David E. Vaillancourt
- Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
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Prell T, Peschel T, Köhler B, Bokemeyer MH, Dengler R, Günther A, Grosskreutz J. Structural brain abnormalities in cervical dystonia. BMC Neurosci 2013; 14:123. [PMID: 24131497 PMCID: PMC3852757 DOI: 10.1186/1471-2202-14-123] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/09/2013] [Indexed: 12/13/2022] Open
Abstract
Background Idiopathic cervical dystonia is characterized by involuntary spasms, tremors or jerks. It is not restricted to a disturbance in the basal ganglia system because non-conventional voxel-based MRI morphometry (VBM) and diffusion tensor imaging (DTI) have detected numerous regional changes in the brains of patients. In this study scans of 24 patients with cervical dystonia and 24 age-and sex-matched controls were analysed using VBM, DTI and magnetization transfer imaging (MTI) using a voxel-based approach and a region-of-interest analysis. Results were correlated with UDRS, TWSTRS and disease duration. Results We found structural alterations in the basal ganglia; thalamus; motor cortex; premotor cortex; frontal, temporal and parietal cortices; visual system; cerebellum and brainstem of the patients with dystonia. Conclusions Cervical dystonia is a multisystem disease involving several networks such as the motor, sensory and visual systems.
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Affiliation(s)
- Tino Prell
- Hans-Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
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27
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Blood AJ. Imaging studies in focal dystonias: a systems level approach to studying a systems level disorder. Curr Neuropharmacol 2013; 11:3-15. [PMID: 23814533 PMCID: PMC3580788 DOI: 10.2174/157015913804999513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/16/2012] [Accepted: 08/29/2012] [Indexed: 12/14/2022] Open
Abstract
Focal dystonias are dystonias that affect one part of the body, and are sometimes task-specific. Brain imaging and transcranial magnetic stimulation techniques have been valuable in defining the pathophysiology of dystonias in general, and are particularly amenable to studying focal dystonias. Over the past few years, several common themes have emerged in the imaging literature, and this review summarizes these findings and suggests some ways in which these distinct themes might all point to one common systems-level mechanism for dystonia. These themes include (1) the role of premotor regions in focal dystonia, (2) the role of the sensory system and sensorimotor integration in focal dystonia, (3) the role of decreased inhibition/increased excitation in focal dystonia, and (4) the role of brain imaging in evaluating and guiding treatment of focal dystonias. The data across these themes, together with the features of dystonia itself, are consistent with a hypothesis that all dystonias reflect excessive output of postural control/stabilization systems in the brain, and that the mechanisms for dystonia reflect amplification of an existing functional system, rather than recruitment of the wrong motor programs. Imaging is currently being used to test treatment effectiveness, and to visually guide treatment of dystonia, such as placement of deep brain stimulation electrodes. In the future, it is hoped that imaging may be used to individualize treatments across behavioral, pharmacologic, and surgical domains, thus optimizing both the speed and effectiveness of treatment for any given individual with focal dystonia.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Laboratory of Neuroimaging and Genetics, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Zoons E, Tijssen MAJ. Pathologic changes in the brain in cervical dystonia pre- and post-mortem - a commentary with a special focus on the cerebellum. Exp Neurol 2013; 247:130-3. [PMID: 23597638 DOI: 10.1016/j.expneurol.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/28/2013] [Accepted: 04/07/2013] [Indexed: 10/27/2022]
Abstract
In a recent issue of Experimental Neurology, Prudente et al. (2012) investigated the neuropathology of cervical dystonia in six patients. Their most important finding was a patchy loss of cerebellar Purkinje cells in the cerebellum. In this article we discuss their findings in the context of a review including primary and secondary cervical dystonia. An update is given of the current knowledge on structural and functional brain abnormalities in idiopathic cervical dystonia with a special focus on the cerebellum.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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29
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Karp BI. Botulinum toxin physiology in focal hand and cranial dystonia. Toxins (Basel) 2012; 4:1404-14. [PMID: 23202323 PMCID: PMC3509715 DOI: 10.3390/toxins4111404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/24/2012] [Accepted: 11/09/2012] [Indexed: 11/16/2022] Open
Abstract
The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.
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Affiliation(s)
- Barbara Illowsky Karp
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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30
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Blood AJ, Kuster JK, Woodman SC, Kirlic N, Makhlouf ML, Multhaupt-Buell TJ, Makris N, Parent M, Sudarsky LR, Sjalander G, Breiter H, Breiter HC, Sharma N. Evidence for altered basal ganglia-brainstem connections in cervical dystonia. PLoS One 2012; 7:e31654. [PMID: 22384048 PMCID: PMC3285161 DOI: 10.1371/journal.pone.0031654] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
Background There has been increasing interest in the interaction of the basal ganglia with the cerebellum and the brainstem in motor control and movement disorders. In addition, it has been suggested that these subcortical connections with the basal ganglia may help to coordinate a network of regions involved in mediating posture and stabilization. While studies in animal models support a role for this circuitry in the pathophysiology of the movement disorder dystonia, thus far, there is only indirect evidence for this in humans with dystonia. Methodology/Principal Findings In the current study we investigated probabilistic diffusion tractography in DYT1-negative patients with cervical dystonia and matched healthy control subjects, with the goal of showing that patients exhibit altered microstructure in the connectivity between the pallidum and brainstem. The brainstem regions investigated included nuclei that are known to exhibit strong connections with the cerebellum. We observed large clusters of tractography differences in patients relative to healthy controls, between the pallidum and the brainstem. Tractography was decreased in the left hemisphere and increased in the right hemisphere in patients, suggesting a potential basis for the left/right white matter asymmetry we previously observed in focal dystonia patients. Conclusions/Significance These findings support the hypothesis that connections between the basal ganglia and brainstem play a role in the pathophysiology of dystonia.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America.
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31
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Zoons E, Booij J, Nederveen AJ, Dijk JM, Tijssen MAJ. Structural, functional and molecular imaging of the brain in primary focal dystonia--a review. Neuroimage 2011; 56:1011-20. [PMID: 21349339 DOI: 10.1016/j.neuroimage.2011.02.045] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 12/31/2022] Open
Abstract
Primary focal dystonias form a group of neurological disorders characterized by involuntary, sustained muscle contractions causing twisting movements and abnormal postures. The estimated incidence is 12-25 per 100,000. The pathophysiology is largely unclear but genetic and environmental influences are suspected. Over the last decade neuroimaging techniques have been applied in patients with focal dystonia. Using structural, functional and molecular imaging techniques, abnormalities have been detected mainly in the sensorimotor cortex, basal ganglia and cerebellum. The shared anatomical localisations in different forms of focal dystonia support the hypothesis of a common causative mechanism. The primary defect in focal dystonia is hypothesised in the motor circuit connecting the cortex, basal ganglia, and cerebellum. Imaging techniques have clearly enhanced current knowledge on the pathophysiology of primary focal dystonia and will continue to do so in the future.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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32
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Blood AJ, Iosifescu DV, Makris N, Perlis RH, Kennedy DN, Dougherty DD, Kim BW, Lee MJ, Wu S, Lee S, Calhoun J, Hodge SM, Fava M, Rosen BR, Smoller JW, Gasic GP, Breiter HC. Microstructural abnormalities in subcortical reward circuitry of subjects with major depressive disorder. PLoS One 2010; 5:e13945. [PMID: 21124764 PMCID: PMC2993928 DOI: 10.1371/journal.pone.0013945] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/16/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies of major depressive disorder (MDD) have focused on abnormalities in the prefrontal cortex and medial temporal regions. There has been little investigation in MDD of midbrain and subcortical regions central to reward/aversion function, such as the ventral tegmental area/substantia nigra (VTA/SN), and medial forebrain bundle (MFB). METHODOLOGY/PRINCIPAL FINDINGS We investigated the microstructural integrity of this circuitry using diffusion tensor imaging (DTI) in 22 MDD subjects and compared them with 22 matched healthy control subjects. Fractional anisotropy (FA) values were increased in the right VT and reduced in dorsolateral prefrontal white matter in MDD subjects. Follow-up analysis suggested two distinct subgroups of MDD patients, which exhibited non-overlapping abnormalities in reward/aversion circuitry. The MDD subgroup with abnormal FA values in VT exhibited significantly greater trait anxiety than the subgroup with normal FA values in VT, but the subgroups did not differ in levels of anhedonia, sadness, or overall depression severity. CONCLUSIONS/SIGNIFICANCE These findings suggest that MDD may be associated with abnormal microstructure in brain reward/aversion regions, and that there may be at least two subtypes of microstructural abnormalities which each impact core symptoms of depression.
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Affiliation(s)
- Anne J. Blood
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dan V. Iosifescu
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Mount Sinai School of Medicine, New York, New York, United States of America
| | - Nikos Makris
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Morphometric Analysis and Center for Integrative Informatics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Roy H. Perlis
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Psychiatric and Neurodevelopmental Genetics Unit and Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - David N. Kennedy
- Center for Morphometric Analysis and Center for Integrative Informatics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Darin D. Dougherty
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Byoung Woo Kim
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Myung Joo Lee
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shirley Wu
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sang Lee
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jesse Calhoun
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Steven M. Hodge
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Morphometric Analysis and Center for Integrative Informatics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maurizio Fava
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Psychiatric and Neurodevelopmental Genetics Unit and Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bruce R. Rosen
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Psychiatric and Neurodevelopmental Genetics Unit and Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gregory P. Gasic
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hans C. Breiter
- Depression Clinic and Research Program, Mood and Motor Control Laboratory, Addiction Research Program, Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Motivation and Emotion Neuroscience Collaboration (MENC) and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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Colosimo C, Suppa A, Fabbrini G, Bologna M, Berardelli A. Craniocervical dystonia: clinical and pathophysiological features. Eur J Neurol 2010; 17 Suppl 1:15-21. [PMID: 20590803 DOI: 10.1111/j.1468-1331.2010.03045.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Blepharospasm, oromandibular, lingual, laryngeal and cervical dystonia are common forms of adult-onset dystonia. Each condition may appear in isolation or manifest along with other forms of craniocervical dystonia. Although the various craniocervical dystonias typically present with involuntary muscle spasms causing abnormal postures, they differ for some clinical features. Neurophysiologic and neuroimaging studies have shown a number of motor and sensory abnormalities at cortical and subcortical levels, probably reflecting a dysfunction in the basal ganglia-thalamo-cortical circuits. The best treatment for craniocervical dystonia is botulinum toxin injected into the overactive muscles.
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Affiliation(s)
- C Colosimo
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
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Pantano P, Totaro P, Fabbrini G, Raz E, Contessa GM, Tona F, Colosimo C, Berardelli A. A transverse and longitudinal MR imaging voxel-based morphometry study in patients with primary cervical dystonia. AJNR Am J Neuroradiol 2010; 32:81-4. [PMID: 20947646 DOI: 10.3174/ajnr.a2242] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Findings of standard MR imaging examinations are usually normal in primary CD. These findings are now increasingly challenged by studies using advanced neuroimaging techniques detecting abnormalities in brain areas that may be functionally involved in the pathophysiology of CD. Our purpose was to evaluate GM volumes in patients with CD at baseline and 5 years later. MATERIALS AND METHODS We enrolled 19 patients (F/M = 15:4, mean age = 53.2 + 11.2 years), 12 of whom were studied at baseline and again approximately 5 years later. Twenty-eight healthy volunteers acted as controls (F/M = 17:11, mean age = 47.5 + 15.6 years). The subjects were imaged with a 1.5T scanner by using a 3D T1-weighted sequence on 150 contiguous axial 1-mm-thick sections to apply VBM. RESULTS At entry, VBM analysis disclosed significantly lower GM volumes in the left caudate head and putamen and in the premotor and primary sensorimotor cortices bilaterally in patients than in controls. No correlation was found between decreased GM volumes and patient age, severity of dystonia, or disease duration. At the 5-year follow-up, GM volumes in the left primary sensorimotor cortex in patients had decreased significantly from baseline. CONCLUSIONS The findings obtained at entry and after a 5-year follow-up consistently showed decreased caudate, putamen, and sensorimotor cortex GM volumes in patients with CD, and they probably play a pathophysiologic role in CD.
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Affiliation(s)
- P Pantano
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy.
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Nahab FB, Hallett M. Current role of functional MRI in the diagnosis of movement disorders. Neuroimaging Clin N Am 2010; 20:103-10. [PMID: 19959022 DOI: 10.1016/j.nic.2009.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The functional magnetic resonance (fMR) technique for brain mapping is a valuable tool for understanding both normal physiology and the dysfunction taking place in disorders of the brain. This article provides an overview of fMR imaging methods and their applications in the study of neurologic movement disorders. The article also reviews the current neuroimaging literature regarding parkinsonisms, dystonia, essential tremor, and Huntington disease, and includes a discussion of current methodological limitations and future directions for this exciting field.
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Affiliation(s)
- Fatta B Nahab
- University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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36
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Familial leukoencephalopathy with slowly progressive dystonia and ataxia. Eur J Paediatr Neurol 2009; 13:530-3. [PMID: 19071044 DOI: 10.1016/j.ejpn.2008.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 10/08/2008] [Accepted: 11/09/2008] [Indexed: 11/21/2022]
Abstract
We describe two siblings with childhood onset, slowly progressive generalized dystonia and cerebellar signs. Brain neuroimaging revealed white matter abnormalities compatible with a neuronal degenerative disorder. An extensive evaluation for mitochondrial, metabolic, autoimmune or other known neurodegenerative disorders did not reveal the etiology of the disease. During a three-year follow-up other neurological signs appeared, but progression was very slow. We believe that our patients have a new type of a leukoencephalopathy with slowly progressive dystonia and cerebellar signs.
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Argyelan M, Carbon M, Niethammer M, Uluğ AM, Voss HU, Bressman SB, Dhawan V, Eidelberg D. Cerebellothalamocortical connectivity regulates penetrance in dystonia. J Neurosci 2009; 29:9740-7. [PMID: 19657027 PMCID: PMC2745646 DOI: 10.1523/jneurosci.2300-09.2009] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 06/16/2009] [Accepted: 06/20/2009] [Indexed: 11/21/2022] Open
Abstract
Dystonia is a brain disorder characterized by sustained involuntary muscle contractions. It is typically inherited as an autosomal dominant trait with incomplete penetrance. While lacking clear degenerative neuropathology, primary dystonia is thought to involve microstructural and functional changes in neuronal circuitry. In the current study, we used magnetic resonance diffusion tensor imaging and probabilistic tractography to identify the specific circuit abnormalities that underlie clinical penetrance in carriers of genetic mutations for this disorder. This approach revealed reduced integrity of cerebellothalamocortical fiber tracts, likely developmental in origin, in both manifesting and clinically nonmanifesting dystonia mutation carriers. In these subjects, reductions in cerebellothalamic connectivity correlated with increased motor activation responses, consistent with loss of inhibition at the cortical level. Nonmanifesting mutation carriers were distinguished by an additional area of fiber tract disruption situated distally along the thalamocortical segment of the pathway, in tandem with the proximal cerebellar outflow abnormality. In individual gene carriers, clinical penetrance was determined by the difference in connectivity measured at these two sites. Overall, these findings point to a novel mechanism to explain differences in clinical expression in carriers of genes for brain disease.
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Affiliation(s)
- Miklos Argyelan
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
| | - Maren Carbon
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
- Departments of Neurology and
- Medicine, North Shore University Hospital and New York University School of Medicine, Manhasset, New York 11030
| | - Martin Niethammer
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
- Departments of Neurology and
- Medicine, North Shore University Hospital and New York University School of Medicine, Manhasset, New York 11030
| | - Aziz M. Uluğ
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
| | - Henning U. Voss
- Department of Radiology, Weill Cornell Medical College, New York, New York 10065, and
| | - Susan B. Bressman
- Mirken Department of Neurology, Beth Israel Medical Center, New York, New York 10003
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
- Departments of Neurology and
- Medicine, North Shore University Hospital and New York University School of Medicine, Manhasset, New York 11030
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030
- Departments of Neurology and
- Medicine, North Shore University Hospital and New York University School of Medicine, Manhasset, New York 11030
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38
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Hinkley LB, Webster R, Byl NN, Nagarajan SS. Neuroimaging characteristics of patients with focal hand dystonia. J Hand Ther 2009; 22:125-34; quiz 135. [PMID: 19217255 PMCID: PMC6287964 DOI: 10.1016/j.jht.2008.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 11/26/2008] [Accepted: 11/26/2008] [Indexed: 02/03/2023]
Abstract
NARRATIVE REVIEW: Advances in structural and functional imaging have provided both scientists and clinicians with information about the neural mechanisms underlying focal hand dystonia (FHd), a motor disorder associated with aberrant posturing and patterns of muscle contraction specific to movements of the hand. Consistent with the hypothesis that FHd is the result of reorganization in cortical fields, studies in neuroimaging have confirmed alterations in the topography and response properties of somatosensory and motor areas of the brain. Noninvasive stimulation of these regions also demonstrates that FHd may be due to reductions in inhibition between competing sensory and motor representations. Compromises in neuroanatomical structure, such as white matter density and gray matter volume, have also been identified through neuroimaging methods. These advances in neuroimaging have provided clinicians with an expanded understanding of the changes in the brain that contribute to FHd. These findings should provide a foundation for the development of retraining paradigms focused on reversing overlapping sensory representations and interactions between brain regions in patients with FHd. Continued collaborations between health professionals who treat FHd and research scientists who examine the brain using neuroimaging tools are imperative for answering difficult questions about patients with specific movement disorders.
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Affiliation(s)
| | - Rebecca Webster
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Nancy N. Byl
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA 94143, USA
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Abstract
Task-specific dystonias are primary focal dystonias characterized by excessive muscle contractions producing abnormal postures during selective motor activities that often involve highly skilled, repetitive movements. Historically these peculiar postures were considered psychogenic but have now been classified as forms of dystonia. Writer's cramp is the most commonly identified task-specific dystonia and has features typical of this group of disorders. Symptoms may begin with lack of dexterity during performance of a specific motor task with increasingly abnormal posturing of the involved body part as motor activity continues. Initially, the dystonia may manifest only during the performance of the inciting task, but as the condition progresses it may also occur during other activities or even at rest. Neurological exam is usually unremarkable except for the dystonia-related abnormalities. Although the precise pathophysiology remains unclear, increasing evidence suggests reduced inhibition at different levels of the sensorimotor system. Symptomatic treatment options include oral medications, botulinum toxin injections, neurosurgical procedures, and adaptive strategies. Prognosis may vary depending upon body part involved and specific type of task affected. Further research may reveal new insights into the etiology, pathophysiology, natural history, and improved treatment of these conditions.
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Affiliation(s)
- Diego Torres-Russotto
- Department of Neurology, Washington University in St. Louis. St. Louis, Missouri, USA
| | - Joel S. Perlmutter
- Department of Neurology, Washington University in St. Louis. St. Louis, Missouri, USA
- Departments of Radiology and Anatomy and Neurobiology and Programs in Physical Therapy and Occupational Therapy, Washington University in St. Louis. St. Louis, Missouri, USA
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40
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White matter in learning, cognition and psychiatric disorders. Trends Neurosci 2008; 31:361-70. [PMID: 18538868 DOI: 10.1016/j.tins.2008.04.001] [Citation(s) in RCA: 889] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/09/2008] [Accepted: 04/21/2008] [Indexed: 12/15/2022]
Abstract
White matter is the brain region underlying the gray matter cortex, composed of neuronal fibers coated with electrical insulation called myelin. Previously of interest in demyelinating diseases such as multiple sclerosis, myelin is attracting new interest as an unexpected contributor to a wide range of psychiatric disorders, including depression and schizophrenia. This is stimulating research into myelin involvement in normal cognitive function, learning and IQ. Myelination continues for decades in the human brain; it is modifiable by experience, and it affects information processing by regulating the velocity and synchrony of impulse conduction between distant cortical regions. Cell-culture studies have identified molecular mechanisms regulating myelination by electrical activity, and myelin also limits the critical period for learning through inhibitory proteins that suppress axon sprouting and synaptogenesis.
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Carbon M, Kingsley PB, Tang C, Bressman S, Eidelberg D. Microstructural white matter changes in primary torsion dystonia. Mov Disord 2008; 23:234-9. [PMID: 17999428 DOI: 10.1002/mds.21806] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Primary torsion dystonia (PTD) has been conceptualized as a disorder of the basal ganglia. However, recent data suggest a widespread pathology involving motor control pathways. In this report, we explored whether PTD is associated with abnormal anatomical connectivity within motor control pathways. We used diffusion tensor magnetic resonance imaging (DT-MRI) to assess the microstructure of white matter. We found that fractional anisotropy, a measure of axonal integrity and coherence, was significantly reduced in PTD patients in the pontine brainstem in the vicinity of the left superior cerebellar peduncle and bilaterally in the white matter of the sensorimotor region. Our data thus support the possibility of a disturbance in cerebello-thalamo-cortical pathways as a cause of the clinical manifestations of PTD.
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Affiliation(s)
- Maren Carbon
- Center for Neurosciences, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030, USA.
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Zhao Y, Xiao J, Ueda M, Wang Y, Hines M, Nowak TS, LeDoux MS. Glial elements contribute to stress-induced torsinA expression in the CNS and peripheral nervous system. Neuroscience 2008; 155:439-53. [PMID: 18538941 DOI: 10.1016/j.neuroscience.2008.04.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/22/2008] [Accepted: 04/25/2008] [Indexed: 12/31/2022]
Abstract
DYT1 dystonia is caused by a single GAG deletion in exon 5 of TOR1A, the gene encoding torsinA, a putative chaperone protein. In this study, central and peripheral nervous system perturbations (transient forebrain ischemia and sciatic nerve transection, respectively) were used to examine the systems biology of torsinA in rats. After forebrain ischemia, quantitative real-time reverse transcriptase-polymerase chain reaction identified increased torsinA transcript levels in hippocampus, cerebral cortex, thalamus, striatum, and cerebellum at 24 h and 7 days. Expression declined toward sham values by 14 days in striatum, thalamus and cortex, and by 21 days in cerebellum and hippocampus. TorsinA transcripts were localized to dentate granule cells and pyramidal neurons in control hippocampus and were moderately elevated in these cell populations at 24 h after ischemia, after which CA1 expression was reduced, consistent with the loss of this vulnerable neuronal population. Increased in situ hybridization signal in CA1 stratum radiatum, stratum lacunosum-moleculare, and stratum oriens at 7 days after ischemia was correlated with the detection of torsinA immunoreactivity in interneurons and reactive astrocytes at 7 and 14 days. Sciatic nerve transection increased torsinA transcript levels between 24 h and 7 days in both ipsilateral and contralateral dorsal root ganglia (DRG). However, increased torsinA immunoreactivity was localized to both ganglion cells and satellite cells in ipsilateral DRG but was restricted to satellite cells contralaterally. These results suggest that torsinA participates in the response of neural tissue to central and peripheral insults and its sustained up-regulation indicates that torsinA may contribute to remodeling of neuronal circuitry. The striking induction of torsinA in astrocytes and satellite cells points to the potential involvement of glial elements in the pathobiology of DYT1 dystonia.
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Affiliation(s)
- Y Zhao
- University of Tennessee Health Science Center, Departments of Neurology and Anatomy and Neurobiology, 855 Monroe Avenue, Suite 415, Memphis, TN 38163, USA
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Breakefield XO, Blood AJ, Li Y, Hallett M, Hanson PI, Standaert DG. The pathophysiological basis of dystonias. Nat Rev Neurosci 2008; 9:222-34. [PMID: 18285800 DOI: 10.1038/nrn2337] [Citation(s) in RCA: 318] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dystonias comprise a group of movement disorders that are characterized by involuntary movements and postures. Insight into the nature of neuronal dysfunction has been provided by the identification of genes responsible for primary dystonias, the characterization of animal models and functional evaluations and in vivo brain imaging of patients with dystonia. The data suggest that alterations in neuronal development and communication within the brain create a susceptible substratum for dystonia. Although there is no overt neurodegeneration in most forms of dystonia, there are functional and microstructural brain alterations. Dystonia offers a window into the mechanisms whereby subtle changes in neuronal function, particularly in sensorimotor circuits that are associated with motor learning and memory, can corrupt normal coordination and lead to a disabling motor disorder.
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Affiliation(s)
- Xandra O Breakefield
- Department of Neurology and Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
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Fabbrini G, Pantano P, Totaro P, Calistri V, Colosimo C, Carmellini M, Defazio G, Berardelli A. Diffusion tensor imaging in patients with primary cervical dystonia and in patients with blepharospasm. Eur J Neurol 2008; 15:185-9. [PMID: 18217887 DOI: 10.1111/j.1468-1331.2007.02034.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Fabbrini
- Department of Neurological Sciences and Neuromed Institute (IRCCS), 'La Sapienza' University of Rome, Rome, Italy
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45
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Blood AJ. New hypotheses about postural control support the notion that all dystonias are manifestations of excessive brain postural function. ACTA ACUST UNITED AC 2008; 1:14-25. [PMID: 19180244 DOI: 10.1016/j.bihy.2008.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This paper postulates that all forms of the neurological movement disorder, dystonia, can be argued to reflect excessive function of one or more components of the brain postural system. This is based on four central arguments. First, because some forms of postural control are already known to be dynamic, rather than static, it is suggested that hyperkinetic dystonias reflect excessive function of dynamic postures, rather than abnormal movements. Second, the range of functional roles served by the postural system is hypothesized to include direct control of movement, suggesting a postural basis for task-specific dystonias. Third, by defining posture as a neural system that maintains body stabilization, it can be shown that the range of mechanical means of implementing stabilization, including co-contraction of antagonistic muscles, matches the range of presentations of dystonia. Fourth, it is shown that the above premises are able to account for previously unexplained observations in dystonia. Based on the inhibitory influence that stabilizing mechanisms exert on movement, it is suggested that the broad functional role that is here referred to as posture may be the function served by the indirect pathway of the basal ganglia. Specifically, it is proposed that this pathway centrally coordinates function of the distributed network of brain regions controlling posture and, in conjunction with the direct pathway, coordinates posture and movement.
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Affiliation(s)
- Anne J Blood
- Departments of Psychiatry and Neurology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, CNY 149-2301, 13th St., Charlestown, MA 02129
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46
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Simonyan K, Tovar-Moll F, Ostuni J, Hallett M, Kalasinsky VF, Lewin-Smith MR, Rushing EJ, Vortmeyer AO, Ludlow CL. Focal white matter changes in spasmodic dysphonia: a combined diffusion tensor imaging and neuropathological study. ACTA ACUST UNITED AC 2007; 131:447-59. [PMID: 18083751 DOI: 10.1093/brain/awm303] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spasmodic dysphonia is a neurological disorder characterized by involuntary spasms in the laryngeal muscles during speech production. Although the clinical symptoms are well characterized, the pathophysiology of this voice disorder is unknown. We describe here, for the first time to our knowledge, disorder-specific brain abnormalities in these patients as determined by a combined approach of diffusion tensor imaging (DTI) and postmortem histopathology. We used DTI to identify brain changes and to target those brain regions for neuropathological examination. DTI showed right-sided decrease of fractional anisotropy in the genu of the internal capsule and bilateral increase of overall water diffusivity in the white matter along the corticobulbar/corticospinal tract in 20 spasmodic dysphonia patients compared to 20 healthy subjects. In addition, water diffusivity was bilaterally increased in the lentiform nucleus, ventral thalamus and cerebellar white and grey matter in the patients. These brain changes were substantiated with focal histopathological abnormalities presented as a loss of axonal density and myelin content in the right genu of the internal capsule and clusters of mineral depositions, containing calcium, phosphorus and iron, in the parenchyma and vessel walls of the posterior limb of the internal capsule, putamen, globus pallidus and cerebellum in the postmortem brain tissue from one patient compared to three controls. The specificity of these brain abnormalities is confirmed by their localization, limited only to the corticobulbar/corticospinal tract and its main input/output structures. We also found positive correlation between the diffusivity changes and clinical symptoms of spasmodic dysphonia (r = 0.509, P = 0.037). These brain abnormalities may alter the central control of voluntary voice production and, therefore, may underlie the pathophysiology of this disorder.
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Affiliation(s)
- Kristina Simonyan
- Laryngeal and Speech Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 5D38, Bethesda, MD 20892-1416, USA.
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Abstract
Diffusion tensor imaging (DTI) is a promising method for characterizing microstructural changes or differences with neuropathology and treatment. The diffusion tensor may be used to characterize the magnitude, the degree of anisotropy, and the orientation of directional diffusion. This review addresses the biological mechanisms, acquisition, and analysis of DTI measurements. The relationships between DTI measures and white matter pathologic features (e.g., ischemia, myelination, axonal damage, inflammation, and edema) are summarized. Applications of DTI to tissue characterization in neurotherapeutic applications are reviewed. The interpretations of common DTI measures (mean diffusivity, MD; fractional anisotropy, FA; radial diffusivity, D(r); and axial diffusivity, D(a)) are discussed. In particular, FA is highly sensitive to microstructural changes, but not very specific to the type of changes (e.g., radial or axial). To maximize the specificity and better characterize the tissue microstructure, future studies should use multiple diffusion tensor measures (e.g., MD and FA, or D(a) and D(r)).
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Affiliation(s)
- Andrew L Alexander
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
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48
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Abstract
Diffusion tensor imaging (DTI) is a promising method for characterizing microstructural changes or differences with neuropathology and treatment. The diffusion tensor may be used to characterize the magnitude, the degree of anisotropy, and the orientation of directional diffusion. This review addresses the biological mechanisms, acquisition, and analysis of DTI measurements. The relationships between DTI measures and white matter pathologic features (e.g., ischemia, myelination, axonal damage, inflammation, and edema) are summarized. Applications of DTI to tissue characterization in neurotherapeutic applications are reviewed. The interpretations of common DTI measures (mean diffusivity, MD; fractional anisotropy, FA; radial diffusivity, D(r); and axial diffusivity, D(a)) are discussed. In particular, FA is highly sensitive to microstructural changes, but not very specific to the type of changes (e.g., radial or axial). To maximize the specificity and better characterize the tissue microstructure, future studies should use multiple diffusion tensor measures (e.g., MD and FA, or D(a) and D(r)).
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Affiliation(s)
- Andrew L Alexander
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
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