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de Souza JCC, Falcone ACM, Barbosa RMG, Soares MC, Munhoz R, Farah M, Capato T, Casagrande SCB, Cordellini MF, de Castro Micheli G, Limongi JCP, Barbosa ER, Listik C, Cury RG. Botulinum Toxin and Deep Brain Stimulation in Dystonia. Toxins (Basel) 2024; 16:282. [PMID: 38922176 PMCID: PMC11209614 DOI: 10.3390/toxins16060282] [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: 03/25/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/27/2024] Open
Abstract
Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study's primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia.
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Affiliation(s)
- Julia Carvalhinho Carlos de Souza
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Ananda Carolina Moraes Falcone
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Renata Montes Garcia Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Miriam Carvalho Soares
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Renato Munhoz
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada;
| | - Marina Farah
- Cajuru University Hospital, Pontíficia Universidade Católica do Paraná, Curitiba 80050-350, Brazil;
| | - Tamine Capato
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
- Department of Neurology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Sara Carvalho Barbosa Casagrande
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | | | - Gabriel de Castro Micheli
- Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil;
| | - João Carlos Papaterra Limongi
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
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Dhar D, Holla VV, Kumari R, Yadav R, Kamble N, Muthusamy B, Pal PK. Clinical and genetic profile of patients with dystonia: An experience from a tertiary neurology center from India. Parkinsonism Relat Disord 2024; 120:105986. [PMID: 38219528 DOI: 10.1016/j.parkreldis.2023.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The genetics of dystonia have varied across different ethnicities worldwide. Its significance has become more apparent with the advent of deep brain stimulation. OBJECTIVE To study the clinico-genetic profile of patients with probable genetic dystonia using whole exome sequencing (WES). METHODS A prospective, cross-sectional study was conducted from May 2021 to September 2022, enrolling patients with dystonia of presumed genetic etiology for WES. The study compared genetically-determined cases harboring pathogenic/likely-pathogenic variants (P/LP subgroup) with the presumed idiopathic or unsolved cases. RESULTS We recruited 65 patients (males, 69.2%) whose mean age of onset (AAO) and assessment were 25.0 ± 16.6 and 31.7 ± 15.2 years, respectively. Fifteen had pathogenic/likely-pathogenic variants (yield = 23.1%), 16 (24.6%) had variants of uncertain significance (VUS), 2 were heterozygous carriers while the remaining 32 cases tested negative (presumed idiopathic group). The P/LP subgroup had a significantly younger AAO (16.8 ± 12.3 vs 31.3 ± 17.0 years, p = 0.009), longer duration of illness (10.9 ± 10.3 vs 4.8 ± 4.3 years, p = 0.006), higher prevalence of generalized dystonia (n = 12, 80.0% vs n = 10, 31.3%, p = 0.004), lower-limb onset (n = 5, 33.3% vs n = 1, 3.1%, p = 0.009), higher motor (p = 0.035) and disability scores (p = 0.042). The classical DYT genes with pathogenic/likely pathogenic variants included 3 cases each of TOR1A, and KMT2B, and single cases each of SGCE, EIF2AK2, and VPS16. Non-DYT pathogenic/likely-pathogenic cases included PINK1, PANK2, CTSF, POLG, MICU1, and TSPOAP1. CONCLUSIONS The yield of WES was 23.1% among cases of probable genetic dystonia. Pathogenic or likely pathogenic variants in TOR1A, KMT2B, and SGCE genes were commoner. The absence of family history emphasizes the importance of accurate assessment of clinical predictors before genetic testing.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Riyanka Kumari
- Institute of Bioinformatics, International Technology Park, Bengaluru 560066, India; Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Babylakshmi Muthusamy
- Institute of Bioinformatics, International Technology Park, Bengaluru 560066, India; Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
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Zhao M, Chen H, Yan X, Li J, Lu C, Cui B, Huo W, Cao S, Guo H, Liu S, Yang C, Liu Y, Yin F. Subthalamic deep brain stimulation for primary dystonia: defining an optimal location using the medial subthalamic nucleus border as anatomical reference. Front Aging Neurosci 2023; 15:1187167. [PMID: 37547744 PMCID: PMC10400903 DOI: 10.3389/fnagi.2023.1187167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Although the subthalamic nucleus (STN) has proven to be a safe and effective target for deep brain stimulation (DBS) in the treatment of primary dystonia, the rates of individual improvement vary considerably. On the premise of selecting appropriate patients, the location of the stimulation contacts in the dorsolateral sensorimotor area of the STN may be an important factor affecting therapeutic effects, but the optimal location remains unclear. This study aimed to define an optimal location using the medial subthalamic nucleus border as an anatomical reference and to explore the influence of the location of active contacts on outcomes and programming strategies in a series of patients with primary dystonia. Methods Data from 18 patients who underwent bilateral STN-DBS were retrospectively acquired and analyzed. Patients were assessed preoperatively and postoperatively (1 month, 3 months, 6 months, 1 year, 2 years, and last follow-up after neurostimulator initiation) using the Toronto Western Spasmodic Torticollis Rating Scale (for cervical dystonia) and the Burke-Fahn-Marsden Dystonia Rating Scale (for other types). Optimal parameters and active contact locations were determined during clinical follow-up. The position of the active contacts relative to the medial STN border was determined using postoperative stereotactic MRI. Results The clinical improvement showed a significant negative correlation with the y-axis position (anterior-posterior; A+, P-). The more posterior the electrode contacts were positioned in the dorsolateral sensorimotor area of the STN, the better the therapeutic effects. Cluster analysis of the improvement rates delineated optimal and sub-optimal groups. The optimal contact coordinates from the optimal group were 2.56 mm lateral, 0.15 mm anterior, and 1.34 mm superior relative to the medial STN border. Conclusion STN-DBS was effective for primary dystonia, but outcomes were dependent on the active contact location. Bilateral stimulation contacts located behind or adjacent to Bejjani's line were most likely to produce ideal therapeutic effects. These findings may help guide STN-DBS preoperative planning, stimulation programming, and prognosis for optimal therapeutic efficacy in primary dystonia.
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Affiliation(s)
- Mingming Zhao
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Hui Chen
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Xin Yan
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Jianguang Li
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Chao Lu
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Bin Cui
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Wenjun Huo
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Shouming Cao
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Hui Guo
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Shuang Liu
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Chunjuan Yang
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Ying Liu
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Feng Yin
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
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Liu X, Teng L, Zuo W, Zhong S, Xu Y, Sun J. Deafness gene screening based on a multilevel cascaded BPNN model. BMC Bioinformatics 2023; 24:56. [PMID: 36803022 PMCID: PMC9942297 DOI: 10.1186/s12859-023-05182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
Sudden sensorineural hearing loss is a common and frequently occurring condition in otolaryngology. Existing studies have shown that sudden sensorineural hearing loss is closely associated with mutations in genes for inherited deafness. To identify these genes associated with deafness, researchers have mostly used biological experiments, which are accurate but time-consuming and laborious. In this paper, we proposed a computational method based on machine learning to predict deafness-associated genes. The model is based on several basic backpropagation neural networks (BPNNs), which were cascaded as multiple-level BPNN models. The cascaded BPNN model showed a stronger ability for screening deafness-associated genes than the conventional BPNN. A total of 211 of 214 deafness-associated genes from the deafness variant database (DVD v9.0) were used as positive data, and 2110 genes extracted from chromosomes were used as negative data to train our model. The test achieved a mean AUC higher than 0.98. Furthermore, to illustrate the predictive performance of the model for suspected deafness-associated genes, we analyzed the remaining 17,711 genes in the human genome and screened the 20 genes with the highest scores as highly suspected deafness-associated genes. Among these 20 predicted genes, three genes were mentioned as deafness-associated genes in the literature. The analysis showed that our approach has the potential to screen out highly suspected deafness-associated genes from a large number of genes, and our predictions could be valuable for future research and discovery of deafness-associated genes.
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Affiliation(s)
- Xiao Liu
- School of Microelectronics and Communication Engineering, Chongqing University, 174 Shapingba District, Chongqing, 400044, China.
| | - Li Teng
- grid.190737.b0000 0001 0154 0904School of Microelectronics and Communication Engineering, Chongqing University, 174 Shapingba District, Chongqing, 400044 China
| | - Wenqi Zuo
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, NO. 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Shixun Zhong
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, NO. 1 Youyi Road, Yuzhong District, Chongqing, 400016 China
| | - Yuqiao Xu
- grid.190737.b0000 0001 0154 0904School of Microelectronics and Communication Engineering, Chongqing University, 174 Shapingba District, Chongqing, 400044 China
| | - Jing Sun
- grid.190737.b0000 0001 0154 0904School of Microelectronics and Communication Engineering, Chongqing University, 174 Shapingba District, Chongqing, 400044 China
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Berryman D, Barrett J, Liu C, Maugee C, Waldbaum J, Yi D, Xing H, Yokoi F, Saxena S, Li Y. Motor deficit and lack of overt dystonia in Dlx conditional Dyt1 knockout mice. Behav Brain Res 2023; 439:114221. [PMID: 36417958 PMCID: PMC10364669 DOI: 10.1016/j.bbr.2022.114221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
DYT1 or DYT-TOR1A dystonia is early-onset generalized dystonia caused by a trinucleotide deletion of GAG in the TOR1A or DYT1 gene leads to the loss of a glutamic acid residue in the resulting torsinA protein. A mouse model with overt dystonia is of unique importance to better understand the DYT1 pathophysiology and evaluate preclinical drug efficacy. DYT1 dystonia is likely a network disorder involving multiple brain regions, particularly the basal ganglia. Tor1a conditional knockout in the striatum or cerebral cortex leads to motor deficits, suggesting the importance of corticostriatal connection in the pathogenesis of dystonia. Indeed, corticostriatal long-term depression impairment has been demonstrated in multiple targeted DYT1 mouse models. Pappas and colleagues developed a conditional knockout line (Dlx-CKO) that inactivated Tor1a in the forebrain and surprisingly displayed overt dystonia. We set out to validate whether conditional knockout affecting both cortex and striatum would lead to overt dystonia and whether machine learning-based video behavioral analysis could be used to facilitate high throughput preclinical drug screening. We generated Dlx-CKO mice and found no overt dystonia or motor deficits at 4 months. At 8 months, retesting revealed motor deficits in rotarod, beam walking, grip strength, and hyperactivity in the open field; however, no overt dystonia was visually discernible or through the machine learning-based video analysis. Consistent with other targeted DYT1 mouse models, we observed age-dependent deficits in the beam walking test, which is likely a better motor behavioral test for preclinical drug testing but more labor-intensive when overt dystonia is absent.
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Affiliation(s)
- David Berryman
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Jake Barrett
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Canna Liu
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Maugee
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Julien Waldbaum
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Daiyao Yi
- Herbert Wertheim College of Engineering, Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Hong Xing
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Fumiaki Yokoi
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Shreya Saxena
- Herbert Wertheim College of Engineering, Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Yuqing Li
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Genetics Institute, University of Florida, Gainesville, FL, USA.
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Sanuki T. Spasmodic dysphonia: An overview of clinical features and treatment options. Auris Nasus Larynx 2023; 50:17-22. [PMID: 35697560 DOI: 10.1016/j.anl.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/06/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
Spasmodic dysphonia (SD) is considered a rare focal laryngeal dystonia characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndrome, it is typically a sporadic phenomenon, and the involvement of the laryngeal adductor muscles is more common than that of the abductor muscles. This research reviews the literature for the pathogenesis, clinical characteristics, treatment options, and current management methods of SD. Technological advances have enabled clinicians to better understand the connection between laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have helped better understand the underlying mechanisms of this neurolaryngology disorder. Currently, the standard of care for SD is the symptomatic management of botulinum toxin (BT) chemodenervation. This is supported by a large body of literature attesting to its efficacy in many different research studies, particularly in the uncomplicated adductor form of the disorder. Efforts towards surgical treatment predate the development of BT treatment by a decade, but the long-term efficacy has not been proven and, further research is expected. Symptom relief in patients with abductor SD and dystonia with tremors after surgical and BT treatments and those in patients remains suboptimal.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-Cho, Mizuho-Ku, Nagoya, Japan.
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Mahadevappa M, Attri LK, Chalasani SH, Syed J. Dextromethorphan Induced Dystonia: A Rare Case Report. Hosp Pharm 2023. [DOI: 10.1177/00185787221150918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dextromethorphan is a distant derivative of morphine, used as an antitussive agent indicated in standard care for various infections and respiratory conditions ranging from the common cold (rhinoviruses) to severe acute respiratory illness (SARI). Being a derivative of morphine, a natural central nervous system (CNS) depressant, dextromethorphan produces little to no action on CNS when ingested in the prescription dosage. We present a case of a 64-year-old female patient, a known case of ischemic heart disease post angioplasty and stenting to the left anterior descending artery (LAD), with heart failure with reduced ejection fraction (HFrEF), diabetes, hypertension, chronic kidney disease, and hypothyroidism who developed extrapyramidal symptoms post dextromethorphan administration. The incidence of dextromethorphan-induced dystonia is unknown, and the literature review suggests 4 case reports indicating dextromethorphan-induced dystonia, and each of those reports is a case of either accidental overdose or overdose in substance abuse disorder. No cases of these CNS side effects are described among adults with a therapeutic dose of dextromethorphan. This case report serves to sensitize the clinician about this rare occurrence.
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Affiliation(s)
| | | | | | - Jehath Syed
- JSS College of Pharmacy, Mysore, Karnataka, India
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Santifort KM, Mandigers PJJ. Dystonia in veterinary neurology. J Vet Intern Med 2022; 36:1872-1881. [PMID: 36086931 DOI: 10.1111/jvim.16532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
Dystonia is a clinical sign and main feature of many movement disorders in humans as well as veterinary species. It is characterized by sustained or intermittent involuntary muscle contractions causing abnormal (often repetitive) movements, postures, or both. This review discusses the terminology and definition of dystonia, its phenomenology, and its pathophysiology, and provides considerations regarding the diagnosis and treatment of dystonia in dogs and cats. In addition, currently recognized or reported disorders in dogs and cats in which dystonia is a particular or main feature are discussed and comparisons are made between disorders featuring dystonia in humans and animals. We suggest that when describing the phenomenology of dogs and cats with dystonia, if possible the following should be included: activity being performed at onset (e.g., resting or running or exercise-induced), body distribution, duration, responsiveness (subjective), severity, temporal pattern (i.e., paroxysmal or persistent, severity at onset and at later stages), presence or absence of autonomic signs (e.g., salivation), presence or absence of preceding signs (e.g., restlessness), presence or absence of signs after dystonia subsides (e.g., sleepiness), coexistence of other movement disorders, any other neurological manifestations, and possible links to administered medications, intoxications or other associated factors. We also suggest that dystonia be classified based on its etiology as either structural genetic, suspected genetic, reactive, or unknown.
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Affiliation(s)
| | - Paul J J Mandigers
- Evidensia Referral Hospitals, Arnhem, The Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Medina A, Nilles C, Martino D, Pelletier C, Pringsheim T. The prevalence of idiopathic or inherited isolated dystonia: a systematic review and meta‐analysis. Mov Disord Clin Pract 2022; 9:860-868. [PMID: 36247920 PMCID: PMC9547134 DOI: 10.1002/mdc3.13524] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background A systematic review of epidemiological studies of primary dystonia from 1985 and 2010 found an overall prevalence of 16.43 per 100,000 (95% CI = 12.09–22.32). Methods We performed a systematic review of studies from 2010 and 2022 to determine if there are important differences in epidemiology between these time periods. Results Nineteen studies were included. Incidence of cervical dystonia, blepharospasm, and oromandibular dystonia were each reported in one study; one study reported incidence for all adult onset idiopathic focal dystonias combined. Using data from 11 studies, we performed random effects meta‐analyses of the prevalence of cervical dystonia (9.95 per 100,000; 95% CI = 3.51–28.17), blepharospasm (2.82 per 100,000; 95% CI = 1.12–7.12), laryngeal dystonia (0.40 per 100,000; 95% CI = 0.09–1.83), upper limb dystonia (1.27 per 100,000; 95% CI = 0.36–4.52), oromandibular dystonia (0.57 per 100,000; 95% CI = 0.15–2.15), and idiopathic or inherited isolated dystonia all subtypes combined (30.85 per 100,000; 95% CI = 5.06–187.74). All studies reported more cases of dystonia in females. There was no significant difference in prevalence by subgroup analysis based on time of study publication (1985–2010 vs. 2010–2022). Subgroup analysis of differences in prevalence by dystonia subtype by continent using all studies published (1985–2022) revealed significant regional differences in the prevalence of cervical and laryngeal dystonia. Conclusion The incidence and prevalence of idiopathic or inherited isolated dystonia in the last decade was not significantly different from earlier reports. Population‐based studies across multiple geographic areas are needed to obtain a clearer understanding of the epidemiology of this condition.
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Affiliation(s)
- Alex Medina
- Department of Clinical Neurosciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Christelle Nilles
- Department of Clinical Neurosciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | | | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- Department of Psychiatry, Pediatrics, Community Health Sciences University of Calgary Calgary Alberta Canada
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Vintimilla-Sarmiento JD, Carrillo-Ruiz JD, Navarro-Olvera JL, Aguado-Carrillo G, Soto-Abraham JE, Velasco-Campos FJ. Specific movement and disability improvements in Burke-Fahn-Marsden Dystonia Rating Scale derived from pallidotomy in refractory patients to medical treatment. Clin Neurol Neurosurg 2021; 210:106955. [PMID: 34607198 DOI: 10.1016/j.clineuro.2021.106955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dystonia is a movement disorder associated with significant disability and is usually refractory to medical treatment. Pallidotomy may decrease dystonic movements. The aim of this study was to quantify movement and disability improvements through Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). METHODS We carried out a longitudinal clinical study in patients with refractory primary and secondary dystonia, who underwent radiofrequency (RF) unilateral and bilateral lesions on the postero-ventro-lateral globus pallidus internus (GPi), evaluating the outcomes through BFMDRS and variables as age, time of evolution, etiology, body distribution, planned target coordinates, and lesion size, during a mean follow-up time of 35.67 months. RESULTS Nine RF pallidotomies were performed on 6 patients, 7 right-sided and 2 left-sided; three patients were treated unilaterally for one occasion, while the others underwent 2 surgeries, including one staged bilateral procedure. Mean BFMDRS scores for movement were 38.5 preoperative and 25.5 postoperative, and for disability were 20.4 preoperative and 17.3 postoperative. We noticed improvement in movement (32.54%, p = 0.001) and disability (17.23%, p = 0.002). There was one right GPi and internal capsule (IC) infarction with contralateral hemiparesis as sequelae. CONCLUSIONS RF pallidotomy is an effective and accessible procedure to reduce BFMDRS scores in refractory dystonia if patients are correctly selected by severity, evolution, and disability as determining factors.
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Affiliation(s)
| | | | | | - Gustavo Aguado-Carrillo
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital, Mexico City, Mexico
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11
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Coblentz A, Elias GJB, Boutet A, Germann J, Algarni M, Oliveira LM, Neudorfer C, Widjaja E, Ibrahim GM, Kalia SK, Jain M, Lozano AM, Fasano A. Mapping efficacious deep brain stimulation for pediatric dystonia. J Neurosurg Pediatr 2021; 27:346-356. [PMID: 33385998 DOI: 10.3171/2020.7.peds20322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to report the authors' experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques. METHODS A retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets. RESULTS A total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem. CONCLUSIONS This study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.
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Affiliation(s)
- Ailish Coblentz
- 1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | | | - Alexandre Boutet
- 2University Health Network, Toronto.,3Joint Department of Medical Imaging, University of Toronto
| | | | - Musleh Algarni
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | - Lais M Oliveira
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | | | - Elysa Widjaja
- 1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | - George M Ibrahim
- 5Department of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Suneil K Kalia
- 3Joint Department of Medical Imaging, University of Toronto.,7Krembil Brain Institute, Toronto; and.,8Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Mehr Jain
- 6Faculty of Medicine, University of Ottawa
| | | | - Alfonso Fasano
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto.,7Krembil Brain Institute, Toronto; and.,8Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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12
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Parameters for subthalamic deep brain stimulation in patients with dystonia: a systematic review. J Neurol 2021; 269:197-204. [PMID: 33385242 DOI: 10.1007/s00415-020-10372-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Deep brain stimulation (DBS) is used for treating dystonia, commonly targeting the subthalamic nucleus (STN). Optimal stimulation parameters are required to achieve satisfying results. However, recommended parameters for STN-DBS remain to be identified. In this review, we aimed to assess the optimal stimulation parameters by analyzing previously published STN-DBS data of patients with dystonia. METHODS We examined the STN-DBS stimulation parameters used in studies on dystonia selected on the PubMed/Medline database. RESULTS Of the 86 publications retrieved from the PubMed/Medline database, we included 24, which consisted of data from 94 patients and 160 electrodes. Overall, the following average stimulation parameters were observed: amplitude, 2.59 ± 0.67 V; pulse width, 83.87 ± 34.70 μs; frequency, 142.08 ± 37.81 Hz. The average improvement rate was 64.72 ± 24.74%. The improvement rate and stimulation parameters were linearly dependent. The average improvement rate increased by 3.58% at each 10-Hz increase in frequency. In focal and segmental dystonia, the improvement rate and stimulation parameters were linearly dependent. The improvement rate increased by 6.06% and decreased by 2.14% at each 10-Hz increase in frequency and pulse width, respectively. Seventeen publications (83 patients) mentioned stimulation-related adverse effects, including dyskinesia (17), depression (8), transient dysarthria (5), weight gain (4), transient dysphasia (3), transient paresthesia (2), and sustained hyperkinesia (2). CONCLUSIONS The optimal stimulation parameter for STN-DBS varies across patients. Our findings may be useful for DBS programming based on the specific dystonia subtypes, especially for patients with focal and segmental dystonia.
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13
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The expanding clinical and genetic spectrum of ANO3 dystonia. Neurosci Lett 2020; 746:135590. [PMID: 33388357 DOI: 10.1016/j.neulet.2020.135590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Dystonia is a movement disorder with high clinical and genetic heterogeneity. Mutations in Anoctamin-3 (ANO3) gene have been reported to cause dystonia 24 (DYT24). This study aims to clarify the spectrum and frequency of ANO3 rare variants in Chinese populations with primary dystonia and understand the clinical and genetic features of DYT24. METHODS Sanger sequencing was used to screen all exons and exon-intron boundaries of ANO3 for rare variants in 115 primary dystonia patients. The clinical manifestations of patients with ANO3 variants in our study and previously reported literatures were further characterized. RESULTS Four distinct variants of ANO3 (c.1127A > G, c.1235 T > A, c.1531-3T > C, c.-11G > T) were identified in six unrelated individuals. Combined with our work and literature review, a total of 35 different rare variants distributed in ANO3 were identified in 62 dystonia patients. The predominant phenotype is cranio-cervical dystonia and more than half of patients develop head/limb tremor. Most of patients presented with isolated dystonia whereas few of them showed combined dystonia. The age of onset ranged from 1 to 69 years and peaked in late adulthood, while for generalized dystonia it peaked in a young age. Half of patients with generalized dystonia experienced deep brain stimulation (DBS). And all of them showed improvement of dystonia by DBS. CONCLUSIONS This study confirms a relatively high frequency of rare ANO3 variants in Chinese patients with dystonia and indicates that the late adulthood-onset, cranio-cervical dystonia seems to be an important feature of the ANO3 phenotype. Further functional studies are warranted to understand the role of ANO3 in dystonia.
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14
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Marogianni C, Georgouli D, Dadouli K, Ntellas P, Rikos D, Hadjigeorgiou GM, Spanaki C, Xiromerisiou G. Identification of a novel de novo KMT2B variant in a Greek dystonia patient via exome sequencing genotype-phenotype correlations of all published cases. Mol Biol Rep 2020; 48:371-379. [PMID: 33300088 DOI: 10.1007/s11033-020-06057-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
Mutations in Lysine-Specific Histone Methyltransferase 2B gene (KMT2B) have been reported to be associated with isolated and complex early-onset generalized dystonia. We describe clinico-genetic features on a Greek patient with a novel de novo variant and demonstrate the phenotypic spectrum of KMT2B variants. We performed whole exome sequencing (WES), in a Greek patient with sporadic generalized dystonia. Additionally, we performed a systematic review of all published cases with KMT2B variants. The patient presented with isolated and mild generalized dystonia. We identified a novel splice site variant that was confirmed by Sanger sequencing and was not found in parents. This is the first reported KMT2B variant, in the Greek population. This case report further highlights the growing trend of identifying genetic diseases previously restricted to few cases in many different ethnic groups worldwide via exome sequencing. In the systematic review, we evaluated the mutation pathogenicity in all previously reported cases to investigate possible phenotype-genotype correlations. Greater mutation numbers in different populations will be important and mutation-specific functional studies will be essential to identify the pathogenicity of the various KMT2B variants.
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Affiliation(s)
- Chrysoula Marogianni
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Despoina Georgouli
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Katerina Dadouli
- Faculty of Medicine, Department of Hygiene and Epidemiology, University of Thessaly, Larissa, Greece
| | - Panagiotis Ntellas
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Rikos
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Cleanthi Spanaki
- Department of Neurology, Medical School, University of Crete, Heraklion, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
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15
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Paracka L, Wegner F, Escher C, Klietz M, de Zwaan M, Abdallat M, Saryyeva A, Krauss JK. Body Concept and Quality of Life in Patients with Idiopathic Dystonia. Brain Sci 2020; 10:E488. [PMID: 32731476 PMCID: PMC7464975 DOI: 10.3390/brainsci10080488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with dystonia experience unusual postures and disfigurement. The aim of the study was to examine changes in the body concept in relation to quality of life and severity of dystonia. Our cohort consisted of 20 patients with idiopathic dystonia resistant to medical therapy who were planned for pallidal deep brain stimulation. The results were compared to 25 healthy controls. The patients were assessed with Frankfurt Body Concept Scale, Short Form 36 (SF-36) Health Survey, Hamilton Depression Scale, Beck Depression Inventory, Social Phobia Inventory and Social Interaction Anxiety Scale. The disease severity was evaluated with Burke-Fahn-Marsden Dystonia Rating Scale and Toronto Western Spasmodic Torticollis Rating Scale. Patients with dystonia had a significantly impaired body concept in eight out of nine subscales in comparison to healthy controls. The differences were most pronounced for the subscales general health, body care, physical efficacy, sexuality and physical appearance (p < 0.001). Furthermore, all eight subscales of SF-36 exhibited significantly lower values in patients with dystonia compared to controls. We also found significant positive correlations between SF-36 and body concept subscales. Impairment of body concept was not associated with disease severity or levels of social anxiety symptoms. However, there was a significant association between self-rated depression and disease severity. Our patients suffered from increased depression and social anxiety symptoms except social interaction anxiety. We conclude that patients with dystonia have significant body concept impairment that interferes with quality of life in both physical and emotional domains. Future studies should focus on assessing these symptoms after adequate therapeutic management of motor symptoms.
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Affiliation(s)
- Lejla Paracka
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.W.); (C.E.); (M.K.)
- Center for Systems Neuroscience, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.W.); (C.E.); (M.K.)
- Center for Systems Neuroscience, 30625 Hannover, Germany;
| | - Claus Escher
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.W.); (C.E.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.W.); (C.E.); (M.K.)
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany;
| | - Mahmoud Abdallat
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (A.S.)
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (A.S.)
| | - Joachim K. Krauss
- Center for Systems Neuroscience, 30625 Hannover, Germany;
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (A.S.)
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16
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Zhang S, Sibel J, Dadgar-Kiani M, Overdorf P, Flemming DJ, Gater DR. Cervical Dystonia Caused by Chronic Nonunion C2 Fracture: A Case Report. Arch Rehabil Res Clin Transl 2020; 2:100073. [PMID: 33543096 PMCID: PMC7853330 DOI: 10.1016/j.arrct.2020.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic nonunion cervical fracture leading to cervical dystonia (CD) is very rare. This study reports a 72-year-old man who presented with 9-month history of progressively worsening neck tilting, neck tightness, neck pain, headache, and difficulty with swallowing. The patient was referred to speech therapy and confirmed to have dysphagia on modified barium swallow study. A cervical spine radiograph showed a chronic C2 nonunion fracture. Subsequent cervical spine magnetic resonance imaging confirmed chronic C2 nonunion fracture with kyphotic deformity of the cervical canal with associated cord compression at C1-C2 and severe central canal stenosis. Needle electromyography revealed dystonic or spasmodic neck muscles, consistent with diagnosis of CD. Botulinum toxin injection resulted in marked clinical improvement. The patient finally underwent occipital to C4 posterior segmental fusion. No recurrence of CD had occurred 12 months after botulinum toxin injection and surgery, which supports the conclusion that chronic C2 nonunion fracture is most likely responsible for CD in this case. The authors suggest that all patients with CD receive dysphagia evaluation and more importantly cervical spine imaging to rule out chronic C2 nonunion fracture.
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Affiliation(s)
- Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA
| | - Jamie Sibel
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA
| | - Majid Dadgar-Kiani
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA
| | - Paul Overdorf
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA
| | - Donald J Flemming
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami, Leonard M. Miller School of Medicine, Miami, FL
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17
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Xu L, Yang Z, Li W, Luo Z, Zhang C, Huang X, Ma S, Long Y, Chu Y, Qian Y, Wang X, Sun H. Cellular analysis of a novel mutation p. Ser287Tyr in TOR1A in late-onset isolated dystonia. Neurobiol Dis 2020; 140:104851. [PMID: 32243914 DOI: 10.1016/j.nbd.2020.104851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/06/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Variations in TOR1A were thought to be associated with early-onset isolated dystonia. The variant S287Y (NM_000113.2: c.860C > A, p. Ser287Tyr, rs766483672) was found in our late-onset isolated dystonia patient. This missense variant is adjacent to R288Q (c.863G > A, p. Arg288Gln), which was reported to be associated with isolated dystonia. The potentially pathogenic role of S287Y is not conclusively known. METHODS Cytological and molecular biological analyses were performed in vitro to determine whether this variant damages the structure and function of the cell. RESULTS Compared with the SH-SY5Y cells overexpressing wild-type TOR1A, the cells overexpressing the protein with S287Y have an enlarged peri-nuclear space. The same changes in nuclear morphology were also found in the cells overexpressing the pathogenic variants ΔE (NM_000113.2:c.904_906delGAG, p. Glu302del), F205I (NM_000113.2:c.613 T > A, p. Phe205Ile), and R288Q (NM_000113.2:c.863G > A, p. Arg288Gln). Mutated proteins with S287Y presented a higher tendency to form dimers under reducing conditions. The same tendencies were observed in other mutated proteins but not in wild-type torsinA. CONCLUSIONS TorsinA with S287Y damages the structure of the cell nucleus and may be a novel pathogenic mutation that causes isolated dystonia.
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Affiliation(s)
- Longjiang Xu
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaoqing Yang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Wenwu Li
- The Department of Neurology, The People's Hospital of ChuXiong Yi Autonomous Prefecture, Chuxiong, China
| | - Zhiling Luo
- The Department of Ultrasound, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Changjun Zhang
- Reproductive Medicine Center, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiaoqin Huang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Shaohui Ma
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yuzhou Long
- The Second People's Hospital of Yunnan Province, Kunming, China
| | - Yan Chu
- The Second People's Hospital of Yunnan Province, Kunming, China
| | - Yuan Qian
- Yunnan Key Laboratory of Laboratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiuyun Wang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hao Sun
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
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Abstract
Movement disorders in women during pregnancy are uncommon. Therefore, high quality studies are limited, and guidelines are lacking for the treatment of movement disorders in pregnancy, thus posing a significant therapeutic challenge for the treating physicians. In this chapter, we discuss movement disorders that arise during pregnancy and the preexisting movement disorders during pregnancy. Common conditions encountered in pregnancy include but are not limited to restless legs syndrome, chorea gravidarum, Parkinson disease, essential tremor, and Huntington disease as well as more rare movement disorders (Wilson's disease, dystonia, etc.). This chapter summarizes the published literature on movement disorders and pharmacologic and surgical considerations for neurologists and physicians in other specialties caring for patients who are pregnant or considering pregnancy.
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Affiliation(s)
- Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Miterko LN, Baker KB, Beckinghausen J, Bradnam LV, Cheng MY, Cooperrider J, DeLong MR, Gornati SV, Hallett M, Heck DH, Hoebeek FE, Kouzani AZ, Kuo SH, Louis ED, Machado A, Manto M, McCambridge AB, Nitsche MA, Taib NOB, Popa T, Tanaka M, Timmann D, Steinberg GK, Wang EH, Wichmann T, Xie T, Sillitoe RV. Consensus Paper: Experimental Neurostimulation of the Cerebellum. CEREBELLUM (LONDON, ENGLAND) 2019; 18:1064-1097. [PMID: 31165428 PMCID: PMC6867990 DOI: 10.1007/s12311-019-01041-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The cerebellum is best known for its role in controlling motor behaviors. However, recent work supports the view that it also influences non-motor behaviors. The contribution of the cerebellum towards different brain functions is underscored by its involvement in a diverse and increasing number of neurological and neuropsychiatric conditions including ataxia, dystonia, essential tremor, Parkinson's disease (PD), epilepsy, stroke, multiple sclerosis, autism spectrum disorders, dyslexia, attention deficit hyperactivity disorder (ADHD), and schizophrenia. Although there are no cures for these conditions, cerebellar stimulation is quickly gaining attention for symptomatic alleviation, as cerebellar circuitry has arisen as a promising target for invasive and non-invasive neuromodulation. This consensus paper brings together experts from the fields of neurophysiology, neurology, and neurosurgery to discuss recent efforts in using the cerebellum as a therapeutic intervention. We report on the most advanced techniques for manipulating cerebellar circuits in humans and animal models and define key hurdles and questions for moving forward.
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Affiliation(s)
- Lauren N Miterko
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA
| | - Kenneth B Baker
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Jaclyn Beckinghausen
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA
| | - Lynley V Bradnam
- Department of Exercise Science, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Michelle Y Cheng
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
| | - Jessica Cooperrider
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mahlon R DeLong
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Simona V Gornati
- Department of Neuroscience, Erasmus Medical Center, 3015 AA, Rotterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Building 10, Room 7D37, 10 Center Dr MSC 1428, Bethesda, MD, 20892-1428, USA
| | - Detlef H Heck
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, 855 Monroe Ave, Memphis, TN, 38163, USA
| | - Freek E Hoebeek
- Department of Neuroscience, Erasmus Medical Center, 3015 AA, Rotterdam, Netherlands
- NIDOD Department, Wilhelmina Children's Hospital, University Medical Center Utrecht Brain Center, Utrecht, Netherlands
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong, VIC, 3216, Australia
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Neuroepidemiology and Clinical Research, Yale School of Medicine, Yale University, New Haven, CT, 06520, USA
| | - Andre Machado
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mario Manto
- Service de Neurologie, CHU-Charleroi, 6000, Charleroi, Belgium
- Service des Neurosciences, Université de Mons, 7000, Mons, Belgium
| | - Alana B McCambridge
- Graduate School of Health, Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Michael A Nitsche
- Department of Psychology and Neurosiences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | | | - Traian Popa
- Human Motor Control Section, NINDS, NIH, Building 10, Room 7D37, 10 Center Dr MSC 1428, Bethesda, MD, 20892-1428, USA
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Ecole Polytechnique Federale de Lausanne (EPFL), Sion, Switzerland
| | - Masaki Tanaka
- Department of Physiology, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan
| | - Dagmar Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
- R281 Department of Neurosurgery, Stanfod University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Eric H Wang
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
| | - Thomas Wichmann
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30322, USA
| | - Tao Xie
- Department of Neurology, University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL, 60637-1470, USA
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA.
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Piña-Fuentes D, Beudel M, Little S, van Zijl J, Elting JW, Oterdoom DLM, van Egmond ME, van Dijk JMC, Tijssen MAJ. Toward adaptive deep brain stimulation for dystonia. Neurosurg Focus 2019; 45:E3. [PMID: 30064317 DOI: 10.3171/2018.5.focus18155] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The presence of abnormal neural oscillations within the cortico-basal ganglia-thalamo-cortical (CBGTC) network has emerged as one of the current principal theories to explain the pathophysiology of movement disorders. In theory, these oscillations can be used as biomarkers and thereby serve as a feedback signal to control the delivery of deep brain stimulation (DBS). This new form of DBS, dependent on different characteristics of pathological oscillations, is called adaptive DBS (aDBS), and it has already been applied in patients with Parkinson's disease. In this review, the authors summarize the scientific research to date on pathological oscillations in dystonia and address potential biomarkers that might be used as a feedback signal for controlling aDBS in patients with dystonia.
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Affiliation(s)
- Dan Piña-Fuentes
- Departments of1Neurosurgery and.,2Neurology, University Medical Center Groningen, University of Groningen
| | - Martijn Beudel
- 2Neurology, University Medical Center Groningen, University of Groningen.,3Department of Neurology, Isala Klinieken, Zwolle, The Netherlands; and
| | - Simon Little
- 4Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Jonathan van Zijl
- 2Neurology, University Medical Center Groningen, University of Groningen
| | - Jan Willem Elting
- 2Neurology, University Medical Center Groningen, University of Groningen
| | | | | | | | - Marina A J Tijssen
- 2Neurology, University Medical Center Groningen, University of Groningen
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Painful Myoclonus Triggered by Lateral Antebrachial Cutaneous Nerve Entrapment at the Brachioradialis Muscle. Am J Phys Med Rehabil 2019; 99:e94-e96. [PMID: 31361616 DOI: 10.1097/phm.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Compression of the lateral antebrachial cutaneous nerve is a rare clinical entrapment syndrome often overlooked as an initial etiology of pain. We present a case of an episodic upper limb painful movement disorder (myoclonus) in a 16-yr-old adolescent girl with a remote history of a surgically stabilized supracondylar humeral fracture who was later found to have entrapment of the lateral antebrachial cutaneous nerve. The incidence of a painful myoclonus triggered by a peripheral nerve entrapment is unknown. Combining a history and physical examination, electromyography, nerve conduction studies, and ultrasound enabled us to make an accurate diagnosis that was confirmed by resolution of symptoms after surgical release. This study conforms to all CARE guidelines and reports the required information accordingly (see Supplemental Check list, Supplemental Digital Content 1, http://links.lww.com/PHM/A855).
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22
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Carecchio M, Invernizzi F, Gonzàlez-Latapi P, Panteghini C, Zorzi G, Romito L, Leuzzi V, Galosi S, Reale C, Zibordi F, Joseph AP, Topf M, Piano C, Bentivoglio AR, Girotti F, Morana P, Morana B, Kurian MA, Garavaglia B, Mencacci NE, Lubbe SJ, Nardocci N. Frequency and phenotypic spectrum of KMT2B dystonia in childhood: A single-center cohort study. Mov Disord 2019; 34:1516-1527. [PMID: 31216378 DOI: 10.1002/mds.27771] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood-onset dystonia is often genetically determined. Recently, KMT2B variants have been recognized as an important cause of childhood-onset dystonia. OBJECTIVE To define the frequency of KMT2B mutations in a cohort of dystonic patients aged <18 years at onset, the associated clinical and radiological phenotype, and the natural history of disease. METHODS Whole-exome sequencing or customized gene panels were used to screen a cohort of 65 patients who had previously tested negative for all other known dystonia-associated genes. RESULTS We identified 14 patients (21.5%) carrying KMT2B variants, of which 1 was classified as a variant of unknown significance. We also identified 2 additional patients carrying pathogenic mutations in GNAO1 and ATM. Overall, we established a definitive genetic diagnosis in 23% of cases. We observed a spectrum of clinical manifestations in KMT2B variant carriers, ranging from generalized dystonia to short stature or intellectual disability alone, even within the same family. In 78.5% of cases, dystonia involved the lower limbs at onset, with later caudocranial generalization. Eight patients underwent pallidal DBS with a median decrease of Burke-Fahn-Marsden Dystonia Rating Scale-Motor score of 38.5% in the long term. We also report on 4 asymptomatic carriers, suggesting that some KMT2B mutations may be associated with incomplete disease penetrance. CONCLUSIONS KMT2B mutations are frequent in childhood-onset dystonia and cause a complex neurodevelopmental syndrome, often featuring growth retardation and intellectual disability as additional phenotypic features. A dramatic and long-lasting response to DBS is characteristic of DYT-KMT2B dystonia. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Miryam Carecchio
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - Federica Invernizzi
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paulina Gonzàlez-Latapi
- Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Celeste Panteghini
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanna Zorzi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Romito
- Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Chiara Reale
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Zibordi
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Agnel P Joseph
- Institute of Structural and Molecular Biology, Crystallography/Department of Biological Sciences, Birkbeck College, University of London, London, United Kingdom
| | - Maya Topf
- Institute of Structural and Molecular Biology, Crystallography/Department of Biological Sciences, Birkbeck College, University of London, London, United Kingdom
| | - Carla Piano
- Policlinico Gemelli Foundation, Institute of Neurology, Catholic University, Rome, Italy
| | - Anna Rita Bentivoglio
- Policlinico Gemelli Foundation, Institute of Neurology, Catholic University, Rome, Italy
| | - Floriano Girotti
- Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences, UCL Institute of Child Health, London, United Kingdom.,Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Barbara Garavaglia
- Molecular Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Niccolò E Mencacci
- Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steven J Lubbe
- Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nardo Nardocci
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Pirio Richardson S, Jinnah HA. New approaches to discovering drugs that treat dystonia. Expert Opin Drug Discov 2019; 14:893-900. [PMID: 31159587 DOI: 10.1080/17460441.2019.1623785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Dystonia consists of involuntary movements, abnormal posturing, and pain. In adults, dystonia presents in a particular region of the body and causes significant disability due to pain as well as impairment in activities of daily living and employment. The current gold standard treatment, botulinum toxin (BoNT), has limitations - painful, frequent injections due to 'wearing off' of treatment effect; expense; and expected side effects like swallowing difficulty and weakness. There is a clear therapeutic gap in our current treatment options for dystonia and also a clear need for an effective novel treatment. Testing any novel treatment is complicated because most adults with focal dystonia are treated with BoNT. Areas covered: This review focuses on establishing the need for novel therapeutics. It also suggests potential leads from preclinical studies; and, discusses the issue of clinical trial readiness in the dystonia field. Expert opinion: Identifying a novel therapeutic intervention for dystonia patients faces two major challenges. The first is acknowledging the therapeutic gap that currently exists. Second, shifting some of our research aims in dystonia to clinical trial readiness is imperative if we are to be ready to test novel therapeutic agents.
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Affiliation(s)
- Sarah Pirio Richardson
- a Department of Neurology, University of New Mexico Health Sciences Center , Albuquerque , NM , USA.,b Neurology Service, New Mexico Veterans Affairs Health Care System , Albuquerque , NM , USA
| | - H A Jinnah
- c Departments of Neurology, Human Genetics & Pediatrics, Emory University School of Medicine , Atlanta , Georgia
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24
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Sasikumar S, Albanese A, Krauss JK, Fasano A. Implementation of the Current Dystonia Classification from 2013 to 2018. Mov Disord Clin Pract 2019; 6:250-253. [PMID: 30949557 DOI: 10.1002/mdc3.12736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 11/05/2022] Open
Abstract
Background There is a discrepancy in the way dystonia is classified in the literature, as articles continue to reference the old criteria or fail to use the 2013 criteria correctly. Methods We performed a systematic review of the dystonia literature and distinguished between studies that use the new classification correctly, made errors in implementing the new classification, or continued to use the old classification methods. Results Of the 990 articles included in the study, 59.8% used the classification correctly, 31.3% used mixed terminology, and 8.9% continued to use the old classification. Articles relating to surgery were significantly less likely to use the new classification correctly. There is an upward trend in the annual rate of articles properly referencing the new classification. Conclusions The 2013 classification has been well received in scientific literature, and more studies are adapting to its use.
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Affiliation(s)
- Sanskriti Sasikumar
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN, Division of Neurology, University of Toronto Toronto Ontario Canada
| | - Alberto Albanese
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milano Italy.,Department of Neurology Catholic University Milano Italy
| | - Joachim K Krauss
- Department of Neurosurgery Medical School Hannover Hannover Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN, Division of Neurology, University of Toronto Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada
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Abstract
Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions. Dystonia can be the manifesting neurological sign of many disorders, either in isolation (isolated dystonia) or with additional signs (combined dystonia). The main focus of this Primer is forms of isolated dystonia of idiopathic or genetic aetiology. These disorders differ in manifestations and severity but can affect all age groups and lead to substantial disability and impaired quality of life. The discovery of genes underlying the mendelian forms of isolated or combined dystonia has led to a better understanding of its pathophysiology. In some of the most common genetic dystonias, such as those caused by TOR1A, THAP1, GCH1 and KMT2B mutations, and idiopathic dystonia, these mechanisms include abnormalities in transcriptional regulation, striatal dopaminergic signalling and synaptic plasticity and a loss of inhibition at neuronal circuits. The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge. Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection and deep brain stimulation are available; however, future research will hopefully lead to reliable biomarkers, better treatments and cure of this disorder.
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26
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Piña-Fuentes D, van Zijl JC, van Dijk JMC, Little S, Tinkhauser G, Oterdoom DLM, Tijssen MAJ, Beudel M. The characteristics of pallidal low-frequency and beta bursts could help implementing adaptive brain stimulation in the parkinsonian and dystonic internal globus pallidus. Neurobiol Dis 2018; 121:47-57. [PMID: 30227227 DOI: 10.1016/j.nbd.2018.09.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Adaptive deep brain stimulation (aDBS) has been applied in Parkinson's disease (PD), based on the presence of brief high-amplitude beta (13-35 Hz) oscillation bursts in the subthalamic nucleus (STN), which correlate with symptom severity. Analogously, average low-frequency (LF) oscillatory power (4-12 Hz) in the internal globus pallidus (GPi) correlates with dystonic symptoms and might be a suitable physiomarker for aDBS in dystonia. Characterization of pallidal bursts could facilitate the implementation of aDBS in the GPi of PD and dystonia patients. OBJECTIVE AND METHODS We aimed to describe the bursting behaviour of LF and beta oscillations in a cohort of five GPi-DBS PD patients and compare their amplitude and length with those of a cohort of seven GPi-DBS dystonia, and six STN-DBS PD patients (n electrodes = 34). Furthermore, we used the information obtained to set up aDBS and test it in the GPi of both a dystonia and a PD patient (n = 2), using either LF (dystonia) or beta oscillations (PD) as feedback signals. RESULTS LF and beta oscillations in the dystonic and parkinsonian GPi occur as phasic, short-lived bursts, similarly to the parkinsonian STN. The amplitude profile of such bursts, however, differed significantly. Dystonia showed higher LF burst amplitudes, while PD presented higher beta burst amplitudes. Burst characteristics in the parkinsonian GPi and STN were similar. Furthermore, aDBS applied in the GPi was feasible and well tolerated in both diseases. CONCLUSION Pallidal LF and beta burst amplitudes have different characteristics in PD and dystonia. The presence of increased burst amplitudes could be employed as feedback for GPi-aDBS.
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Affiliation(s)
- Dan Piña-Fuentes
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jonathan C van Zijl
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Simon Little
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Gerd Tinkhauser
- Medical Research Council Brain Network Dynamics Unit and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martijn Beudel
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Neurology, Isala Clinics, Zwolle, The Netherlands.
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27
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Vinagre-Aragón A, Zis P, Grunewald RA, Hadjivassiliou M. Movement Disorders Related to Gluten Sensitivity: A Systematic Review. Nutrients 2018; 10:E1034. [PMID: 30096784 PMCID: PMC6115931 DOI: 10.3390/nu10081034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022] Open
Abstract
Gluten related disorders (GRD) represent a wide spectrum of clinical manifestations that are triggered by the ingestion of gluten. Coeliac disease (CD) or gluten sensitive enteropathy is the most widely recognised, but extra-intestinal manifestations have also been increasingly identified and reported. Such manifestations may exist in the absence of enteropathy. Gluten sensitivity (GS) is another term that has been used to include all GRD, including those where there is serological positivity for GS related antibodies in the absence of an enteropathy. Gluten ataxia (GA) is the commonest extraintestinal neurological manifestation and it has been the subject of many publications. Other movement disorders (MDs) have also been reported in the context of GS. The aim of this review was to assess the current available medical literature concerning MDs and GS with and without enteropathy. A systematic search was performed while using PubMed database. A total of 48 articles met the inclusion criteria and were included in the present review. This review highlights that the phenomenology of gluten related MDs is broader than GA and demonstrates that gluten-free diet (GFD) is beneficial in a great percentage of such cases.
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Affiliation(s)
- Ana Vinagre-Aragón
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, South Yorkshire, UK.
| | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, South Yorkshire, UK.
| | - Richard Adam Grunewald
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, South Yorkshire, UK.
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, South Yorkshire, UK.
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29
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Lee WW, Jeon B, Kim R. Expanding the Spectrum of Dopa-Responsive Dystonia (DRD) and Proposal for New Definition: DRD, DRD-plus, and DRD Look-alike. J Korean Med Sci 2018; 33:e184. [PMID: 29983692 PMCID: PMC6033101 DOI: 10.3346/jkms.2018.33.e184] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/10/2018] [Indexed: 12/14/2022] Open
Abstract
Previously, we defined DRD as a syndrome of selective nigrostriatal dopamine deficiency caused by genetic defects in the dopamine synthetic pathway without nigral cell loss. DRD-plus also has the same etiologic background with DRD, but DRD-plus patients have more severe features that are not seen in DRD because of the severity of the genetic defect. However, there have been many reports of dystonia responsive to dopaminergic drugs that do not fit into DRD or DRD-plus (genetic defects in the dopamine synthetic pathway without nigral cell loss). We reframed the concept of DRD/DRD-plus and proposed the concept of DRD look-alike to include the additional cases described above. Examples of dystonia that is responsive to dopaminergic drugs include the following: transportopathies (dopamine transporter deficiency; vesicular monoamine transporter 2 deficiency); SOX6 mutation resulting in a developmentally decreased number of nigral cells; degenerative disorders with progressive loss of nigral cells (juvenile Parkinson's disease; pallidopyramidal syndrome; spinocerebellar ataxia type 3), and disorders that are not known to affect the nigrostriatal dopaminergic system (DYT1; GLUT1 deficiency; myoclonus-dystonia; ataxia telangiectasia). This classification will help with an etiologic diagnosis as well as planning the work up and guiding the therapy.
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Affiliation(s)
- Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ryul Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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Rossi M, Balint B, Millar Vernetti P, Bhatia KP, Merello M. Genetic Dystonia-ataxia Syndromes: Clinical Spectrum, Diagnostic Approach, and Treatment Options. Mov Disord Clin Pract 2018; 5:373-382. [PMID: 30363394 PMCID: PMC6174447 DOI: 10.1002/mdc3.12635] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Dystonia and ataxia are manifestations of numerous disorders, and indeed, an ever-expanding spectrum of genes causing diseases that encompass dystonia and ataxia are discovered with the advances of genetic techniques. In recent years, a pathophysiological link between both clinical features and the role of the cerebellum in the genesis of dystonia, in some cases, has been proposed. In clinical practice, the genetic diagnosis of dystonia-ataxia syndromes is a major issue for genetic counseling, prognosis and, occasionally, specific treatment. METHODS For this pragmatic and educational review, we conducted a comprehensive and structured literature search in Pubmed, OMIM, and GeneReviews using the key words "dystonia" and "ataxia" to identify those genetic diseases that may combine dystonia with ataxia. RESULTS There are a plethora of genetic diseases causing dystonia and ataxia. We propose a series of clinico-radiological algorithms to guide their differential diagnosis depending on the age of onset, additional neurological or systemic features, and imaging findings. We suggest a sequential diagnostic approach to dystonia-ataxia syndromes. We briefly highlight the pathophysiological links between dystonia and ataxia and conclude with a review of specific treatment implications. CONCLUSIONS The clinical approach presented in this review is intended to improve the diagnostic success of clinicians when faced with patients with dystonia-ataxia syndromes.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology, Queen SquareLondonWC1N3BGUK
- Department of NeurologyUniversity HospitalHeidelbergGermany
- Neuroimmunology Group, Nuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalOxfordUK
| | - Patricio Millar Vernetti
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology, Queen SquareLondonWC1N3BGUK
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)
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Cury RG, Kalia SK, Shah BB, Jimenez-Shahed J, Prashanth LK, Moro E. Surgical treatment of dystonia. Expert Rev Neurother 2018; 18:477-492. [PMID: 29781334 DOI: 10.1080/14737175.2018.1478288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.
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Affiliation(s)
- Rubens Gisbert Cury
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France.,b Department of Neurology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Suneil Kumar Kalia
- c Division of Neurosurgery and Krembil Research Institute, Department of Surgery , University of Toronto , Toronto , Canada
| | - Binit Bipin Shah
- d Parkinson's Disease and Movement Disorders Center, Department of Neurology , University of Virginia , Charlottesville , VA , USA
| | - Joohi Jimenez-Shahed
- e Parkinson's Disease Center and Movement Disorders Clinic , Baylor College of Medicine , Houston , TX , USA
| | | | - Elena Moro
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France
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Mandarelli G, Moretti G, Pasquini M, Nicolò G, Ferracuti S. Informed Consent Decision-Making in Deep Brain Stimulation. Brain Sci 2018; 8:E84. [PMID: 29751598 PMCID: PMC5977075 DOI: 10.3390/brainsci8050084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.
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Affiliation(s)
- Gabriele Mandarelli
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Germana Moretti
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Massimo Pasquini
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Giuseppe Nicolò
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Stefano Ferracuti
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
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33
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Kaji R, Bhatia K, Graybiel AM. Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin? J Neurol Neurosurg Psychiatry 2018; 89:488-492. [PMID: 29089396 PMCID: PMC5909758 DOI: 10.1136/jnnp-2017-316250] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/27/2017] [Accepted: 10/08/2017] [Indexed: 02/05/2023]
Abstract
Dystonia is a disorder of motor programmes controlling semiautomatic movements or postures, with clinical features such as sensory trick, which suggests sensorimotor mismatch as the basis. Dystonia was originally classified as a basal ganglia disease. It is now regarded as a 'network' disorder including the cerebellum, but the exact pathogenesis being unknown. Rare autopsy studies have found pathology both in the striatum and the cerebellum, and functional disorganisation was reported in the somatosensory cortex in patients. Recent animal studies showed physiologically tight disynaptic connections between the cerebellum and the striatum. We review clinical evidence in light of this new functional interaction between the cerebellum and basal ganglia, and put forward a hypothesis that dystonia is a basal ganglia disorder that can be induced by aberrant afferent inputs from the cerebellum.
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Affiliation(s)
- Ryuji Kaji
- Department of Neurology, Tokushima University School of Medicine, Tokushima, Japan
| | - Kailash Bhatia
- Sobell Department of Movement Neuroscience, UCL Institute of Neurology, London, UK
| | - Ann M Graybiel
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology McGovern Institute for Brain Research, Cambridge, Massachusetts, USA
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Review of differential diagnosis and management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg 2018; 24:203-7. [PMID: 26900821 DOI: 10.1097/moo.0000000000000253] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. RECENT FINDINGS Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. SUMMARY Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.
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Abstract
Dystonia is one of the most frequent movement disorders in childhood. It can impede normal motor development and cause significant motor disability. The diagnostic evaluation of childhood dystonia is challenging due to the phenotypic variability and heterogeneous etiologies. Evidence to guide the diagnostic evaluation and treatment is limited. Assessment is primarily directed by clinical history and distinctive examination findings. Neuroimaging is typically necessary to evaluate for acquired or complex inherited dystonias. A trial of levodopa can be both diagnostic and therapeutic in children with dopa-responsive dystonia. However, for the majority of children with early-onset dystonia, treatment is symptomatic with varying efficacy. There is a paucity of therapeutic trials for childhood dystonia and most treatment recommendations are consensus or expert opinion driven. This review summarizes the available evidence and guidelines on the diagnostic evaluation and pharmacological treatment of childhood-onset dystonia and provides practical frameworks to approach both issues based on best evidence.
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Li J, Long Y, Huang X, Chen Y, Chen W, Liu S, Chu J, Yang Z, Sun H, Fang K. Deletion variant rs35153737 in TOR1A is associated with isolated dystonia in a Southwestern Chinese Population. Neurosci Lett 2017; 657:1-4. [PMID: 28756192 DOI: 10.1016/j.neulet.2017.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND TOR1A plays a very important role in early-onset isolated dystonia. Studying the association between the common variants of this gene and dystonia can help us understand the connection between TOR1A mutations and this disease. METHODS The TOR1A exon 5 was sequenced in 223 isolated dystonia patients and 210 age-adjusted controls. Patients and controls all came from Southwest China. RESULTS The following two common variants were found in the 3'-UTR of TOR1A: NM_000113.2:c.*414delG (rs35153737) and NM_000113.2:c.*824delG (rs3842225). The rs35153737 variant showed a statistically significant association with dystonia using the allele model (P=0.035) and the dominant genetic model (P=0.018); however, no association between rs3842225 and dystonia was found. CONCLUSION Our study suggests that there is an association between rs35153737 and dystonia in a southwestern Chinese population, and it may be caused by high linkage disequilibrium between this deletion and potential pathogenic variants in TOR1A.
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Affiliation(s)
- Jiang Li
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuzhou Long
- Department of Neurology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoqin Huang
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yuan Chen
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Weikang Chen
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shang Liu
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiayou Chu
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaoqing Yang
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hao Sun
- Department of Medical Genetics, The Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
| | - Kewei Fang
- Department of Urology Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
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Hintze JM, Ludlow CL, Bansberg SF, Adler CH, Lott DG. Spasmodic Dysphonia: A Review. Part 1: Pathogenic Factors. Otolaryngol Head Neck Surg 2017; 157:551-557. [PMID: 28850801 DOI: 10.1177/0194599817728521] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The purpose of this review is to describe the recent advances in identifying possible factors involved in the pathogenesis of spasmodic dysphonia. Spasmodic dysphonia is a task-specific focal laryngeal dystonia characterized by irregular and uncontrolled voice breaks. Pathogenesis of the disorder is poorly understood. Data Sources PubMed, Google Scholar, and Cochrane Library. Review Methods The data sources were searched using the following search terms: ( spasmodic dysphonia or laryngeal dystonia) and ( etiology, aetiology, diagnosis, pathogenesis, or pathophysiology). Conclusions Several potential etiological factors have been proposed by epidemiological, genetic, and neuropathological studies. Spasmodic dysphonia is a rare disorder primarily affecting females beginning in their 40s. Vocal tremor co-occurs in 30% to 60%. Large cohort studies identified risk factors such as a family history of neurological disorders including dystonia and tremor, recent viral illness, and heavy voice use. As none are rare events, a complex interactive process may contribute to pathogenesis in a small proportion of those at risk. Consequences to pathogenesis are neurological processes found in spasmodic dysphonia: loss of cortical inhibition, sensory processing disturbances, and neuroanatomical and physiological differences in the laryngeal motor control system. Implications for Practice Diagnosis of spasmodic dysphonia usually includes speech and laryngoscopic assessment. However, as diagnosis is sometimes problematic, measurement of neurophysiological abnormalities may contribute useful adjuncts for the diagnosis of spasmodic dysphonia in the future.
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Affiliation(s)
- Justin M Hintze
- 1 Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Christy L Ludlow
- 2 Department of Communication Sciences and Disorders, James Madison University, Virginia, USA
| | - Stephen F Bansberg
- 3 Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Charles H Adler
- 4 Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David G Lott
- 1 Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.,3 Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Tewari A, Fremont R, Khodakhah K. It's not just the basal ganglia: Cerebellum as a target for dystonia therapeutics. Mov Disord 2017; 32:1537-1545. [PMID: 28843013 DOI: 10.1002/mds.27123] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/01/2023] Open
Abstract
Dystonia is a common movement disorder that devastates the lives of many patients, but the etiology of this disorder remains poorly understood. Dystonia has traditionally been considered a disorder of the basal ganglia. However, growing evidence suggests that the cerebellum may be involved in certain types of dystonia, raising several questions. Can different types of dystonia be classified as either a basal ganglia disorder or a cerebellar disorder? Is dystonia a network disorder that involves the cerebellum and basal ganglia? If dystonia is a network disorder, how can we target treatments to alleviate symptoms in patients? A recent study by Chen et al, using the pharmacological mouse model of rapid-onset dystonia parkinsonism, has provided some insight into these important questions. They showed that the cerebellum can directly modulate basal ganglia activity through a short latency cerebello-thalamo-basal ganglia pathway. Further, this article and others have provided evidence that in some cases, aberrant cerebello-basal ganglia communication can be involved in dystonia. In this review we examine the evidence for the involvement of the cerebellum and cerebello-basal ganglia interactions in dystonia. We conclude that there is ample evidence to suggest that the cerebellum plays a role in some dystonias, including the early-onset primary torsion dystonia DYT1 and that further studies examining the role of this brain region and its interaction with the basal ganglia in dystonia are warranted. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Fremont
- Columbia University Medical Center, Department of Psychiatry, New York, New York, USA
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
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Zech M, Jech R, Havránková P, Fečíková A, Berutti R, Urgošík D, Kemlink D, Strom TM, Roth J, Růžička E, Winkelmann J. KMT2B rare missense variants in generalized dystonia. Mov Disord 2017; 32:1087-1091. [PMID: 28520167 DOI: 10.1002/mds.27026] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Recently a novel syndrome of childhood-onset generalized dystonia originating from mutations in lysine-specific methyltransferase 2B (KMT2B) has been reported. METHODS We sequenced the exomes of 4 generalized dystonia-affected probands recruited from a Prague movement disorders center (Czech Republic). Bioinformatics analyses were conducted to select candidate causal variants in described dystonia-mutated genes. After cosegregation testing, checklists from the American College of Medical Genetics and Genomics were adopted to judge variant pathogenicity. RESULTS Three novel, predicted protein-damaging missense variants in KMT2B were identified (p.Glu1234Lys, p.Ala1541Val, p.Arg1779Gln). Meeting pathogenicity criteria, p.Glu1234Lys was absent from population-based controls, situated in a key protein domain, and had occurred de novo. The associated phenotype comprised adolescence-onset generalized isolated dystonia with prominent speech impairment. Although linked to a similar clinical expression, p.Ala1541Val and p.Arg1779Gln remained of uncertain significance. CONCLUSIONS Rare missense variation in KMT2B represents an additional cause of generalized dystonia. Application of sequence interpretation standards is required before assigning pathogenicity to a KMT2B missense variant. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michael Zech
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Petra Havránková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Anna Fečíková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Riccardo Berutti
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, Germany
| | - Dušan Urgošík
- Department of Stereotactic Neurosurgery and Radiosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Tim M Strom
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, Germany.,Institut für Humangenetik, Technische Universität München, Munich, Germany
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Juliane Winkelmann
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institut für Humangenetik, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
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Long Y, Chen Y, Qian Y, Wang J, Luo L, Huang X, Li L, Chu J, Yang Z, Sun H. A rare variant in TOR1A exon 5 associated with isolated dystonia in southwestern Chinese. Mov Disord 2017; 32:1083-1087. [PMID: 28432771 DOI: 10.1002/mds.27016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND TOR1A has been proposed as an important genetic factor in early-onset isolated dystonia. Variants located in the 3' untranslated region of TOR1A are of particular importance because they may influence gene expression, although related studies are limited. The objectives of the present study focused on variants in the TOR1A 3' untranslated region. METHODS The last exon of TOR1A was sequenced in 229 cases with isolated dystonia and in 210 controls. In addition, 471 controls were tested to determine the frequency of the variants in the 3' untranslated region. RESULTS Except for c.904_906delGAG, 3 rare sequence variants (NM_000113.2:c.*454T>A, NM_000113.2:c.860C>A [rs766483672], and NM_000113.2:c.*302T>A [rs563498119]) were found only in the patients. The c.*302T>A variant was located in the conserved region of the human microRNA (hsa-miR-494) binding site. A luciferase reporter assay showed that c.*302T>A significantly altered gene expression. CONCLUSIONS Population frequencies, computational analyses, and function experiments in this study implied that c.*302T>A is associated with dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yuzhou Long
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yang Chen
- Department of Ultrasound, First People's Hospital of Yunnan Province, Kunming, China
| | - Yuan Qian
- Obstetrics and Gynecology Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianlin Wang
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lihua Luo
- Neurology Department, Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoqin Huang
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Li Li
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Jiayou Chu
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaoqing Yang
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hao Sun
- Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
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Fremont R, Tewari A, Angueyra C, Khodakhah K. A role for cerebellum in the hereditary dystonia DYT1. eLife 2017; 6. [PMID: 28198698 PMCID: PMC5340526 DOI: 10.7554/elife.22775] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
DYT1 is a debilitating movement disorder caused by loss-of-function mutations in torsinA. How these mutations cause dystonia remains unknown. Mouse models which have embryonically targeted torsinA have failed to recapitulate the dystonia seen in patients, possibly due to differential developmental compensation between rodents and humans. To address this issue, torsinA was acutely knocked down in select brain regions of adult mice using shRNAs. TorsinA knockdown in the cerebellum, but not in the basal ganglia, was sufficient to induce dystonia. In agreement with a potential developmental compensation for loss of torsinA in rodents, torsinA knockdown in the immature cerebellum failed to produce dystonia. Abnormal motor symptoms in knockdown animals were associated with irregular cerebellar output caused by changes in the intrinsic activity of both Purkinje cells and neurons of the deep cerebellar nuclei. These data identify the cerebellum as the main site of dysfunction in DYT1, and offer new therapeutic targets. DOI:http://dx.doi.org/10.7554/eLife.22775.001 Dystonia is the third most common type of movement disorder after Parkinson’s disease and tremor. Patients with dystonia experience prolonged involuntary contractions of their muscles, often causing uncontrollable postures or repetitive movements. Almost thirty years ago, genetic studies revealed that a mutation in the gene that encodes a protein called torsinA causes the most common type of dystonia, called DYT1. Exactly how mutations that affect the torsinA protein give rise to DYT1 remains unclear, and there are still no effective treatments for the disorder. Part of the problem is that we do not fully understand how torsinA works, or which of its many proposed functions is relevant to dystonia. Moreover, attempts to study DYT1 using genetically modified mice have proved largely unsuccessful. This is because mice that simply express the same genetic mutations that cause dystonia in humans do not show the overt symptoms of dystonia. Fremont, Tewari et al. have now generated a mouse ‘model’ that does show symptoms of dystonia, and used these model mice to investigate the role of torsinA in the disorder. Acutely reducing the amount of torsinA protein in a region of the brain called the cerebellum induced the symptoms of dystonia in the mice. Conversely, reducing the amount of torsinA in a different brain area known as the basal ganglia had no such effect, even though both the cerebellum and the basal ganglia contribute to movement. Furthermore, neither manipulation had any effect in juvenile mice, which suggests that, in contrast to humans, young mice can compensate for the loss of torsinA. Fremont, Tewari et al. also found that the loss of torsinA causes the cerebellum to generate incorrect output signals, which in turn trigger the abnormal movements seen in dystonia. In the future, further studies of the model mice could identify the exact changes that occur in neurons following the loss of torsinA from the cerebellum. Understanding these changes could potentially pave the way for developing effective treatments for DYT1 and other dystonias. DOI:http://dx.doi.org/10.7554/eLife.22775.002
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Affiliation(s)
- Rachel Fremont
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Chantal Angueyra
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
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Verbeek DS, Gasser T. Unmet Needs in Dystonia: Genetics and Molecular Biology-How Many Dystonias? Front Neurol 2017; 7:241. [PMID: 28138320 PMCID: PMC5237827 DOI: 10.3389/fneur.2016.00241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022] Open
Abstract
Genetic findings of the past years have provided ample evidence for a substantial etiologic heterogeneity of dystonic syndromes. While an increasing number of genes are being identified for Mendelian forms of isolated and combined dystonias using classical genetic mapping and whole-exome sequencing techniques, their precise role in the molecular pathogenesis is still largely unknown. Also, the role of genetic risk factors in the etiology of sporadic dystonias is still enigmatic. Only the systematic ascertainment and precise clinical characterization of very large cohorts with dystonia, combined with systematic genetic studies, will be able to unravel the complex network of factors that determine disease risk and phenotypic expression.
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Affiliation(s)
- Dineke S Verbeek
- Department of Genetics, University Medical Center Groningen, University of Groningen , Groningen , Netherlands
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, and German Center for Neurodegenerative Diseases (DZNE) , Tübingen , Germany
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Abstract
PURPOSE OF REVIEW This review highlights the recent developments in immune-mediated movement disorders and how they reflect on clinical practice and our understanding of the underlying pathophysiological mechanisms. RECENT FINDINGS The antibody spectrum associated with stiff person syndrome and related disorders (SPSD) has broadened and, apart from the classic glutamic acid decarboxylase (GAD)- and amphiphysin-antibodies, includes now also antibodies against dipeptidyl-peptidase-like protein-6 (DPPX), gamma-aminobutyric acid type A receptor (GABAAR), glycine receptor (GlyR) and glycine transporter 2 (GlyT2). The field of movement disorders with neuronal antibodies keeps expanding with the discovery for example of antibodies against leucine rich glioma inactivated protein 1 (LGI1) and contactin associated protein 2 (Caspr2) in chorea, or antibodies targeting ARHGAP26- or Na/K ATPase alpha 3 subunit (ATP1A3) in cerebellar ataxia. Moreover, neuronal antibodies may partly account for movement disorders attributed for example to Sydenham's chorea, coeliac disease, or steroid responsive encephalopathy with thyroid antibodies. Lastly, there is an interface of immunology, genetics and neurodegeneration, e.g. in Aicardi-Goutières syndrome or the tauopathy with IgLON5-antibodies. SUMMARY Clinicians should be aware of new antibodies such as dipeptidyl-peptidase-like protein-6, gamma-aminobutyric acid type A receptor and glycine transporter 2 in stiff person syndrome and related disorders, as well as of the expanding spectrum of immune-mediated movement disorders.
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Pirio Richardson S, Wegele AR, Skipper B, Deligtisch A, Jinnah HA. Dystonia treatment: Patterns of medication use in an international cohort. Neurology 2017; 88:543-550. [PMID: 28077492 DOI: 10.1212/wnl.0000000000003596] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/08/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the frequency of medication use in patients with dystonia enrolled in an international biorepository study. METHODS In a cross-sectional analysis, we included 2,026 participants enrolled at 37 sites in the United States, Canada, Europe, and Australia through Project 1 of the Dystonia Coalition, an international biorepository study. The primary aim was to assess the frequency of medication classes recommended for treating patients with dystonia, and the secondary aim was to compare characteristics (disease type, age, sex, duration of disease, comorbid conditions, severity). RESULTS Querying the database for the presence of any medication for dystonia used (includes both injectable and oral therapy), we found 73% using medications (n = 1,488) and 27% using no dystonia medications (n = 538). Furthermore, 61% of the total sample used botulinum toxin (BoNT) therapy alone or in combination. Differences were found in medication use patterns by dystonia type, with the lowest oral medication use in focal dystonia and highest use in generalized dystonia; by region, with highest BoNT therapy rate reported in Italy and the lowest in the Northeast region of the United States; and by focal dystonia subtype, with highest BoNT therapy alone in blepharospasm and spasmodic dysphonia (49%) and lowest in other cranial dystonia (32%). CONCLUSIONS The majority of patients with dystonia enrolled in the Dystonia Coalition Project 1 were using medications to treat their dystonia. Overall, a complex picture of medication use patterns emerged, with factors such as region, disease duration, type of dystonia, disease severity, and psychiatric comorbidities all playing a significant role.
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Affiliation(s)
- Sarah Pirio Richardson
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA.
| | - Ashley R Wegele
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Betty Skipper
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - Amanda Deligtisch
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
| | - H A Jinnah
- From the Departments of Neurology (S.P.R., A.R.W., A.D.) and Family and Community Medicine (B.S.), University of New Mexico Health Sciences Center, Albuquerque; and Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University School of Medicine, Atlanta, GA
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Hudson VE, Elniel A, Ughratdar I, Zebian B, Selway R, Lin JP. A comparative historical and demographic study of the neuromodulation management techniques of deep brain stimulation for dystonia and cochlear implantation for sensorineural deafness in children. Eur J Paediatr Neurol 2017; 21:122-135. [PMID: 27562095 DOI: 10.1016/j.ejpn.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Cochlear implants for sensorineural deafness in children is one of the most successful neuromodulation techniques known to relieve early chronic neurodisability, improving activity and participation. In 2012 there were 324,000 recipients of cochlear implants globally. AIM To compare cochlear implant (CI) neuromodulation with deep brain stimulation (DBS) for dystonia in childhood and explore relations between age and duration of symptoms at implantation and outcome. METHODS Comparison of published annual UK CI figures for 1985-2009 with a retrospective cohort of the first 9 years of DBS for dystonia in children at a single-site Functional Neurosurgery unit from 2006 to 14. RESULTS From 2006 to 14, DBS neuromodulation of childhood dystonia increased by a factor of 3.8 to a total of 126 cases over the first 9 years, similar to the growth in cochlear implants which increased by a factor of 4.1 over a similar period in the 1980s rising to 527 children in 2009. The CI saw a dramatic shift in practice from implantation at >5 years of age at the start of the programme towards earlier implantation by the mid-1990s. Best language results were seen for implantation <5 years of age and duration of cochlear neuromodulation >4 years, hence implantation <1 year of age, indicating that severely deaf, pre-lingual children could benefit from cochlear neuromodulation if implanted early. Similar to initial CI use, the majority of children receiving DBS for dystonia in the first 9 years were 5-15 years of age, when the proportion of life lived with dystonia exceeds 90% thus limiting benefits. CONCLUSION Early DBS neuromodulation for acquired motor disorders should be explored to maximise the benefits of dystonia reduction in a period of maximal developmental plasticity before the onset of disability. Learning from cochlear implantation, DBS can become an accepted management option in children under the age of 5 years who have a reduced proportion of life lived with dystonia, and not viewed as a last resort reserved for only the most severe cases where benefits may be at their most limited.
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Affiliation(s)
- V E Hudson
- Guys', King's and St Thomas' School of Medical Education, United Kingdom.
| | - A Elniel
- Guys', King's and St Thomas' School of Medical Education, United Kingdom
| | | | - B Zebian
- King's College Hospital, United Kingdom
| | - R Selway
- King's College Hospital, United Kingdom
| | - J P Lin
- Evelina London Children's Hospital, United Kingdom.
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Zech M, Boesch S, Maier EM, Borggraefe I, Vill K, Laccone F, Pilshofer V, Ceballos-Baumann A, Alhaddad B, Berutti R, Poewe W, Haack TB, Haslinger B, Strom TM, Winkelmann J. Haploinsufficiency of KMT2B, Encoding the Lysine-Specific Histone Methyltransferase 2B, Results in Early-Onset Generalized Dystonia. Am J Hum Genet 2016; 99:1377-1387. [PMID: 27839873 DOI: 10.1016/j.ajhg.2016.10.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022] Open
Abstract
Early-onset generalized dystonia represents the severest form of dystonia, a hyperkinetic movement disorder defined by involuntary twisting postures. Although frequently transmitted as a single-gene trait, the molecular basis of dystonia remains largely obscure. By whole-exome sequencing a parent-offspring trio in an Austrian kindred affected by non-familial early-onset generalized dystonia, we identified a dominant de novo frameshift mutation, c.6406delC (p.Leu2136Serfs∗17), in KMT2B, encoding a lysine-specific methyltransferase involved in transcriptional regulation via post-translational modification of histones. Whole-exome-sequencing-based exploration of a further 30 German-Austrian individuals with early-onset generalized dystonia uncovered another three deleterious mutations in KMT2B-one de novo nonsense mutation (c.1633C>T [p.Arg545∗]), one de novo essential splice-site mutation (c.7050-2A>G [p.Phe2321Serfs∗93]), and one inherited nonsense mutation (c.2428C>T [p.Gln810∗]) co-segregating with dystonia in a three-generation kindred. Each of the four mutations was predicted to mediate a loss-of-function effect by introducing a premature termination codon. Suggestive of haploinsufficiency, we found significantly decreased total mRNA levels of KMT2B in mutant fibroblasts. The phenotype of individuals with KMT2B loss-of-function mutations was dominated by childhood lower-limb-onset generalized dystonia, and the family harboring c.2428C>T (p.Gln810∗) showed variable expressivity. In most cases, dystonic symptoms were accompanied by heterogeneous non-motor features. Independent support for pathogenicity of the mutations comes from the observation of high rates of dystonic presentations in KMT2B-involving microdeletion syndromes. Our findings thus establish generalized dystonia as the human phenotype associated with haploinsufficiency of KMT2B. Moreover, we provide evidence for a causative role of disordered histone modification, chromatin states, and transcriptional deregulation in dystonia pathogenesis.
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Affiliation(s)
- Michael Zech
- Institut für Neurogenomik, Helmholtz Zentrum München, 85764 Munich, Germany; Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Esther M Maier
- Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Ingo Borggraefe
- Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Katharina Vill
- Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Franco Laccone
- Institute of Medical Genetics, Medical School of Vienna, 1090 Vienna, Austria
| | | | - Andres Ceballos-Baumann
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Schön Klinik München Schwabing, 80804 Munich, Germany
| | - Bader Alhaddad
- Institut für Humangenetik, Technische Universität München, 81675 Munich, Germany
| | - Riccardo Berutti
- Institut für Humangenetik, Helmholtz Zentrum München, 85764 Munich, Germany
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Tobias B Haack
- Institut für Humangenetik, Technische Universität München, 81675 Munich, Germany; Institut für Humangenetik, Helmholtz Zentrum München, 85764 Munich, Germany; Devision of Molecular Genetics, Universitätsklinikum Tübingen, 72076 Tübingen, Germany
| | - Bernhard Haslinger
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Tim M Strom
- Institut für Humangenetik, Technische Universität München, 81675 Munich, Germany; Institut für Humangenetik, Helmholtz Zentrum München, 85764 Munich, Germany
| | - Juliane Winkelmann
- Institut für Neurogenomik, Helmholtz Zentrum München, 85764 Munich, Germany; Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany; Institut für Humangenetik, Technische Universität München, 81675 Munich, Germany; Munich Cluster for Systems Neurology, SyNergy, 81377 Munich, Germany.
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Boček V, Štětkářová I, Fečíková A, Čejka V, Urgošík D, Jech R. Pallidal stimulation in dystonia affects cortical but not spinal inhibitory mechanisms. J Neurol Sci 2016; 369:19-26. [DOI: 10.1016/j.jns.2016.07.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022]
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Zech M, Boesch S, Jochim A, Weber S, Meindl T, Schormair B, Wieland T, Lunetta C, Sansone V, Messner M, Mueller J, Ceballos-Baumann A, Strom TM, Colombo R, Poewe W, Haslinger B, Winkelmann J. Clinical exome sequencing in early-onset generalized dystonia and large-scale resequencing follow-up. Mov Disord 2016; 32:549-559. [PMID: 27666935 DOI: 10.1002/mds.26808] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dystonia is clinically and genetically heterogeneous. Despite being a first-line testing tool for heterogeneous inherited disorders, whole-exome sequencing has not yet been evaluated in dystonia diagnostics. We set up a pilot study to address the yield of whole-exome sequencing for early-onset generalized dystonia, a disease subtype enriched for monogenic causation. METHODS Clinical whole-exome sequencing coupled with bioinformatics analysis and detailed phenotyping of mutation carriers was performed on 16 consecutive cases with genetically undefined early-onset generalized dystonia. Candidate pathogenic variants were validated and tested for cosegregation. The whole-exome approach was complemented by analyzing 2 mutated yet unestablished causative genes in another 590 dystonia cases. RESULTS Whole-exome sequencing detected clinically relevant mutations of known dystonia-related genes in 6 generalized dystonia cases (37.5%), among whom 3 had novel variants. Reflecting locus heterogeneity, identified unique variants were distributed over 5 genes (GCH1, THAP1, TOR1A, ANO3, ADCY5), of which only 1 (ANO3) was mutated recurrently. Three genes (GCH1, THAP1, TOR1A) were associated with isolated generalized dystonia, whereas 2 (ANO3, ADCY5) gave rise to combined dystonia-myoclonus phenotypes. Follow-up screening of ANO3 and ADCY5 revealed a set of distinct variants of interest, the pathogenicity of which was supported by bioinformatics testing and cosegregation work. CONCLUSIONS Our study identified whole-exome sequencing as an effective strategy for molecular diagnosis of early-onset generalized dystonia and offers insights into the heterogeneous genetic architecture of this condition. Furthermore, it provides confirmatory evidence for a dystonia-relevant role of ANO3 and ADCY5, both of which likely associate with a broader spectrum of dystonic expressions than previously thought. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michael Zech
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Angela Jochim
- Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany
| | - Sandrina Weber
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany
| | - Tobias Meindl
- Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany
| | - Barbara Schormair
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany
| | - Thomas Wieland
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, Germany
| | - Christian Lunetta
- Neuromuscular Omnicentre Sud (NEMO SUD), Fondazione Aurora Onlus, Messina, Italy
| | - Valeria Sansone
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy.,Department of Biochemical Sciences for Health, University of Milan, Milan, Italy
| | | | - Joerg Mueller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Vivantes Klinikum Spandau, Berlin, Germany
| | - Andres Ceballos-Baumann
- Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany.,Schön Klinik München Schwabing, Munich, Germany
| | - Tim M Strom
- Institut für Humangenetik, Helmholtz Zentrum München, Munich, Germany.,Institut für Humangenetik, Technische Universität München, Munich, Germany
| | - Roberto Colombo
- Institute of Clinical Biochemistry, Catholic University, Rome, Italy.,Center for the Study of Rare Hereditary Diseases, Niguarda Ca' Granda Metropolitan Hospital, Milan, Italy
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Haslinger
- Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany
| | - Juliane Winkelmann
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Klinik und Poliklinik für Neurologie, Klinikum rechts der lsar, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology, SyNergy, Munich, Germany.,Institute of Human Genetics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Systematic TOR1A non-c.907_909delGAG variant analysis in isolated dystonia and controls. Parkinsonism Relat Disord 2016; 31:119-123. [PMID: 27477622 DOI: 10.1016/j.parkreldis.2016.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/10/2016] [Accepted: 07/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND An increasing number of rare, functionally relevant non-c.907_909delGAG (non-ΔGAG) variants in TOR1A have been recognized, associated with phenotypic expressions different from classic DYT1 childhood-onset generalized dystonia. Only recently, DYT1 genotype-phenotype correlations have been proposed, awaiting further elucidation in independent cohorts. METHODS We screened the entire coding sequence and the 5'-UTR region of TOR1A for rare non-ΔGAG sequence variants in a large series of 940 individuals with various forms of isolated dystonia as well as in 376 ancestry-matched controls. The frequency of rare, predicted deleterious non-ΔGAG TOR1A variants was assessed in the European sample of the Exome Aggregation Consortium (ExAC) dataset. RESULTS In the case cohort, we identified a rare 5'-UTR variant (c.-39G > T), a rare splice-region variant (c.445-8T > C), as well as one novel (p.Ile231Asn) and two rare (p.Ala163Val, p.Thr321Met) missense variants, each in a single patient with adult-onset focal/segmental isolated dystonia. Of these variants, only p.Thr321Met qualified as possibly disease-related according to variant interpretation criteria. One novel, predicted deleterious missense substitution (p.Asn208Ser) was detected in the control cohort. Among European ExAC individuals, the carrier rate of rare, predicted deleterious non-ΔGAG variants was 0.4%. CONCLUSIONS Our study does not allow the establishment of genotype-specific clinical correlations for DYT1. Further large-scale genetic screening accompanied by comprehensive segregation and functional studies is required to conclusively define the contribution of TOR1A whole-gene variation to the pathogenesis of isolated dystonia.
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50
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Abstract
Movement disorders comprise hyperkinetic involuntary movements (eg tremor, myoclonus, tics, dystonia and chorea) and hypokinetic (parkinsonism) disorders. Tics are cardinal features of primary tic disorders encompassing Tourette syndrome (TS), but are also found in some neurodegenerative conditions and may be induced by psychoactive substances. The first line treatment for tics is pharmacological (mainly dopamine receptor blockers or alpha-2 adrenergic agonists) and behavioural. Dystonia and chorea syndromes are considerably heterogeneous in aetiology, and age at onset, body distribution of the movement disorder, accompanying neurological motor and non-motor features, and systemic manifestations are all important to reach a correct aetiological diagnosis. While symptomatic pharmacological treatment remains the mainstay of treatment for choreas, deep brain stimulation surgery has a well-defined place in the management of medically refractory dystonia.
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Affiliation(s)
| | - Davide Martino
- National Parkinson Foundation International Centre of Excellence, King's College Hospital NHS Trust, London, UK and Queen Elizabeth Hospital Lewisham and Greenwich NHS Trust, London, UK
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