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Lai R, Rummey C, Amlang CJ, Lin CR, Chen TX, Perlman S, Wilmot G, Gomez CM, Schmahmann JD, Paulson H, Ying SH, Onyike CU, Zesiewicz TA, Bushara KO, Geschwind MD, Figueroa KP, Pulst SM, Subramony SH, Burns MR, Opal P, Duquette A, Ashizawa T, Hamedani AG, Davis MY, Srinivasan SR, Moore LR, Shakkottai VG, Rosenthal LS, Kuo S. Fatigue Impacts Quality of Life in People with Spinocerebellar Ataxias. Mov Disord Clin Pract 2024; 11:496-503. [PMID: 38419568 PMCID: PMC11078491 DOI: 10.1002/mdc3.14006] [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: 07/25/2023] [Revised: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Fatigue is a prevalent and debilitating symptom in neurological disorders, including spinocerebellar ataxias (SCAs). However, the risk factors of fatigue in the SCAs as well as its impact have not been well investigated. OBJECTIVES To study the prevalence of fatigue in SCAs, the factors contributing to fatigue, and the influence of fatigue on quality of life. METHODS Fatigue was assessed in 418 participants with SCA1, SCA2, SCA3, and SCA6 from the Clinical Research Consortium for the Study of Cerebellar Ataxia using the Fatigue Severity Scale. We conducted multi-variable linear regression models to examine the factors contributing to fatigue as well as the association between fatigue and quality of life. RESULTS Fatigue was most prevalent in SCA3 (52.6%), followed by SCA1 (36.7%), SCA6 (35.7%), and SCA2 (35.6%). SCA cases with fatigue had more severe ataxia and worse depressive symptoms. In SCA3, those with fatigue had a longer disease duration and longer pathological CAG repeat numbers. In multi-variable models, depressive symptoms, but not ataxia severity, were associated with more severe fatigue. Fatigue, independent of ataxia and depression, contributed to worse quality of life in SCA3 and SCA6 at baseline, and fatigue continued affecting quality of life throughout the disease course in all types of SCA. CONCLUSIONS Fatigue is a common symptom in SCAs and is closely related to depression. Fatigue significantly impacts patients' quality of life. Therefore, screening for fatigue should be considered a part of standard clinical care for SCAs.
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Affiliation(s)
- Ruo‐Yah Lai
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
- Initiative of Columbia Ataxia and TremorColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | - Christian J. Amlang
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
- Initiative of Columbia Ataxia and TremorColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklyn, New YorkNew YorkUSA
| | - Chi‐Ying R. Lin
- Alzheimer's Disease and Parkinson's Disease Centers, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
| | - Tiffany X. Chen
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
- Initiative of Columbia Ataxia and TremorColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Biomedical Engineering, Whiting School of EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Susan Perlman
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - George Wilmot
- Department of NeurologyEmory UniversityAtlantaGeorgiaUSA
| | | | - Jeremy D. Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Cognitive Behavioral Neurology Unit, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Henry Paulson
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah H. Ying
- Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Chiadi U. Onyike
- Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Khalaf O. Bushara
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Michael D. Geschwind
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Stefan M. Pulst
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
| | - Sub H. Subramony
- Department of Neurology, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Matthew R. Burns
- Department of Neurology, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Puneet Opal
- Department of NeurologyNorthwestern UniversityChicagoIllinoisUSA
| | - Antoine Duquette
- Centre Hospitalier de l'Université de MontréalUniversity of MontrealMontrealQuebecCanada
| | | | - Ali G. Hamedani
- Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marie Y. Davis
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
- Neurology DivisionVA Puget Sound Health Care SystemSeattleWAUnited States
| | | | | | - Vikram G. Shakkottai
- Department of NeurologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Sheng‐Han Kuo
- Department of NeurologyColumbia University Medical CenterNew YorkNew YorkUSA
- Initiative of Columbia Ataxia and TremorColumbia University Irving Medical CenterNew YorkNew YorkUSA
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2
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Urbini N, Siciliano L, Olivito G, Leggio M. Unveiling the role of cerebellar alterations in the autonomic nervous system: a systematic review of autonomic dysfunction in spinocerebellar ataxias. J Neurol 2023; 270:5756-5772. [PMID: 37749264 PMCID: PMC10632228 DOI: 10.1007/s00415-023-11993-8] [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: 08/17/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Autonomic dysfunctions are prevalent in several cerebellar disorders, but they have not been systematically investigated in spinocerebellar ataxias (SCAs). Studies investigating autonomic deficits in SCAs are fragmented, with each one focusing on different autonomic dysfunctions and different SCA subtypes. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a systematic review of the literature to assess the presence of autonomic dysfunctions in various SCAs. PubMed served as the primary database, and the Rayyan web application was employed for study screening. RESULTS We identified 46 articles investigating at least one autonomic function in patients with SCA. The results were analyzed and categorized based on the genetic subtype of SCA, thereby characterizing the specific autonomic deficits associated with each subtype. CONCLUSION This review confirms the presence of autonomic dysfunctions in various genetic subtypes of SCA, underscoring the cerebellum's role in the autonomic nervous system (ANS). It also emphasizes the importance of investigating these functions in clinical practice.
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Affiliation(s)
- Nicole Urbini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy.
| | - Libera Siciliano
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy
| | - Giusy Olivito
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy
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Takekoshi A, Kimura A, Yoshikura N, Yamakawa I, Urushitani M, Nakamura K, Yoshida K, Shimohata T. Clinical Features and Neuroimaging Findings of Neuropil Antibody-Positive Idiopathic Sporadic Ataxia of Unknown Etiology. CEREBELLUM (LONDON, ENGLAND) 2023; 22:915-924. [PMID: 36057079 DOI: 10.1007/s12311-022-01468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Idiopathic sporadic ataxia (ISA) is the clinical term for nonfamilial ataxia with adult-onset and a slowly progressive course. However, immune-mediated cerebellar ataxia cannot be completely excluded from ISA. The current study investigated the neuropil antibodies against cell-surface antigens and clarified the clinical features and neuroimaging findings of patients with these antibodies. Using tissue-based immunofluorescence assays (TBAs), we examined antibodies against the cerebellum in serum samples from 67 patients who met the ISA diagnostic criteria, including 30 patients with multiple system atrophy with predominant cerebellar features (MSA-C) and 20 patients with hereditary ataxia (HA), and 18 healthy control subjects. According to the TBA results, we divided subjects into three groups: subjects positive for neuropil antibodies, subjects positive for intracellular antibodies only, and subjects negative for antibodies. We compared clinical features and neuroimaging findings in ISA patients among these three groups. The prevalence of neuropil antibodies in ISA (17.9%) was significantly higher than that in MSA-C (3.3%), HA (0%), or healthy subjects (0%). The neuropil antibody-positive ISA patients showed pure cerebellar ataxia more frequently than the other ISA patients. Two neuropil antibody-positive patients showed significant improvement of cerebellar ataxia after immunotherapy. We detected neuropil antibodies in 17.9% of ISA patients. Characteristic clinical features of neuropil antibody-positive ISA patients were pure cerebellar ataxia. Some cases of neuropil antibody-positive ISA responded to immunotherapy.
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Affiliation(s)
- Akira Takekoshi
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuaki Yoshikura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Isamu Yamakawa
- Department of Neurology, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Japan
| | - Makoto Urushitani
- Department of Neurology, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Japan
| | - Katsuya Nakamura
- Department of Neurology (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kunihiro Yoshida
- Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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Sharma P, Sonakar AK, Tyagi N, Suroliya V, Kumar M, Kutum R, Asokchandran V, Ambawat S, Shamim U, Anand A, Ahmad I, Shakya S, Uppili B, Mathur A, Parveen S, Jain S, Singh J, Seth M, Zahra S, Joshi A, Goel D, Sahni S, Kamai A, Wadhwa S, Murali A, Saifi S, Chowdhury D, Pandey S, Anand KS, Narasimhan RL, Laskar S, Kushwaha S, Kumar M, Shaji CV, Srivastava MVP, Srivastava AK, Faruq M. Genetics of Ataxias in Indian Population: A Collative Insight from a Common Genetic Screening Tool. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100078. [PMID: 36618024 PMCID: PMC9744545 DOI: 10.1002/ggn2.202100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 01/11/2023]
Abstract
Cerebellar ataxias (CAs) represent a group of autosomal dominant and recessive neurodegenerative disorders affecting cerebellum with or without spinal cord. Overall, CAs have preponderance for tandem nucleotide repeat expansions as an etiological factor (10 TREs explain nearly 30-40% of ataxia cohort globally). The experience of 10 years of common genetic ataxia subtypes for ≈5600 patients' referrals (Pan-India) received at a single center is shared herein. Frequencies (in %, n) of SCA types and FRDA in the sample cohort are observed as follows: SCA12 (8.6%, 490); SCA2 (8.5%, 482); SCA1 (4.8%, 272); SCA3 (2%, 113); SCA7 (0.5%, 28); SCA6 (0.1%, 05); SCA17 (0.1%, 05), and FRDA (2.2%, 127). A significant amount of variability in TRE lengths at each locus is observed, we noted presence of biallelic expansion, co-occurrence of SCA-subtypes, and the presence of premutable normal alleles. The frequency of mutated GAA-FRDA allele in healthy controls is 1/158 (0.63%), thus an expected FRDA prevalence of 1:100 000 persons. The data of this study are relevant not only for clinical decision making but also for guidance in direction of genetic investigations, transancestral comparison of genotypes, and lastly provide insight for policy decision for the consideration of SCAs under rare disease category.
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Affiliation(s)
- Pooja Sharma
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | | | - Nishu Tyagi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Varun Suroliya
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Manish Kumar
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Rintu Kutum
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Vivekananda Asokchandran
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Sakshi Ambawat
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Uzma Shamim
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Avni Anand
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Ishtaq Ahmad
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Sunil Shakya
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Bharathram Uppili
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aradhana Mathur
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shaista Parveen
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shweta Jain
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Jyotsna Singh
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Malika Seth
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Sana Zahra
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aditi Joshi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Divya Goel
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shweta Sahni
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Asangla Kamai
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Saruchi Wadhwa
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aparna Murali
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Sheeba Saifi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | | | - Sanjay Pandey
- Department of NeurologyGB Pant HospitalDelhi110002India
| | - Kuljeet Singh Anand
- Department of NeurologyPost Graduate Institute of Medical Education and ResearchDr. Ram Manohar Lohia HospitalNew Delhi110001India
| | | | | | - Suman Kushwaha
- Department of NeurologyInstitute of Human Behaviour and Allied SciencesDelhi110095India
| | | | | | | | | | - Mohammed Faruq
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
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Pradeep S, Mehanna R. Gastrointestinal disorders in hyperkinetic movement disorders and ataxia. Parkinsonism Relat Disord 2021; 90:125-133. [PMID: 34544654 DOI: 10.1016/j.parkreldis.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrointestinal (GI) disorders have been thoroughly investigated in hypokinetic disorders such as Parkinson's disease, but much less is known about GI disorders in hyperkinetic movement disorders and ataxia. The aim of this review is to draw attention to the GI disorders that are associated with these movement disorders. METHODS References for this systematic review were identified by searches of PubMed through May 2020. Only publications in English were reviewed. RESULTS Data from 249 articles were critically reviewed, compared, and integrated. The most frequently reported GI symptoms overall in hyperkinetic movement disorders and ataxia are dysphagia, sialorrhea, weight changes, esophago-gastritis, gastroparesis, constipation, diarrhea, and malabsorption. We report in detail on the frequency, characteristics, pathophysiology, and management of GI symptoms in essential tremor, restless legs syndrome, chorea, and spinocerebellar ataxias. The limited available data on GI disorders in dystonias, paroxysmal movement disorders, tardive dyskinesias, myoclonus, and non-SCA ataxias are also summarized. CONCLUSION The purpose of our systematic review is to draw attention that, although primarily motor disorders, hyperkinetic movement disorders and ataxia can involve the GI system. Raising awareness about the GI symptom burden in hyperkinetic movement disorders and ataxia could contribute to a new research interest in that field, as well as improved patient care.
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Affiliation(s)
- Swati Pradeep
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
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6
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Tamuli D, Kaur M, Jaryal AK, Srivastava AK, Senthil Kumaran S, Deepak KK. Structural atrophy of central autonomic network correlates with the functional attributes of autonomic nervous system in spinocerebellar ataxia patients. J Clin Neurosci 2021; 93:274-281. [PMID: 34353716 DOI: 10.1016/j.jocn.2021.07.031] [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: 03/17/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Spinocerebellar ataxia (SCA) is a neurodegenerative disorder in which, autonomic dysfunction is a common manifestation. Brain area atrophy also involves the areas comprising central autonomic network (CAN) in SCA. Structural atrophy of CAN and autonomic dysfunction should go hand in hand. But this important relationship has not been studied to date. Therefore, using SCA as a disease model, the present study has been designed to explore the plausible correlations between the brain areas of CAN and clinical autonomic function modalities in SCA patients. MATERIALS AND METHODS 3D T1-weighted scans were acquired on 3T MRI, analyzed by FreeSurfer software in genetically confirmed forty-nine SCA patients (SCA1 = 18, SCA2 = 25 and SCA3 = 6). Heart rate variability (HRV), blood pressure variability (BPV), baroreflex sensitivity (BRS), and autonomic reactivity tests were used for evaluation of autonomic nervous system. Additionally, autonomic dysfunction scoring was done using composite autonomic severity score (CASS). RESULTS On correlation analysis, the study showed the association of atrophic cortical and subcortical brain areas (predominantly prefrontal cortex, bilateral middle temporal, left cuneus, left lingual and left caudate) with altered clinical autonomic function parameters in SCA patients. These areas were primarily comprised of sympathetic and parasympathetic brain areas of CAN. One of the key brain areas of CAN - left cuneus was found to be associated with both HRV (r = 0.295, p = 0.040) and BRS (r = 0.326, p = 0.022). CONCLUSION A characteristic pattern of association between particular brain areas of CAN and clinical autonomic function parameters was observed in SCA patients.
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Affiliation(s)
| | - Manpreet Kaur
- Department of Physiology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ashok K Jaryal
- Department of Physiology, All India Institute of Medical Sciences, India
| | | | | | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, India.
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7
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Almaguer-Mederos LE, Pérez-Ávila I, Aguilera-Rodríguez R, Velázquez-Garcés M, Almaguer-Gotay D, Hechavarría-Pupo R, Rodríguez-Estupiñán A, Auburger G. Body Mass Index Is Significantly Associated With Disease Severity in Spinocerebellar Ataxia Type 2 Patients. Mov Disord 2021; 36:1372-1380. [PMID: 33548146 DOI: 10.1002/mds.28498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia type 2 is a progressive neurodegenerative disorder due to an unstable expansion of a CAG repeat in the ATXN2 gene. Although weight loss has been associated with disease progression in several neurodegenerative conditions, it has been barely assessed in patients with spinocerebellar ataxia type 2. OBJECTIVE The objective of this study was to test whether body mass index is altered in patients with spinocerebellar ataxia type 2 with varying expansion sizes from early to late disease stages. METHODS A cross-sectional case-control study was performed, which included 222 clinically and molecularly diagnosed patients and 214 sex- and age-matched healthy individuals. ATXN2 genotypes and sex were considered as risk factors. Clinical outcomes included the body mass index, age at onset, disease duration, Scale for the Assessment and Rating of Ataxia score, disease stage, dysphagia, and progression rate. Multiple linear regression models were generated. RESULTS Body mass index was significantly decreased in male patients, but not in female patients, relative to control subjects. In addition to sex, body mass index was significantly associated with age at onset and progression rate. Conversely, body mass index, along with repeat length in ATXN2 expanded alleles and disease duration, was associated with Scale for the Assessment and Rating of Ataxia score. In addition, body mass index, along with the age at onset and the repeat length in ATXN2 normal and expanded alleles, has a significant influence on progression rate. CONCLUSIONS Body mass index might be a useful biomarker of disease severity, particularly in male patients with spinocerebellar ataxia type 2 in the context of nutritional interventions or clinical trials assessing the efficacy of promising new drugs. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Ilbedis Pérez-Ávila
- Center for the Investigation and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Center for Sports Medicine, Holguín, Cuba
| | | | | | - Dennis Almaguer-Gotay
- Center for the Investigation and Rehabilitation of Hereditary Ataxias, Holguín, Cuba
| | | | | | - Georg Auburger
- Experimental Neurology, Goethe University Medical Faculty, Frankfurt, Germany
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8
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Moro A, Moscovich M, Farah M, Camargo CHF, Teive HAG, Munhoz RP. Nonmotor symptoms in spinocerebellar ataxias (SCAs). CEREBELLUM & ATAXIAS 2019; 6:12. [PMID: 31485334 PMCID: PMC6712685 DOI: 10.1186/s40673-019-0106-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
Nonmotor symptoms (NMS) have been increasingly recognized in a number of neurodegenerative diseases with a burden of disability that parallels or even surpasses that induced by motor symptoms. As NMS have often been poorly recognized and inadequately treated, much of the most recent developments in the investigation of these disorders has focused on the recognition and quantification of NMS, which will form the basis of improved clinical care for these complex cases. NMS have been only sparsely investigated in a limited number of spinocerebellar ataxias (SCAs), particularly SCA3, and have not been systematically reviewed for other forms of SCAs. The aim of the present study was to review the available literature on the presence of NMS among different types of SCAs.
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Affiliation(s)
- Adriana Moro
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,Department of Medicine, Pequeno Príncipe College, Curitiba, PR Brazil
| | - Mariana Moscovich
- 3Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marina Farah
- 4Neurology Service, Hospital Universitário Cajurú, Catholic University of Paraná, Curitiba, PR Brazil
| | - Carlos Henrique F Camargo
- 5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Hélio A G Teive
- 1Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, 50 Teixeira Soares Street, Batel, Curitiba, PR CEP 80240-440 Brazil.,5Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR Brazil
| | - Renato P Munhoz
- 6Department of Medicine, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, ON Canada
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9
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Takazaki KAG, Rezende TJR, Martinez ARM, Gonzalez-Salazar C, Nucci A, Lopes-Cendes I, França MC. Sudomotor dysfunction is frequent and correlates with disability in Friedreich ataxia. Clin Neurophysiol 2018; 129:2290-2295. [PMID: 30227349 DOI: 10.1016/j.clinph.2018.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate autonomic symptoms and function in Friedreich's Ataxia (FRDA). METHODS Twenty-eight FRDA patients and 24 controls underwent clinical/electrophysiological testing. We employed the Friedreich's Ataxia Rating Scale (FARS) and the Scales for Outcomes in Parkinson's Disease: Autonomic Questionnaire-SCOPA-AUT to estimate the intensity of ataxia and autonomic complaints, respectively. Cardiovagal tests and the quantitative sudomotor axonal reflex, Q-SART, were then assessed in both groups. RESULTS In the patient group, there were 11 men with mean age of 31.5 ± 11.1 years. Mean SCOPA-AUT score was 15.1 ± 8.1. Minimum RR interval at rest was shorter in the FRDA group (Median 831.3 × 724.0 ms, p < 0.001). The 30:15 ratio, Valsalva index, E:I ratio, low and high frequency power presented no differences between patients and controls (p > 0.05). Sweat responses were significantly reduced in patients for all sites tested (forearm 0.389 × 1.309 µL; proximal leg 0.406 × 1.107 µL; distal leg 0.491 × 1.232 µL; foot 0.265 × 0.708 µL; p value < 0.05). Sweat volumes correlated with FARS scores. CONCLUSIONS We found abnormal sudomotor but normal heart rate variability in FRDA. Small cholinergic post-ganglionic fibers are affected in the disease. SIGNIFICANCE Quantification of sudomotor function might be a biomarker for FRDA.
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Affiliation(s)
- Karen A G Takazaki
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Thiago Junqueira R Rezende
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Alberto R M Martinez
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Carelis Gonzalez-Salazar
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Anamarli Nucci
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Iscia Lopes-Cendes
- Medical Genetics, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Marcondes C França
- Departments of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil.
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10
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Indelicato E, Fanciulli A, Ndayisaba JP, Nachbauer W, Granata R, Wanschitz J, Wagner M, Gizewski ER, Poewe W, Wenning GK, Boesch S. Autonomic function testing in spinocerebellar ataxia type 2. Clin Auton Res 2018; 28:341-346. [PMID: 29435867 PMCID: PMC5995979 DOI: 10.1007/s10286-018-0504-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether autonomic failure belongs to the clinical spectrum of spinocerebellar ataxia type 2 (SCA2), an autosomal dominant genetic disorder showing progressive cerebellar and brainstem dysfunction. METHODS We evaluated cardiovascular autonomic function in 8 patients with SCA2 and 16 age- and gender-matched healthy controls. Other autonomic domains were examined through standardized questionnaires and by testing the skin sympathetic reflex. RESULTS Patients with SCA2 showed normal responses to cardiovascular autonomic function tests, with the exception of lower baroreflex sensitivity upon standing compared to controls. In questionnaires, 7 out of 8 patients reported bladder disturbances, while 3 out of 6 tested patients had no skin sympathetic reflex. CONCLUSIONS We did not observe clinically overt cardiovascular autonomic failure in patients with SCA2. Other autonomic domains (i.e., bladder and sudomotor function) may be affected in the disease.
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Affiliation(s)
- Elisabetta Indelicato
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alessandra Fanciulli
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Jean Pierre Ndayisaba
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Nachbauer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michaela Wagner
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria.,Neuroimaging Research Core Facility, Innsbruck Medical University, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria.,Neuroimaging Research Core Facility, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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11
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Diallo A, Jacobi H, Schmitz-Hübsch T, Cook A, Labrum R, Durr A, Brice A, Charles P, Marelli C, Mariotti C, Nanetti L, Panzeri M, Rakowicz M, Sobanska A, Sulek A, Schöls L, Hengel H, Melegh B, Filla A, Antenora A, Infante J, Berciano J, van de Warrenburg BP, Timmann D, Boesch S, Pandolfo M, Schulz JB, Bauer P, Giunti P, Baliko L, Parkinson MH, Kang JS, Klockgether T, Tezenas du Montcel S. Body Mass Index Decline Is Related to Spinocerebellar Ataxia Disease Progression. Mov Disord Clin Pract 2017; 4:689-697. [PMID: 30363449 DOI: 10.1002/mdc3.12522] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/01/2017] [Accepted: 06/17/2017] [Indexed: 12/14/2022] Open
Abstract
Background Spinocerebellar ataxias (SCAs) are dominantly inherited, progressive ataxia disorders. Disease progression could be preceded by weight loss. Objectives We aimed to study the course of weight loss in patients who had the most common SCAs (SCA1, SCA2 SCA3, and SCA6). Additional objectives were to identify subgroups of weight evolution, to determine the factors influencing these evolutions, and to assess the impact of these evolutions on disease progression. Methods In total, 384 patients from the EUROSCA prospective cohort study were analyzed who had SCA1, SCA2, SCA3, or SCA6 and at least 3 measurements of weight. Age was used as a time scale. Clinical outcomes were body mass index (BMI) and the Scale for the Assessment and Rating Ataxia (SARA), with scores ranging from 0 to 40. We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup BMI evolution. Results Overall, BMI declined over time (-0.11 ± 0.03 kg/m2 per decade; P = 0.0009). Three subgroups of BMI evolution were identified: "decreasing BMI" (n = 88; 23%), "increasing BMI" (n = 70; 18%) and "stable BMI" (n = 226; 59%). Patients in the decreasing BMI group were more severely affected at baseline with higher SARA scores and a higher frequency of non-ataxia signs (especially motor symptoms) compared with those in the other groups. Weight loss was associated with faster disease progression (5.7 ± 0.7 SARA points per decade; P = 0.036). Conclusions The current data have substantial implications for the design of future interventional studies in SCA, as they provide a basis for patient stratification and emphasize the usefulness of BMI as a biomarker for monitoring disease progression.
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12
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Increased Catabolic State in Spinocerebellar Ataxia Type 1 Patients. THE CEREBELLUM 2014; 13:440-6. [DOI: 10.1007/s12311-014-0555-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Dysautonomia is frequent in Machado-Joseph disease: clinical and neurophysiological evaluation. THE CEREBELLUM 2014; 12:513-9. [PMID: 23413156 DOI: 10.1007/s12311-013-0458-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Autonomic dysfunction has been already described in patients with SCA3/MJD, but several important questions remain unanswered. The objectives of this study are to determine the frequency and the intensity of autonomic manifestations in SCA3/MJD, as well as to identify possible correlations between autonomic manifestations and genetic and clinical parameters. We have performed clinical and electrophysiological evaluations of 40 patients with SCA3/MJD and 38 healthy controls. We used the Scale for the Assessment and Rating of Ataxia (SARA) and the scales for Outcomes in Parkinson's Disease: Autonomic Questionnaire to quantify the severity of ataxia and autonomic complaints, respectively. We also studied heart rate variability at rest, during orthostatic challenge (30:15 ratio), Valsalva maneuver (Valsalva index), and deep breathing (E/I ratio). We evaluated spectral analyses of RR intervals at rest and the sympathetic skin response. Mean RR intervals at rest and the 30:15 ratio were different between patients and controls (811.8 versus 933.4 ms; p = 0.001 and 1.10 versus 1.15; p = 0.038, respectively). The Valsalva index and the E/I ratio were similar between the groups (p = 0.373 and p = 0.08). Spectral analysis presented distinct results in patients and controls, related to low- and high-frequency power (p < 0.001 and <0.001, respectively). We found cardiovascular and sympathetic sweat disautonomia in 30 % and 45 % of the patients with SCA3/MJD. Autonomic manifestations were related neither to genetic (CAG repeat length) nor clinical parameters (age, disease duration, SARA scores). Autonomic dysfunction is frequent and sometimes disabling in SCA3/MJD. We found evidence of both cardiovascular and sudomotor dysfunction in the disease.
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14
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Doherty KM, Warner TT, Lees AJ. Late onset ataxia: MSA-C or SCA 17? A gene penetrance dilemma. Mov Disord 2013; 29:36-8. [PMID: 24343983 DOI: 10.1002/mds.25770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/10/2013] [Accepted: 10/28/2013] [Indexed: 12/20/2022] Open
Affiliation(s)
- Karen M Doherty
- Reta Lila Weston Institute of Neurological studies, UCL Institute of Neurology, London, United Kingdom; National hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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15
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Reduced cardiac 123I-metaiodobenzylguanidine uptake in patients with spinocerebellar ataxia type 2: a comparative study with Parkinson's disease. Eur J Nucl Med Mol Imaging 2013; 40:1914-21. [PMID: 23929432 DOI: 10.1007/s00259-013-2524-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disorder characterized by cerebellar ataxia, supranuclear ophthalmoplegia, and peripheral neuropathy. Autonomic nervous system dysfunction is often present. This study evaluated the cardiac sympathetic function in patients with SCA2 using (123)I-metaiodobenzylguanidine (MIBG) in comparison with patients with Parkinson's disease (PD) and control subjects. METHODS Nine patients with SCA2, nine patients with PD, and nine control subjects underwent (123)I-MIBG imaging studies from which early and late heart-to-mediastinum (H/M) ratios and myocardial washout rates were calculated. RESULTS Early (F = 12.3, p < 0.0001) and late (F = 16.8, p < 0.0001) H/M ratios were significantly different among groups. In controls, early and late H/M ratios (2.2 ± 0.12 and 2.1 ± 0.20) were significantly higher than in patients with SCA2 (1.9 ± 0.23 and 1.8 ± 0.20, both p < 0.05) and with patients with PD (1.7 ± 0.29 and 1.4 ± 0.35, both p < 0.001). There was also a significant difference in washout rates among groups (F = 11.7, p < 0.0001). In controls the washout rate (19.9 ± 9.6%) was significantly lower (p < 0.005) than in patients with PD (51.0 ± 23.7%), but not different from that in SCA2 patients (19.5 ± 9.4%). In SCA2 patients, in a multivariable linear regression analysis only the Scale for the Assessment and Rating of Ataxia score was independently associated with early H/M ratio (β = -0.12, p < 0.05). CONCLUSION (123)I-MIBG myocardial scintigraphy demonstrated an impairment of cardiac sympathetic function in patients with SCA2, which was less marked than in PD patients. These results suggest that (123)I-MIBG cardiac imaging could become a useful tool for analysing the pathophysiology of SCA2.
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16
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Spence JL, Wallihan S. Computational prediction of the polyQ and CAG repeat spinocerebellar ataxia network based on sequence identity to untranslated regions. Gene 2012; 509:273-81. [PMID: 22967711 DOI: 10.1016/j.gene.2012.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/30/2012] [Indexed: 01/01/2023]
Abstract
Computational prediction of biological networks would be a tremendous asset to systems biology and personalized medicine. In this paper, we use a moving window bioinformatic screen to identify transcripts with partial identity to the 5' and 3'UTRs of the polyQ spinocerebellar ataxia (SCA) genes ATXN1, ATXN2, ATXN3, ATXN7, TBP and CACNA1A and the CAG repeat expansion gene PPP2R2B. We find that the bioinformatic screen enriches for transcripts that encode proteins that interact and that have functions relevant to polyQ SCA. Transcription control and RNA binding are the primary functional groups represented in the proteins from the combined screens. The insulin growth factor pathway, the WNT pathway, long term potentiation, melanogenesis and ATM mediated DNA repair pathways were identified as important pathways. UGUUU repeats were identified as an abundant motif in the SCA network and PAXIP1, CELF2, CREBBP, EBF1, PLEKHG4, SRSF4, C5orf42, NFIA, STK24, and YWHAG were identified as statistically significant proteins in the polyQ and PPP2R2B network.
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17
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Koht J, Stevanin G, Durr A, Mundwiller E, Brice A, Tallaksen CME. SCA14 in Norway, two families with autosomal dominant cerebellar ataxia and a novel mutation in the PRKCG gene. Acta Neurol Scand 2012; 125:116-22. [PMID: 21434874 DOI: 10.1111/j.1600-0404.2011.01504.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite a similar prevalence of autosomal dominant cerebellar ataxia (ADCA) in Norway compared to other European countries, less than 10% of the families are explained by the CAG trinucleotide expansions. We wanted to find the occurence of SCA14 in the dominant ataxia population and describe the phenotype. METHODS We screened a large dominant cerebellar ataxia cohort for mutations in the PRKCG gene. Patients were evaluated according to a standard clinical protocol for ataxia patients. RESULTS A novel mutation was found in two families, a C to A transversion altering Histidine to a Glutamine at codon 139, located in a highly concerved region in the gene. It completely co-segregated with the affected family members and was not seen in 576 control chromosomes. Genetic analysis revealed common alleles at three microsatellite markers between these two families suggesting a shared ancestral chromosome. Affected subjects displayed a mild, slowly progressive cerebellar syndrome that included gait and limb ataxia and saccadic pursuit and head tremor in one. Age at onset ranged from 10 to 45 years. CONCLUSIONS These are the first families with SCA14 reported from Scandinavia and a new mutation in the PRKCG gene. The occurrence in the Norwegian dominant ataxia cohort is 3.5%.
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Montes-Brown J, Machado A, Estévez M, Carricarte C, Velázquez-Pérez L. Autonomic dysfunction in presymptomatic spinocerebellar ataxia type-2. Acta Neurol Scand 2012; 125:24-9. [PMID: 22188373 DOI: 10.1111/j.1600-0404.2011.01494.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore and quantify possible abnormalities in the autonomic cardiovascular regulation in presymptomatic stage of type 2 spinocerebellar ataxia (PS-SCA2). MATERIALS & METHODS Heart rate variability (HRV) for 5-min series of RR intervals was analyzed in 48 PS-SCA2. Autonomic testing included resting recording, standing, Valsalva maneuver, and deep breathing. The results were compared with a group of sex- and age-matched controls. RESULTS Time-and-frequency domain HRV indices were significantly different between PS-SCA2 and control groups. Using two standard diagnostic procedures were identified 4 (8.33%) subjects with severe and 8 (16.66%) subjects with early cardiac autonomic neuropathy in PS-SCA2. CAG index significantly correlated with age (-0.35) and HR (0.31). CONCLUSIONS Our results confirm the presence of cardiovascular autonomic dysfunction in PS-SCA2 subjects.
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Affiliation(s)
- J Montes-Brown
- General Hospital Dr Ernesto Guevara de la Serna, Las Tunas, Cuba.
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Sriranjini SJ, Pal PK, Krishna N, Sathyaprabha TN. Subclinical pulmonary dysfunction in spinocerebellar ataxias 1, 2 and 3. Acta Neurol Scand 2010; 122:323-8. [PMID: 20002004 DOI: 10.1111/j.1600-0404.2009.01306.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Evaluation of pulmonary function in patients with spinocerebellar ataxias (SCA) 1, 2 and 3 without clinical evidence of pulmonary dysfunction. METHODS Thirty patients (F:M = 7:23; age: 35 ± 11.3 years; SCA1 - 13, SCA2 - 9 and SCA3 - 8) without clinical manifestations of respiratory dysfunction and 30 controls underwent pulmonary function tests. The percentage predicted values of forced vital capacity (FVC), volume of air exhaled during first second of FVC (FEV1), peak expiratory flow rate (PEFR) and maximal voluntary ventilation (MVV), actual values of maximal inspiratory and expiratory pressures (MIP and MEP in mmHg), and ratios of actual values of FEV1/FVC (%) and FEV1/PEFR (ml/l/min) were analyzed. RESULTS Compared with controls SCA patients had significant reductions of FVC (71.1 ± 17.5 vs 85.5 ± 18.7; P < 0.01), PEFR (51.5 ± 20.7 vs 77.1 ± 24.9; P < 0.001), MVV (64.4 ± 21.6 vs 97.2 ± 22.7; P < 0.001), MIP (27.7 ± 16.8 vs 50.1 ± 15.1; P < 0.001) and MEP (38.1 ± 18.7 vs 74.7 ± 16.0; P < 0.001), elevation of FEV1/PEFR (10.5 ± 2.8 vs 7.4 ± 2.1; P < 0.001), but no significant change of FEV1 and FEV1/FVC. FEV1/PEFR correlated positively with illness duration and MVV negatively with severity of illness. CONCLUSIONS The present study showed subclinical restrictive type of pulmonary dysfunction in SCA, and possible presence of upper airway obstruction. Chest physiotherapy and breathing exercises should be introduced early in management of SCA.
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Affiliation(s)
- S J Sriranjini
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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