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Relevance of Fluorodopa PET Scan in Dopamine Responsive Dystonia and Juvenile Parkinsonism: A Systematic Review. Neurol Int 2022; 14:997-1006. [PMID: 36548184 PMCID: PMC9781753 DOI: 10.3390/neurolint14040079] [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: 07/30/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dopamine Responsive Dystonia (DRD) and Juvenile Parkinsonism (JP) are two diseases commonly presenting with parkinsonian symptoms in young patients. Current clinical guidelines offer a diagnostic approach based on molecular analysis. However, developing countries have limitations in terms of accessibility to these tests. We aimed to assess the utility of imaging equipment, usually more available worldwide, to help diagnose and improve patients' quality of life with these diseases. METHODS We performed a systematic literature review in English using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE) protocols. We only used human clinical trials about dopamine responsive dystonia and juvenile parkinsonism patients in which a fluorodopa (FD) positron emission tomography (PET) scan was performed to identify its use in these diseases. RESULTS We included six studies that fulfilled our criteria. We found a clear pattern of decreased uptake in the putamen and caudate nucleus in JP cases. At the same time, the results in DRD were comparable to normal subjects, with only a slightly decreased marker uptake in the previously mentioned regions by the FD PET scan. CONCLUSIONS We found a distinctive pattern for each of these diseases. Identifying these findings with FD PET scans can shorten the delay in making a definitive diagnosis when genetic testing is unavailable, a common scenario in developing countries.
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Champagne M, Horvath GA, Perreault S, Gauthier J, Hyland K, Soucy J, Mitchell GA. Intermittent neurologic decompensation: An underrecognized presentation of tyrosine hydroxylase deficiency. JIMD Rep 2022; 63:400-406. [PMID: 36101825 PMCID: PMC9458604 DOI: 10.1002/jmd2.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Tyrosine hydroxylase deficiency (THD) is a treatable inborn error of dopamine biosynthesis caused by mutations in TH. Two presentations are described. Type A, milder, presents after 12 months of age with progressive hypokinesis and rigidity. Type B presents before 12 months as a progressive complex encephalopathy. We report a girl with mild THD who had recurrent episodes of neurological decompensations. Before the first episode, she had normal development except for mild head tremor. Episodes occurred at 12, 19, and 25 months of age. After viral infections or vaccination, she developed lethargy, worsened tremor, language, and motor regression including severe axial hypotonia, recuperating over several weeks of intensive rehabilitation but with residual tremor and mild lower limb spasticity. Basal ganglia imaging was normal. Exome sequencing revealed two missense variants of uncertain significance in TH: c.1147G>T and c.1084G>A. Both have low gnomAD allele frequencies and in silico, are predicted to be deleterious. Cerebrospinal fluid analysis showed low homovanillic acid (HVA, 160 nmol/L, reference 233-938) and low HVA/5-hydroxyindolacetic acid molar ratio (1.07, reference .5-3.5). She responded rapidly to L-Dopa/carbidopa without further episodes. Literature review revealed four other THD patients who had a total of seven episodes of marked hypotonia and motor regression following infections, occurring between ages 12 months and 6 years. All improved with L-Dopa/carbidopa treatment. Intermittent THD is treatable, important for genetic counseling, and should be considered after even a single episode of marked hypotonia with recuperation over weeks, especially in patients with preexisting tremor, dystonia, or rigidity.
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Affiliation(s)
- Marjolaine Champagne
- Division of Medical Genetics, Department of Pediatrics, Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte‐JustineUniversité de MontréalMontréalQuébecCanada
| | - Gabriella A. Horvath
- Division of Biochemical Diseases, Department of PediatricsBC Children's HospitalVancouverBritish ColumbiaCanada
| | - Sébastien Perreault
- Division of Child Neurology, Department of PediatricsCentre Hospitalier Universitaire Sainte‐JustineMontréalQuébecCanada
| | - Julie Gauthier
- Division of Medical Genetics, Department of Pediatrics, Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte‐JustineUniversité de MontréalMontréalQuébecCanada
- Integrated Centre for Pediatric Clinical Genomics, Centre Hospitalier Universitaire Sainte‐JustineMontréalQuébecCanada
| | - Keith Hyland
- MNG Laboratories (Medical Neurogenetics, LLC.), MNG, a Wholly Owned Subsidiary of Laboratory Corporation of America HoldingsSan DiegoCaliforniaUSA
| | - Jean‐François Soucy
- Division of Medical Genetics, Department of Pediatrics, Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte‐JustineUniversité de MontréalMontréalQuébecCanada
- Integrated Centre for Pediatric Clinical Genomics, Centre Hospitalier Universitaire Sainte‐JustineMontréalQuébecCanada
| | - Grant A. Mitchell
- Division of Medical Genetics, Department of Pediatrics, Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte‐JustineUniversité de MontréalMontréalQuébecCanada
- Integrated Centre for Pediatric Clinical Genomics, Centre Hospitalier Universitaire Sainte‐JustineMontréalQuébecCanada
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Alves Júnior AC, Daker MV, Machado AM, Luna AS, Valladares Neto DC, Valadares ER. Neuropsychiatric and sleep study in autosomal dominant dopa-responsive dystonia. Mol Genet Metab Rep 2022; 31:100870. [PMID: 35782624 PMCID: PMC9248209 DOI: 10.1016/j.ymgmr.2022.100870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Although the diurnal fluctuation of motor dysfunction, reversible with small doses of dopamine, is a cornerstone for the phenotype of the autosomal dominant Segawa syndrome, the non-motor symptoms of this neurotransmitter deficiency have still received limited attention. Objective This study aims to evaluate non-motor symptoms of this dopa-responsive dystonia through an intrafamilial comparative cross-sectional study. Methods Seventeen individuals with a c.IVS5 + 3insT (c.626 + 3insT) variation in the GTP cyclohydrolase-1 gene (GCH1, HGNC: 4193) and 34 intrafamilial controls were studied using the Beck Depression Inventory-II, the Wiener Matrizen Test 2, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the MINI/MINI PLUS Questionnaires, the World Health Organization Quality of Life – BREF Instrument and a drug use assessment questionnaire. Results No significant difference was found between the groups in the prevalence of sleep disorders and in cognitive function. Nevertheless, generalized anxiety disorder (p = 0.050) and attention-deficit/hyperactivity disorder in childhood (p = 0.011) were observed only in individuals without the molecular variation. The group with the GCH1 variation presented a worse perception about how safe they feel in their daily lives (p = 0.034), less satisfaction with themselves (p = 0.049) and with their relationships (p = 0.029), and a higher prevalence of past major depressive episodes before use of L-Dopa (p = 0.046). Conclusion Low dopamine could have been protective against generalized anxiety disorder and attention-deficit/hyperactivity disorder in childhood in Segawa group individuals. The prevalence of depression was higher in individuals with the molecular variant prior to the L-Dopa treatment. Considering it, the penetrance estimates for the variant carriers increased from 58.8% to up to 88% in this large studied family. Additionally, neuropsychiatric tests of all individuals with a molecular diagnosis in an affected family are a valuable instrument for its clinical management. Depression can be a non-motor symptom of autosomal dominant DYT/PARK-GCH1. Variable expressivity and penetrance can be considered high in this syndrome. Relatives without dystonia should also be investigated for the genetic variation.
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Salles PA, Terán-Jimenez M, Vidal-Santoro A, Chaná-Cuevas P, Kauffman M, Espay AJ. Recognizing Atypical Dopa-Responsive Dystonia and Its Mimics. Neurol Clin Pract 2022; 11:e876-e884. [PMID: 34992971 DOI: 10.1212/cpj.0000000000001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review Dopa-responsive dystonia (DRD) encompasses a group of phenotypically and genetically heterogeneous neurochemical disorders. Classic GTP cyclohydrolase 1 (GCH-1)-associated DRD consists of early-onset lower limb asymmetrical dystonia, with sleep benefit, diurnal variation, and excellent and sustained response to low l-dopa doses. Recent Findings Unlike the classic phenotype, GCH-1-associated DRD may include features inconsistent with the original phenotype. We describe a GCH-1-associated late-onset DRD case with a family history of parkinsonism and cervical dystonia whose response to levodopa was poor and complicated with dyskinesia, blepharospasm, and severe nonmotor symptoms. We use this case as a springboard to review the spectrum of atypical DRD, DRD-plus, and DRD mimics. Summary GCH-1-related dystonia may exhibit wide intrafamilial phenotypic variability, no diurnal fluctuation, poor response to l-dopa, and such complications as dyskinesia, epilepsy, sleep disorders, autonomic dysfunction, oculogyric crisis, myoclonus, or tics. More recently, rare GCH-1 variants have been found to be associated with Parkinson disease. Clinicians should be aware of atypical DRD, DRD-plus, and DRD mimics.
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Affiliation(s)
- Philippe A Salles
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Mérida Terán-Jimenez
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Alvaro Vidal-Santoro
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Pedro Chaná-Cuevas
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Marcelo Kauffman
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
| | - Alberto J Espay
- Center for the Study of Movement Disorders (CETRAM) (PAS, MT-J, PC-C), Santiago de Chile University, Santiago, Chile; Movement Disorders Section (PAS, MT-J), Neuroscience Department, Davila Clinic, Santiago, Chile; Movement Disorders Section (MT-J), Neurology Department, Felix Bulnes Hospital, Mayor University, Santiago, Chile; Neurology Department (AV-S), Fuérza Aérea de Chile Hospital, Mayor University, Santiago, Chile; Neurogenetics Unit (MK), Neurology Division, J.M. Ramos Mejía Hospital, University Center of Neurology "J.M. Ramos Mejia". Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurology (AJE); and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (AZ, AJE), University of Cincinnati, OH
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Mishra S, Mallick AK, Panigrahy D, Nayak P, Biswal NR. Series of Dopa Responsive Dystonia Masquerading as Other Diseases with Short Review. J Pediatr Neurosci 2021; 15:421-425. [PMID: 33936308 PMCID: PMC8078628 DOI: 10.4103/jpn.jpn_74_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/18/2019] [Accepted: 05/24/2020] [Indexed: 12/01/2022] Open
Abstract
Dopa-responsive dystonia (DRD) encompasses a group of clinically and genetically heterogeneous disorders that typically manifest as limb-onset, diurnally fluctuating dystonia presenting in early life and exhibits a robust and sustained response to levodopa treatment. DRD is one of the treatable dystonia syndromes of childhood. It starts with the involvement of lower limb and associated with characteristic diurnal variation. Many times it is misdiagnosed as cerebral palsy due to selective lower limb preference. We report a series of three cases of DRD which were previously misdiagnosed. The first case presented as myelopathy and other two were diagnosed as cerebral palsy. It is a treatable condition with very good response to drugs. Early diagnosis and adequate therapy can prevent from catastrophic complications.
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Affiliation(s)
- Shubhankar Mishra
- Department of Neurology, S.C.B. Medical College, Cuttack, Odisha, India
| | - Ashok K Mallick
- Department of Neurology, S.C.B. Medical College, Cuttack, Odisha, India
| | | | - Priyabrata Nayak
- Department of Neurology, S.C.B. Medical College, Cuttack, Odisha, India
| | - Nihar R Biswal
- Department of Neurology, S.C.B. Medical College, Cuttack, Odisha, India
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Weissbach A, Saranza G, Domingo A. Combined dystonias: clinical and genetic updates. J Neural Transm (Vienna) 2020; 128:417-429. [PMID: 33099685 DOI: 10.1007/s00702-020-02269-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
The genetic combined dystonias are a clinically and genetically heterogeneous group of neurologic disorders defined by the overlap of dystonia and other movement disorders such as parkinsonism or myoclonus. The number of genes associated with combined dystonia syndromes has been increasing due to the wider recognition of clinical features and broader use of genetic testing. Nevertheless, these diseases are still rare and represent only a small subgroup among all dystonias. Dopa-responsive dystonia (DYT/PARK-GCH1), rapid-onset dystonia-parkinsonism (DYT/PARK-ATP1A3), X-linked dystonia-parkinsonism (XDP, DYT/PARK-TAF1), and young-onset dystonia-parkinsonism (DYT/PARK-PRKRA) are monogenic combined dystonias accompanied by parkinsonian features. Meanwhile, MYC/DYT-SGCE and MYC/DYT-KCTD17 are characterized by dystonia in combination with myoclonus. In the past, common molecular pathways between these syndromes were the center of interest. Although the encoded proteins rather affect diverse cellular functions, recent neurophysiological evidence suggests similarities in the underlying mechanism in a subset. This review summarizes recent developments in the combined dystonias, focusing on clinico-genetic features and neurophysiologic findings. Disease-modifying therapies remain unavailable to date; an overview of symptomatic therapies for these disorders is also presented.
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Affiliation(s)
- Anne Weissbach
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Aloysius Domingo
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Collaborative Center for X-Linked Dystonia-Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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7
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Chen Y, Bao X, Wen Y, Wang J, Zhang Q, Yan J. Clinical and Genetic Heterogeneity in a Cohort of Chinese Children With Dopa-Responsive Dystonia. Front Pediatr 2020; 8:83. [PMID: 32185155 PMCID: PMC7058807 DOI: 10.3389/fped.2020.00083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The aim of this study was to investigate the genetic and clinical features of dopa-responsive dystonia (DRD) in China. Method: Characteristics of gene mutations and clinical manifestations of 31 patients diagnosed with DRD were analyzed retrospectively. Result: From January 2000 to January 2019, 31 patients were diagnosed with DRD. Twenty (64.5%) were male, and 11 (35.5%) were female. Ten patients (32.3%) had classic DRD, 19 (61.3%) had DRD-plus, and 2 (6.4%) patients had mutations in the dopamine synthetic pathway (PTS gene mutation) without a typical phenotype (not DRD or DRD-plus). Twenty-eight (90.3%) patients underwent genetic testing. Homozygous or compound heterozygous TH gene mutations were found in 22 patients. GCH1 and PTS gene mutations were found in 2 patients. Heterozygous TH mutation and genetic testing were negative in 1 patient. They took different doses of L-dopa, ranging from 0.4 to 8.7 mg/kg/d. Patients with classic DRD responded well. In patients with DRD-plus, 94.7% (18/19) responded well with residual symptoms. One patient (5.3%) did not show any improvement. Conclusion: DRD can be divided into classic DRD and DRD-plus. In this cohort, the most common pathogenic gene was TH. Fever was the important inducing factor of the disease. L-dopa has sustained and stable effects on patients with classic DRD. In patients with DRD-plus, treatment with L-dopa could ameliorate most of the symptoms.
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Affiliation(s)
- Yan Chen
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Xinhua Bao
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Yongxin Wen
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Jiaping Wang
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Qingping Zhang
- Department of Pediatric, Peking University First Hospital, Beijing, China
| | - Jiayou Yan
- Department of Pediatric, Peking University First Hospital, Beijing, China
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Mohammad SS, Paget SP, Dale RC. Current therapies and therapeutic decision making for childhood-onset movement disorders. Mov Disord 2019; 34:637-656. [PMID: 30919519 DOI: 10.1002/mds.27661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Movement disorders differ in children to adults. First, neurodevelopmental movement disorders such as tics and stereotypies are more prevalent than parkinsonism, and second, there is a genomic revolution which is now explaining many early-onset dystonic syndromes. We outline an approach to children with movement disorders starting with defining the movement phenomenology, determining the level of functional impairment due to abnormal movements, and screening for comorbid psychiatric conditions and cognitive impairments which often contribute more to disability than the movements themselves. The rapid improvement in our understanding of the etiology of movement disorders has resulted in an increasing focus on precision medicine, targeting treatable conditions and defining modifiable disease processes. We profile some of the key disease-modifying therapies in metabolic, neurotransmitter, inflammatory, and autoimmune conditions and the increasing focus on gene or cellular therapies. When no disease-modifying therapies are possible, symptomatic therapies are often all that is available. These classically target dopaminergic, cholinergic, alpha-adrenergic, or GABAergic neurochemistry. Increasing interest in neuromodulation has highlighted that some clinical syndromes respond better to DBS, and further highlights the importance of "disease-specific" therapies with a future focus on individualized therapies according to the genomic findings or disease pathways that are disrupted. We summarize some pragmatic applications of symptomatic therapies, neuromodulation techniques, and some rehabilitative interventions and provide a contemporary overview of treatment in childhood-onset movement disorders. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shekeeb S Mohammad
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Doummar D, Moussa F, Nougues MC, Ravelli C, Louha M, Whalen S, Burglen L, Rodriguez D, Billette de Villemeur T. Monoamine neurotransmitters and movement disorders in children and adults. Rev Neurol (Paris) 2018; 174:581-588. [DOI: 10.1016/j.neurol.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022]
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10
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Katus LE, Frucht SJ. An unusual presentation of tyrosine hydroxylase deficiency. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017; 4:18. [PMID: 29225908 PMCID: PMC5716367 DOI: 10.1186/s40734-017-0065-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022]
Abstract
Background Dopa-responsive dystonia (DRD) has largely been associated with autosomal dominant mutations in the GCH1 gene leading to GTP cyclohydrolase 1 deficiency. More recently, a deficiency in tyrosine hydroxylase (TH) has been recognized to cause DRD. This is a rare disorder resulting from genetic mutations in the TH gene on chromosome 11. The phenotype ranges from DRD with complete resolution on levodopa to infantile parkinsonism and encephalopathy only partially responsive to levodopa. Here we discuss an adult with TH deficiency with a history of possible parkinsonism and dystonia responsive to levodopa, notable for a residual dynamic segmental dystonia. Case presentation Our patient grew up in rural Myanmar with limited medical care. Childhood was normal except for episodic illness with difficulty moving and speaking. At 18 years he developed difficulty writing. At 21 years he could not speak, walk, or write and was taken to a city hospital. Multiple medications were tried without benefit until he received carbidopa/levodopa, to which he had a miraculous response. Since then he has attempted to come off medication, however after several weeks his symptoms returned. On presentation to us at 31 years he was taking 450 mg levodopa/day and 4 mg trihexyphenidyl/day. He had a dynamic dystonia in his neck and trunk, subtle at rest and prominent with walking. He exhibited a sensory trick when touching his hand to his chin; improvement occurred to a lesser degree when he imagined touching his chin, and to an even lesser degree when the examiner touched his chin. He had no parkinsonism. He underwent genetic testing which revealed a homozygous variant mutation in the TH gene (p.Thr494Met) leading to a diagnosis of autosomal recessive tyrosine hydroxylase deficiency. Conclusions TH deficiency can cause a broad range of clinical symptoms and severity. As more cases are discovered, the phenotype expands. Here we describe a unique case of DRD and possible parkinsonism due to TH deficiency with residual symptoms of dystonia that was task dependent and responded to a sensory trick. In addition, while the history is limited, it is possible he may have had episodes similar to "lethargy-irritability crises" seen in more severe cases. In large part he fits within the milder form of TH hydroxylase deficiency.
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Affiliation(s)
- Linn E Katus
- Movement Disorders Division, Department of Neurology, Mount Sinai Hospital, 5 E 98th Street, 1st floor, New York, NY 10029 USA
| | - Steven J Frucht
- Movement Disorders Division, Department of Neurology, Mount Sinai Hospital, 5 E 98th Street, 1st floor, New York, NY 10029 USA
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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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12
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Genetic variation associated with the occurrence and progression of neurological disorders. Neurotoxicology 2017; 61:243-264. [DOI: 10.1016/j.neuro.2016.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 02/08/2023]
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Maas RP, Wassenberg T, Lin JP, van de Warrenburg BP, Willemsen MA. l-Dopa in dystonia. Neurology 2017; 88:1865-1871. [DOI: 10.1212/wnl.0000000000003897] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/26/2017] [Indexed: 11/15/2022] Open
Abstract
“Every child exhibiting dystonia merits anl-dopa trial, lest the potentially treatable condition of dopa-responsive dystonia (DRD) is missed” has been a commonly cited and highly conserved adage in movement disorders literature stemming from the 1980s. We here provide a historical perspective on this statement, discuss the current diagnostic and therapeutic applications ofl-dopa in everyday neurologic practice, contrast these with its approved indications, and finish with our view on both a diagnostic and therapeutic trial in children and adults with dystonia. In light of the relatively low prevalence of DRDs, the large interindividual variation in the requiredl-dopa dose, the uncertainty about an adequate trial duration, the substantial advances in knowledge on etiology and pathophysiology of these disorders, and the availability of various state-of-the-art diagnostic tests, we think that a diagnosticl-dopa trial as a first step in the approach of early-onset dystonia (≤25 years) is outdated. Rather, in high-resource countries, we suggest to usel-dopa after biochemical corroboration of a defect in dopamine biosynthesis, in genetically confirmed DRD, or if nigrostriatal degeneration has been demonstrated by nuclear imaging in adult patients presenting with lower limb dystonia. Furthermore, our literature study on the effect of a therapeutic trial to gain symptomatic relief revealed thatl-dopa has occasionally proven beneficial in several established “non-DRDs” and may therefore be considered in selected cases of dystonia due to other causes. In summary, we argue against the application ofl-dopa in every patient with early-onset dystonia and support a more rational therapeutic use.
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Termsarasab P, Thammongkolchai T, Frucht SJ. Medical treatment of dystonia. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:19. [PMID: 28031858 PMCID: PMC5168853 DOI: 10.1186/s40734-016-0047-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Abstract
Therapeutic strategies in dystonia have evolved considerably in the past few decades. Three major treatment modalities include oral medications, botulinum toxin injections and surgical therapies, particularly deep brain stimulation. Although there has been a tremendous interest in the later two modalities, there are relatively few recent reviews of oral treatment. We review the medical treatment of dystonia, focusing on three major neurotransmitter systems: cholinergic, GABAergic and dopaminergic. We also provide a practical guide to medication selection, therapeutic strategy and unmet needs.
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Affiliation(s)
- Pichet Termsarasab
- Movement Disorder Division, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Steven J. Frucht
- Movement Disorder Division, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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