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Liu C, Lan C, Chen Y. The use of sertraline to treat an adolescent of dystonia comorbid with major depressive disorder with psychotic features. Neuropsychopharmacol Rep 2024; 44:275-279. [PMID: 37987035 PMCID: PMC10932769 DOI: 10.1002/npr2.12401] [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: 07/26/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
Dystonia is characterized by sustained or intermittent involuntary muscle contractions. Psychiatric symptoms are essential non-motor features of dystonia, and higher risks of depressive and anxiety disorders have been reported. The precedence of psychiatric to motor symptoms in some patients and the dopaminergic and serotonergic system involvement in both the motor and psychiatric aspects suggest these psychiatric disorders may be intrinsic to the neurobiology of dystonia. Nevertheless, psychiatric comorbidities are often construed as secondary reactions to motor disabilities and the negative bio-psycho-social impacts of dystonia, leading to underdiagnosis and undertreatment. Research on antidepressant use in dystonia is scarce, especially in children and adolescents. This report presents a 17-year-old female with dystonia comorbid with depression with psychotic features, whose motor symptoms improved but psychiatric symptoms persisted with dopaminergic pharmacotherapy. Sertraline was finally added 5 years after the onset and successfully managed her psychotic depression without worsening motor symptoms. Early detection, prompt diagnosis, and timely holistic treatment with dopaminergic agents, antidepressants, and psychosocial interventions are critical for the mental health of dystonia patients.
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Affiliation(s)
- Chia‐Chien Liu
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Chen‐Chia Lan
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Ying‐Sheue Chen
- Department of PsychiatryTaipei Veterans General HospitalTaipeiTaiwan
- Department of PsychiatryChina Medical University HospitalTaichungTaiwan
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2
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Gafarov VV, Gromova EA, Gubina MA, Gagulin IV, Maksimov VN, Gafarova AV. [The association of polymorphisms of the serotonin transporter gene SLC6A4 with depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:135-139. [PMID: 38465822 DOI: 10.17116/jnevro2024124021135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To study the relationship of polymorphic variants of the SLC6A4 gene with depression among people aged 25-44 years in Novosibirsk. MATERIAL AND METHODS Under the WHO program «MONICA-psychosocial (MOPSY)», a random representative sample of people aged 25-44 years from the population of the Oktyabrsky district of Novosibirsk (men n=725, mean age 43.4±0.4 years, response - 71.3%, women n=710, mean age 44.8±0.4 years, response - 72%). Depression was assessed using the MONICA-MOPSY psychosocial questionnaire. Every fourth respondent was examined for polymorphic variants of 5HTTLPR-VNTR SNP rs25531 A>G of the SLC6A4 gene. The study was carried out within the framework of the budget topic Reg. No. 122031700094-5. RESULTS The high level of depression among people aged 25-44 was 12.8% (for men 9.1%, for women - 15.92%); the average level of depression occurred in 24.5% of the population (among men in 21.24%, among women in 26.76%) (χ2=17.071, df=2, p<0.001). The most common genotype of the SLC6A4 gene, among people aged 25--4 years old in Novosibirsk, was SLA - 43.29%, LALA - 26.53% - in second place, SS - 17.87% - third, LALG - 6 genotypes were less represented genotypes. 74%, SLG - 4.18%, LGLG - 1.39%. Carrying the SLA genotype (53.3% and 63.6%) increased the chance of developing both the average level of depression by 2.359 (95% CI 1.278-4.355) times, and depression in general by 1.933 (95% CI 1.142-3.271) times, compared with persons carrying the LALA genotype (32.0% and 46.9%), (χ2=7.674, df=1, p<0.01 and χ2=6.095, df=1, p<0.05). Persons carrying the LALG genotype (54.5%) also had a higher chance of developing a mean level of depression RR=2.929 (95% CI 1.039-8.261), compared with carriers of the LALA genotype (32.0%) (χ2=4.326, df =1, p<0.05) (p<0.05). CONCLUSION Associative links between polymorphic variants of the SLC6A4 gene and depression have been established.
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Affiliation(s)
- V V Gafarov
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - E A Gromova
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - M A Gubina
- Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - I V Gagulin
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - V N Maksimov
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - A V Gafarova
- Research Institute of Therapy and Preventive Medicine - branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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Martino D. What can epidemiological studies teach on the pathophysiology of adult-onset isolated dystonia? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:21-60. [PMID: 37482393 DOI: 10.1016/bs.irn.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Several demographic and environmental factors may play an important role in determining the risk of developing adult-onset isolated dystonia (AOID) and/or modifying its course. However, epidemiologic studies have provided to date only partial insight on the disease mechanisms that are actively influenced by these factors. The age-related increase in female predominance in both patients diagnosed with AOID and subjects carrying its putative mediational phenotype suggests sexual dimorphism that has been demonstrated for mechanisms related to blepharospasm and cervical dystonia. The opposite relationship that spread and spontaneous remission of AOID have with age suggests age-related decline of compensatory mechanisms that protect from the progression of AOID. Epidemiological studies focusing on environmental risk factors yielded associations only with specific forms of AOID, even for those factors that are not likely to predispose exclusively to specific focal forms (for example, only writing dystonia was found associated with head trauma, and only blepharospasm with coffee intake). Other factors show biological plausibility of their mechanistic role for specific forms, e.g., dry eye syndrome or sunlight exposure for blepharospasm, scoliosis for cervical dystonia, repetitive writing for writing dystonia. Overall, the relationship between environment and AOID remains complex and incompletely defined. Both hypothesis-driven preclinical studies and well-designed cross-sectional or prospective clinical studies are still necessary to decipher this intricate relationship.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Hospital Drive NW, Calgary, AB, Canada; The Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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4
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Martino D, Nosratmirshekarlou E, Cothros N, Medina Escobar A, Goodarzi Z. Development of a New Care Pathway for Depression and Anxiety in Adult-Onset Isolated Dystonia. Mov Disord Clin Pract 2023; 10:415-426. [PMID: 36949792 PMCID: PMC10026302 DOI: 10.1002/mdc3.13655] [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: 09/13/2021] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023] Open
Abstract
Background Recently, we identified barriers and facilitators to the screening and treatment of depressive and anxiety symptoms in adult-onset isolated dystonia (AOID). These symptoms are common, functionally impairing, and often underdetected and undertreated. Objectives To develop a care pathway for mood symptoms in AOID. Methods We used a multistep modified Delphi approach to seek consensus among healthcare professionals with experience of AOID on the screening, diagnosis, and treatment of mood symptoms. A combination of face-to-face meetings and online surveys was performed from 2019 to 2020. We created the survey and then reviewed with stakeholders before 2 rounds of Delphi surveys, all of which was finally reviewed in a consensus meeting. A purposive sample of 41 expert stakeholders from 4 Canadian provinces, including neurologists, nurses, psychiatrists, psychologists, and family physicians, was identified by the research team. Results The Delphi process led to consensus on 12 statements that operationalized a pathway of care to screen for and manage depression and anxiety in people with AOID. Key actions of the pathway included yearly screening with self-rated instruments, multidisciplinary involvement in management involving local networks of providers coordinated by movement disorders neurologists, and access to educational resources. The Delphi panel indicated the 2 core steps as the documentation of the most recent screening outcome and the documentation of a management plan for patients who were positive at the last screening. Conclusions This new care pathway represents a potentially useful intervention that can be used to build an integrated model of care for AOID.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Mathison Centre for Mental Health Research and EducationCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Elaheh Nosratmirshekarlou
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Nicholas Cothros
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - Alex Medina Escobar
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of NeurologyThe Moncton HospitalMonctonNew BrunswickCanada
| | - Zahra Goodarzi
- Mathison Centre for Mental Health Research and EducationCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of MedicineUniversity of Calgary, Foothills Medical CentreCalgaryAlbertaCanada
- O'Brien Institute of Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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Bailey GA, Rawlings A, Torabi F, Pickrell WO, Peall KJ. Longitudinal analysis of the relationship between motor and psychiatric symptoms in idiopathic dystonia. Eur J Neurol 2022; 29:3513-3527. [PMID: 35997000 PMCID: PMC9826317 DOI: 10.1111/ene.15530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Although psychiatric diagnoses are recognized in idiopathic dystonia, no previous studies have examined the temporal relationship between idiopathic dystonia and psychiatric diagnoses at scale. Here, we determine rates of psychiatric diagnoses and psychiatric medication prescription in those diagnosed with idiopathic dystsuponia compared to matched controls. METHODS A longitudinal population-based cohort study using anonymized electronic health care data in Wales (UK) was conducted to identify individuals with idiopathic dystonia and comorbid psychiatric diagnoses/prescriptions between 1 January 1994 and 31 December 2017. Psychiatric diagnoses/prescriptions were identified from primary and secondary health care records. RESULTS Individuals with idiopathic dystonia (n = 52,589) had higher rates of psychiatric diagnosis and psychiatric medication prescription when compared to controls (n = 216,754, 43% vs. 31%, p < 0.001; 45% vs. 37.9%, p < 0.001, respectively), with depression and anxiety being most common (cases: 31% and 28%). Psychiatric diagnoses predominantly predated dystonia diagnosis, particularly in the 12 months prior to diagnosis (incidence rate ratio [IRR] = 1.98, 95% confidence interval [CI] = 1.9-2.1), with an IRR of 12.4 (95% CI = 11.8-13.1) for anxiety disorders. There was, however, an elevated rate of most psychiatric diagnoses throughout the study period, including the 12 months after dystonia diagnosis (IRR = 1.96, 95% CI = 1.85-2.07). CONCLUSIONS This study suggests a bidirectional relationship between psychiatric disorders and dystonia, particularly with mood disorders. Psychiatric and motor symptoms in dystonia may have common aetiological mechanisms, with psychiatric disorders potentially forming prodromal symptoms of idiopathic dystonia.
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Affiliation(s)
- Grace A. Bailey
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK
| | | | - Fatemeh Torabi
- Swansea University Medical SchoolSwanseaUK
- Health Data ResearchLondonUK
| | - William Owen Pickrell
- Swansea University Medical SchoolSwanseaUK
- Department of Neurology, Morriston HospitalSwansea Bay University Health BoardSwanseaUK
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK
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Bailey GA, Martin E, Peall KJ. Cognitive and Neuropsychiatric Impairment in Dystonia. Curr Neurol Neurosci Rep 2022; 22:699-708. [PMID: 36201146 PMCID: PMC9633506 DOI: 10.1007/s11910-022-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review recent literature evaluating psychiatric and cognitive symptoms in dystonia, the two non-motor symptom groups most frequently evaluated in dystonia research and recognised in clinical practice. RECENT FINDINGS Recent work has embedded clinical recognition of psychiatric symptoms in dystonia, with depressive and anxiety-related symptoms routinely observed to be the most common. Less explored symptoms, such as self-harm, suicidal ideation, and substance abuse, represent newer areas of investigation, with initial work suggesting higher rates than the background population. Investigation of cognitive function has provided less consistent results, both within individual dystonia subtypes and across the spectrum of dystonias, partly reflecting the heterogeneity in approaches to assessment. However, recent work indicates impairments of higher cognitive function, e.g. social cognition, and disrupted visual and auditory sensory processing. Dystonia demonstrates psychiatric and cognitive symptom heterogeneity, with further work needed to recognise endophenotypes and improve diagnostic accuracy, symptom recognition, and management.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eva Martin
- School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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Scarduzio M, Hess EJ, Standaert DG, Eskow Jaunarajs KL. Striatal synaptic dysfunction in dystonia and levodopa-induced dyskinesia. Neurobiol Dis 2022; 166:105650. [DOI: 10.1016/j.nbd.2022.105650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
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8
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The prevalence of depression in adult onset idiopathic dystonia: Systematic review and metaanalysis. Neurosci Biobehav Rev 2021; 125:221-230. [PMID: 33662441 DOI: 10.1016/j.neubiorev.2021.02.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Adult onset idiopathic dystonia (AOID) is the third most common movement disorder in adults. Co-existing depressive symptoms and disorders represent major contributors of disability and quality of life in these patients, but their prevalence remains unclear. We investigated the point prevalence of supra-clinical threshold depressive symptoms/depressive disorders in AOID in a systematic review with qualitative synthesis and meta-analysis. Our search identified 60 articles suitable for qualitative synthesis and 54 for meta-analysis. The overall pooled prevalence of either supra-clinical threshold depressive symptoms or depressive disorders was 31.5 % for cervical dystonia, 29.2 % for cranial dystonia, and 33.6 % for clinical samples with mixed forms of AOID. Major depressive disorder was more prevalent than dysthymia in cervical dystonia, whereas dysthymia was more prevalent in cranial dystonia. In cervical dystonia, the prevalence of supra-clinical threshold depressive symptoms screened by rating scales was higher than that of depressive disorders diagnosed with structured interviews. Prevalence studies using rating scales yielded higher heterogeneity. More research is warranted to standardize screening methodology and characterization of mood disorders in AOID.
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Fratelli C, Siqueira J, Silva C, Ferreira E, Silva I. 5HTTLPR Genetic Variant and Major Depressive Disorder: A Review. Genes (Basel) 2020; 11:E1260. [PMID: 33114535 PMCID: PMC7692865 DOI: 10.3390/genes11111260] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023] Open
Abstract
Major Depressive Disorder (MDD) is a disease that involves biological, psychological, and social interactions. Studies have shown the importance of genetics contribution to MDD development. The SCL6A4 protein (5HTTLPR) functions transporting serotonin, a neurotransmitter linked to mood and emotion, to the synaptic cleft. Hence, this study seeks, through a literature review, a better comprehension of the 5HTTLPR genetic variant association with MDD. For this purpose, a search was performed on the Virtual Health Library Portal for articles that related 5HTTLPR to MDD. Most of the articles found were conducted in the American continent, with one (1) study implemented in Brazil. 5HTTLPR associations were found regarding changes in the nervous system, pharmacology, and risk factors seen in MDD patients. When verifying the allelic distribution, the S allele had a higher frequency in most of the studies analyzed. Despite not finding a commonality in the different studies, the tremendous genetic variation found demonstrates the MDD complexity. For this reason, further studies in diverse populations should be conducted to assist in the understanding and treatment of the disease.
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Affiliation(s)
- Caroline Fratelli
- Postgraduate Program in Health Sciences and Technologies, Campus Faculty of Ceilandia, University of Brasilia, Brasilia 72220-275, Brazil;
| | - Jhon Siqueira
- Department of Pharmacy, Campus Faculty of Ceilandia, University of Brasilia, Brasilia 72220-275, Brazil; (J.S.); (C.S.); (E.F.)
| | - Calliandra Silva
- Department of Pharmacy, Campus Faculty of Ceilandia, University of Brasilia, Brasilia 72220-275, Brazil; (J.S.); (C.S.); (E.F.)
| | - Eduardo Ferreira
- Department of Pharmacy, Campus Faculty of Ceilandia, University of Brasilia, Brasilia 72220-275, Brazil; (J.S.); (C.S.); (E.F.)
| | - Izabel Silva
- Department of Pharmacy, Campus Faculty of Ceilandia, University of Brasilia, Brasilia 72220-275, Brazil; (J.S.); (C.S.); (E.F.)
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Martino D, Brander G, Svenningsson P, Larsson H, Cruz LF. Association and Familial Coaggregation of Idiopathic Dystonia With Psychiatric Outcomes. Mov Disord 2020; 35:2270-2278. [DOI: 10.1002/mds.28257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Gustaf Brander
- Stockholm Health Care Services, Region Stockholm Stockholm Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology Uppsala University Uppsala Sweden
| | - Per Svenningsson
- Stockholm Health Care Services, Region Stockholm Stockholm Sweden
- Neuro Division, Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
- School of Medical Sciences, Örebro University Örebro Sweden
| | - Lorena Fernández Cruz
- Stockholm Health Care Services, Region Stockholm Stockholm Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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Bajenaru OL, Popescu-Olaru I, Dumitrescu L, Serban E, Cozma L, Raicu F, Cocos R, Popescu OB. Non-Motor Manifestations in Idiopathic Dystonia with Focal Onset - A Pilot Study. J Med Life 2020; 13:170-174. [PMID: 32742509 PMCID: PMC7378344 DOI: 10.25122/jml-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients' quality of life. This study represents a component of an ongoing research project - GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression. Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
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Affiliation(s)
- Ovidiu-Lucian Bajenaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Ana Aslan" National Institute of Geriatrics and Gerontology, Bucharest, Romania
| | - Iulia Popescu-Olaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Laura Dumitrescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Elena Serban
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liviu Cozma
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Florina Raicu
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Relu Cocos
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bogdan Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania.,Laboratory of Molecular Biology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
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12
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The Effect of Escitalopram on Central Serotonergic and Dopaminergic Systems in Patients with Cervical Dystonia, and Its Relationship with Clinical Treatment Effects: A Double-Blind Placebo-Controlled Trial. Biomolecules 2020; 10:biom10060880. [PMID: 32521736 PMCID: PMC7355711 DOI: 10.3390/biom10060880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: The pathophysiology of cervical dystonia (CD) is thought to be related to changes in dopamine and serotonin levels in the brain. We performed a double-blind trial with escitalopram (selective serotonin reuptake inhibitor; SSRI) in patients with CD. Here, we report on changes in dopamine D2/3 receptor (D2/3R), dopamine transporter (DAT) and serotonin transporter (SERT) binding potential (BPND) after a six-week treatment course with escitalopram or placebo. Methods: CD patients had [123I]FP-CIT SPECT (I-123 fluoropropyl carbomethoxy-3 beta-(4-iodophenyltropane) single-photon emission computed tomography) scans, to quantify extrastriatal SERT and striatal DAT, and [123I]IBZM SPECT (I-123 iodobenzamide SPECT) scans to quantify striatal D2/3R BPND before and after six weeks of treatment with either escitalopram or placebo. Treatment effect was evaluated with the Clinical Global Impression scale for dystonia, jerks and psychiatric symptoms, both by physicians and patients. Results: In both patients treated with escitalopram and placebo there were no significant differences after treatment in SERT, DAT or D2/3R BPND. Comparing scans after treatment with escitalopram (n = 8) to placebo (n = 8) showed a trend (p = 0.13) towards lower extrastriatal SERT BPND in the SSRI group (median SERT occupancy of 64.6%). After treatment with escitalopram, patients who reported a positive effect on dystonia or psychiatric symptoms had significantly higher SERT occupancy compared to patients who did not experience an effect. Conclusion: Higher extrastriatal SERT occupancy after treatment with escitalopram is associated with a trend towards a positive subjective effect on dystonia and psychiatric symptoms in CD patients.
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13
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Ospina-García N, Escobar-Barrios M, Rodríguez-Violante M, Benitez-Valenzuela J, Cervantes-Arriaga A. Neuropsychiatric profile of patients with craniocervical dystonia: A case-control study. Clin Neurol Neurosurg 2020; 193:105794. [PMID: 32203707 DOI: 10.1016/j.clineuro.2020.105794] [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: 04/25/2019] [Revised: 02/20/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depression, anxiety, and obsessive-compulsive disorder have been widely reported in patients with dystonia. On the other hand, cognitive impairment, frontal lobe function, impulsiveness and pseudobulbar affect are less studied. The objective of the study is to assess these neuropsychiatric symptoms along with the quality of life of subjects with craniocervical dystonia. PATIENTS AND METHODS A cross-sectional study was carried out in patients with craniocervical dystonia. Sex- and age-matched healthy controls were included. Neuropsychiatric assessment included the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Barrat Impulsiveness Scale (BIS-11), Center for Neurologic Study-Lability Scale (CNS-LS), Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and the 12-item Short Form Health Survey (SF-12). RESULTS A total of 44 patients with craniocervical dystonia and 44 controls were included. The mean age was 57 ± 13.7 years. Depression (56.1 % vs 9.1 %, p < 0.001), anxiety (56.8 % vs 6.8 %, p < 0.001), and pseudobulbar affect (31.8 % vs 9.1 %, p = 0.02) were more common in the dystonia group in comparison to controls. No difference between groups was found in impulsiveness (p = 0.65), MoCA score (p = 0.14) or executive dysfunction (p = 0.42). Quality of life was worst in the dystonia group with 90.9 % (p = 0.03) and 61.4 % (p < 0.001) of the subjects scoring under average in the Physical Composite Score (PCS) and Mental Composite Score (MCS) of the SF-12. CONCLUSION MoCA scores ≤18, pseudobulbar affect, depression and anxiety are more prevalent in subjects with craniocervical dystonia in comparison to sex- and age-matched healthy controls. Regarding quality of life, MCS is more affected that the PCS in subjects with dystonia.
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Affiliation(s)
- Natalia Ospina-García
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Faculty of Health Sciences, University of Tolima, Ibague, Colombia
| | - Marisa Escobar-Barrios
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Juan Benitez-Valenzuela
- Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurodegenerative Disease Clinical Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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14
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Zoons E, Booij J, Delnooz CCS, Dijk JM, Dreissen YEM, Koelman JHTM, van der Salm SMA, Skorvanek M, Smit M, Aramideh M, Bienfait H, Boon AJW, Brans JWM, Hoogerwaard E, Hovestadt A, Kamphuis DJ, Munts AG, Speelman JD, Tijssen MAJ. Randomised controlled trial of escitalopram for cervical dystonia with dystonic jerks/tremor. J Neurol Neurosurg Psychiatry 2018; 89:579-585. [PMID: 29326295 DOI: 10.1136/jnnp-2017-317352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/24/2017] [Accepted: 12/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Trials for additional or alternative treatments for cervical dystonia (CD) are scarce since the introduction of botulinum neurotoxin (BoNT). We performed the first trial to investigate whether dystonic jerks/tremor in patients with CD respond to the selective serotonin reuptake inhibitor (SSRI) escitalopram. METHODS In a randomised, double-blind, crossover trial, patients with CD received escitalopram and placebo for 6 weeks. Treatment with BoNT was continued, and scores on rating scales regarding dystonia, psychiatric symptoms and quality of life (QoL) were compared. Primary endpoint was the proportion of patients that improved at least one point on the Clinical Global Impression Scale for jerks/tremor scored by independent physicians with experience in movement disorders. RESULTS Fifty-threepatients were included. In the escitalopram period, 14/49 patients (29%) improved on severity of jerks/tremor versus 11/48 patients (23%) in the placebo period (P=0.77). There were no significant differences between baseline and after treatment with escitalopram or placebo on severity of dystonia or jerks/tremor. Psychiatric symptoms and QoL improved significantly in both periods compared with baseline. There were no significant differences between treatment with escitalopram and placebo for dystonia, psychiatric or QoL rating scales. During treatment with escitalopram, patients experienced slightly more adverse events, but no serious adverse events occurred. CONCLUSION In this innovative trial, no add-on effect of escitalopram for treatment of CD with jerks was found on motor or psychiatric symptoms. However, we also did not find a reason to withhold patients treatment with SSRIs for depression and anxiety, which are common in dystonia. TRIAL REGISTRATION NUMBER NTR2178.
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Affiliation(s)
- Evelien Zoons
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Joke M Dijk
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Sandra M A van der Salm
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - Matej Skorvanek
- Department of Neurology, Safarik University, Kosice, Slovakia.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Marenka Smit
- Department of Neurology, University Medical Center, Groningen, The Netherlands
| | - Majid Aramideh
- Department of Neurology, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | | | - Agnita J W Boon
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen W M Brans
- Department of Neurology, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Edo Hoogerwaard
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ad Hovestadt
- Department of Neurology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Daan J Kamphuis
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Johannes D Speelman
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center, Groningen, The Netherlands
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15
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Treatment of Myoclonus-dystonia with carbamazepine. Parkinsonism Relat Disord 2018; 53:116-117. [PMID: 29853296 DOI: 10.1016/j.parkreldis.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022]
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