1
|
Massuyama BK, Gama MTD, Silva TYT, Braga-Neto P, Pedroso JL, Barsottini OGP. Ataxias in Brazil: 17 years of experience in an ataxia center. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-8. [PMID: 38964341 DOI: 10.1055/s-0044-1787800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
BACKGROUND Cerebellar ataxias comprise sporadic and genetic etiologies. Ataxia may also be a presenting feature in hereditary spastic paraplegias (HSPs). OBJECTIVE To report a descriptive analysis of the frequency of different forms of cerebellar ataxia evaluated over 17 years in the Ataxia Unit of Universidade Federal de São Paulo, Brazil. METHODS Charts of patients who were being followed from January 2007 to December 2023 were reviewed. We used descriptive statistics to present our results as frequencies and percentages of the overall analysis. Diagnosed patients were classified according to the following 9 groups: sporadic ataxia, spinocerebellar ataxias (SCAs), other autosomal dominant cerebellar ataxias, autosomal recessive cerebellar ataxias (ARCAs), mitochondrial ataxias, congenital ataxias, X-linked ataxias, HSPs, and others. RESULTS There were 1,332 patients with ataxias or spastic paraplegias. Overall, 744 (55.85%) of all cases were successfully diagnosed: 101 sporadic ataxia, 326 SCAs, 20 of other autosomal dominant cerebellar ataxias, 186 ARCAs, 6 X-linked ataxias, 2 mitochondrial ataxias, 4 congenital ataxias, and 51 HSPs. CONCLUSION This study describes the frequency of cerebellar ataxias in a large group of patients followed for the past 17 years, of whom 55% obtained a definitive clinical or molecular diagnosis. Future demographic surveys in Brazil or Latin American remain necessary.
Collapse
Affiliation(s)
- Breno Kazuo Massuyama
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurologia Clínica, Setor de Ataxias, São Paulo SP, Brazil
| | - Maria Thereza Drumond Gama
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurologia Clínica, Setor de Ataxias, São Paulo SP, Brazil
| | - Thiago Yoshinaga Tonholo Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurologia Clínica, Setor de Ataxias, São Paulo SP, Brazil
| | - Pedro Braga-Neto
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Clínica Médica, Fortaleza CE, Brazil
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurologia Clínica, Setor de Ataxias, São Paulo SP, Brazil
| | - Orlando Graziani Povoas Barsottini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurologia Clínica, Setor de Ataxias, São Paulo SP, Brazil
| |
Collapse
|
2
|
Indelicato E, Boesch S. CACNA1A-Related Channelopathies: Clinical Manifestations and Treatment Options. Handb Exp Pharmacol 2023; 279:227-248. [PMID: 36592223 DOI: 10.1007/164_2022_625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the last decade, variants in the Ca2+ channel gene CACNA1A emerged as a frequent aetiology of rare neurological phenotypes sharing a common denominator of variable paroxysmal manifestations and chronic cerebellar dysfunction. The spectrum of paroxysmal manifestations encompasses migraine with hemiplegic aura, episodic ataxia, epilepsy and paroxysmal non-epileptic movement disorders. Additional chronic neurological symptoms range from severe developmental phenotypes in early-onset cases to neurobehavioural disorders and chronic cerebellar ataxia in older children and adults.In the present review we systematically approach the clinical manifestations of CACNA1A variants, delineate genotype-phenotype correlations and elaborate on the emerging concept of an age-dependent phenotypic spectrum in CACNA1A disease. We furthermore reflect on different therapy options available for paroxysmal symptoms in CACNA1A and address open issues to prioritize in the future clinical research.
Collapse
Affiliation(s)
- Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Jacobi H, Schaprian T, Beyersmann J, Tezenas du Montcel S, Schmid M, Klockgether T. Evolution of disability in spinocerebellar ataxias type 1, 2, 3, and 6. Ann Clin Transl Neurol 2022; 9:286-295. [PMID: 35188716 PMCID: PMC8935317 DOI: 10.1002/acn3.51515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The aim was to study the evolution of disability in spinocerebellar ataxias (SCAs) type 1, 2, 3, and 6 (SCA1, 2, 3, 6). Methods We analyzed data of two longitudinal cohorts (RISCA, EUROSCA) which recruited ataxic and non‐ataxic SCA1, SCA2, SCA3, and SCA6 mutation carriers. To study disability, we used a five‐stage system for ataxia defined by walking ability (stages 0–3) and death (stage 4). Transitions were analyzed using a multi‐state model with proportional transition hazards. Based on the hazard estimates, transition probabilities and the expected lengths of stay in each stage were calculated. We further studied the effect of sex and CAG repeat length on progression. Results Data of 3138 visits in 677 participants were analyzed. Median SARA scores for SCA1, SCA2, SCA3, and SCA6 ranged from 1.5 (interquartile range [IQR] = 0.0–3.5) to 3.5 (IQR = 1.4–6.1) in stage 0, 11.5 (IQR = 9.6–14.0) to 13.8 (IQR = 11.0–16.0) in stage 1, 19.0 (IQR = 17.0–21.0) to 23.8 (IQR = 19.5–27.0) in stage 2, and 28.5 (IQR = 26.0–32.5) to 34.0 (IQR = 32.6–37.1) in stage 3. Modeling allowed to calculate the subtype‐specific probability to be in a certain stage at a given age and duration of each stage. CAG repeat length was associated with faster progression in SCA1 (HR, 95% CI: 1.1, 1.1–1.2), SCA2 (1.2, 1.1–1.3), and SCA3 (1.1, 1.0–1.2). In SCA6, female sex was associated with faster progression (1.7, 1.1–2.6). Interpretation Our data are important for counselling of patients, assessment of the relevance of outcome markers, and design of clinical trials.
Collapse
Affiliation(s)
- Heike Jacobi
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, Bonn, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, Bonn, Germany
| | - Jan Beyersmann
- Institute of Statistics, Ulm University, Helmholtzstr. 20, Ulm, 89081, Germany
| | - Sophie Tezenas du Montcel
- INSERM, Institute Pierre Louis de Santé Publique, AP-HP, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Venusberg-Campus 1, Bonn, D-53127, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, Bonn, Germany.,Department of Neurology, University Hospital of Bonn, Bonn, Germany
| | | |
Collapse
|
4
|
Louis ED, Faust PL. Essential Tremor Within the Broader Context of Other Forms of Cerebellar Degeneration. THE CEREBELLUM 2021; 19:879-896. [PMID: 32666285 DOI: 10.1007/s12311-020-01160-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Essential tremor (ET) has recently been reconceptualized by many as a degenerative disease of the cerebellum. Until now, though, there has been no attempt to frame it within the context of these diseases. Here, we compare the clinical and postmortem features of ET with other cerebellar degenerations, thereby placing it within the broader context of these diseases. Action tremor is the hallmark feature of ET. Although often underreported in the spinocerebellar ataxias (SCAs), action tremors occur, and it is noteworthy that in SCA12 and 15, they are highly prevalent, often severe, and can be the earliest disease manifestation, resulting in an initial diagnosis of ET in many cases. Intention tremor, sometimes referred to as "cerebellar tremor," is a common feature of ET and many SCAs. Other features of cerebellar dysfunction, gait ataxia and eye motion abnormalities, are seen to a mild degree in ET and more markedly in SCAs. Several SCAs (e.g., SCA5, 6, 14, and 15), like ET, follow a milder and more protracted disease course. In ET, numerous postmortem changes have been localized to the cerebellum and are largely confined to the cerebellar cortex, preserving the cerebellar nuclei. Purkinje cell loss is modest. Similarly, in SCA3, 12, and 15, Purkinje cell loss is limited, and in SCA12 and 15, there is preservation of cerebellar nuclei and relative sparing of other central nervous system regions. Both clinically and pathologically, there are numerous similarities and intersection points between ET and other disorders of cerebellar degeneration.
Collapse
Affiliation(s)
- Elan D Louis
- Department of Neurology and Therapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
5
|
de Gusmão CM, Garcia L, Mikati MA, Su S, Silveira-Moriyama L. Paroxysmal Genetic Movement Disorders and Epilepsy. Front Neurol 2021; 12:648031. [PMID: 33833732 PMCID: PMC8021799 DOI: 10.3389/fneur.2021.648031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Paroxysmal movement disorders include paroxysmal kinesigenic dyskinesia, paroxysmal non-kinesigenic dyskinesia, paroxysmal exercise-induced dyskinesia, and episodic ataxias. In recent years, there has been renewed interest and recognition of these disorders and their intersection with epilepsy, at the molecular and pathophysiological levels. In this review, we discuss how these distinct phenotypes were constructed from a historical perspective and discuss how they are currently coalescing into established genetic etiologies with extensive pleiotropy, emphasizing clinical phenotyping important for diagnosis and for interpreting results from genetic testing. We discuss insights on the pathophysiology of select disorders and describe shared mechanisms that overlap treatment principles in some of these disorders. In the near future, it is likely that a growing number of genes will be described associating movement disorders and epilepsy, in parallel with improved understanding of disease mechanisms leading to more effective treatments.
Collapse
Affiliation(s)
- Claudio M. de Gusmão
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil
| | - Lucas Garcia
- Department of Medicine, Universidade 9 de Julho, São Paulo, Brazil
| | - Mohamad A. Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke University Medical Center, Durham, NC, United States
| | - Samantha Su
- Division of Pediatric Neurology and Developmental Medicine, Duke University Medical Center, Durham, NC, United States
| | - Laura Silveira-Moriyama
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil
- Department of Medicine, Universidade 9 de Julho, São Paulo, Brazil
- Education Unit, University College London Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
6
|
Cocozza S, Pontillo G, De Michele G, Di Stasi M, Guerriero E, Perillo T, Pane C, De Rosa A, Ugga L, Brunetti A. Conventional MRI findings in hereditary degenerative ataxias: a pictorial review. Neuroradiology 2021; 63:983-999. [PMID: 33733696 PMCID: PMC8213578 DOI: 10.1007/s00234-021-02682-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Purpose Cerebellar ataxias are a large and heterogeneous group of disorders. The evaluation of brain parenchyma via MRI plays a central role in the diagnostic assessment of these conditions, being mandatory to exclude the presence of other underlying causes in determining the clinical phenotype. Once these possible causes are ruled out, the diagnosis is usually researched in the wide range of hereditary or sporadic ataxias. Methods We here propose a review of the main clinical and conventional imaging findings of the most common hereditary degenerative ataxias, to help neuroradiologists in the evaluation of these patients. Results Hereditary degenerative ataxias are all usually characterized from a neuroimaging standpoint by the presence, in almost all cases, of cerebellar atrophy. Nevertheless, a proper assessment of imaging data, extending beyond the mere evaluation of cerebellar atrophy, evaluating also the pattern of volume loss as well as concomitant MRI signs, is crucial to achieve a proper diagnosis. Conclusion The integration of typical neuroradiological characteristics, along with patient’s clinical history and laboratory data, could allow the neuroradiologist to identify some conditions and exclude others, addressing the neurologist to the more appropriate genetic testing.
Collapse
Affiliation(s)
- Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| |
Collapse
|
7
|
Indelicato E, Boesch S. From Genotype to Phenotype: Expanding the Clinical Spectrum of CACNA1A Variants in the Era of Next Generation Sequencing. Front Neurol 2021; 12:639994. [PMID: 33737904 PMCID: PMC7960780 DOI: 10.3389/fneur.2021.639994] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Ion channel dysfunction is a key pathological substrate of episodic neurological disorders. A classical gene associated to paroxysmal movement disorders is CACNA1A, which codes for the pore-forming subunit of the neuronal calcium channel P/Q. Non-polyglutamine CACNA1A variants underlie familial hemiplegic ataxia type 1 (FHM1) and episodic ataxia type 2 (EA2). Classical paroxysmal manifestations of FHM1 are migraine attacks preceded by motor aura consisting of hemiparesis, aphasia, and disturbances of consciousness until coma. Patients with EA2 suffer of recurrent episodes of vertigo, unbalance, diplopia, and vomiting. Beyond these typical presentations, several reports highlighted manifold clinical features associated with P/Q channelopathies, from chronic progressive cerebellar ataxia to epilepsy and psychiatric disturbances. These manifestations may often outlast the burden of classical episodic symptoms leading to pitfalls in the diagnostic work-up. Lately, the spreading of next generation sequencing techniques linked de novo CACNA1A variants to an even broader phenotypic spectrum including early developmental delay, autism spectrum disorders, epileptic encephalopathy, and early onset paroxysmal dystonia. The age-dependency represents a striking new aspect of these phenotypes und highlights a pivotal role for P/Q channels in the development of the central nervous system in a defined time window. While several reviews addressed the clinical presentation and treatment of FHM1 and EA2, an overview of the newly described age-dependent manifestations is lacking. In this Mini-Review we present a clinical update, delineate genotype-phenotype correlations as well as summarize evidence on the pathophysiological mechanisms underlying the expanded phenotype associated with CACNA1A variants.
Collapse
Affiliation(s)
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
8
|
Gur-Hartman T, Berkowitz O, Yosovich K, Roubertie A, Zanni G, Macaya A, Heimer G, Dueñas BP, Sival DA, Pode-Shakked B, López-Laso E, Humbertclaude V, Riant F, Bosco L, Cayron LB, Nissenkorn A, Nicita F, Bertini E, Hassin S, Ben Zeev B, Zerem A, Libzon S, Lev D, Linder I, Lerman-Sagie T, Blumkin L. Clinical phenotypes of infantile onset CACNA1A-related disorder. Eur J Paediatr Neurol 2021; 30:144-154. [PMID: 33349592 DOI: 10.1016/j.ejpn.2020.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND CACNA1A-related disorders present with persistent progressive and non-progressive cerebellar ataxia and paroxysmal events: epileptic seizures and non-epileptic attacks. These phenotypes overlap and co-exist in the majority of patients. OBJECTIVE To describe phenotypes in infantile onset CACNA1A-related disorder and to explore intra-familial variations and genotype-phenotype correlations. MATERIAL AND METHODS This study was a multicenter international collaboration. A retrospective chart review of CACNA1A patients was performed. Clinical, radiological, and genetic data were collected and analyzed in 47 patients with infantile-onset disorder. RESULTS Paroxysmal non-epileptic events (PNEE) were observed in 68% of infants, with paroxysmal tonic upward gaze (PTU) noticed in 47% of infants. Congenital cerebellar ataxia (CCA) was diagnosed in 51% of patients including four patients with developmental delay and only one neurological sign. PNEEs were found in 63% of patients at follow-up, with episodic ataxia (EA) in 40% of the sample. Cerebellar ataxia was found in 58% of the patients at follow-up. Four patients had epilepsy in infancy and nine in childhood. Seven infants had febrile convulsions, three of which developed epilepsy later; all three patients had CCA. Cognitive difficulties were demonstrated in 70% of the children. Cerebellar atrophy was found in only one infant but was depicted in 64% of MRIs after age two. CONCLUSIONS Nearly all of the infants had CCA, PNEE or both. Cognitive difficulties were frequent and appeared to be associated with CCA. Epilepsy was more frequent after age two. Febrile convulsions in association with CCA may indicate risk of epilepsy in later childhood. Brain MRI was normal in infancy. There were no genotype-phenotype correlations found.
Collapse
Affiliation(s)
- Tamar Gur-Hartman
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel; Pediatric Movement Disorders Service, Wolfson Medical Center, Holon, Israel; School of Psychological Sciences, Tel-Aviv University, Israel
| | - Oren Berkowitz
- Department of Health Systems Management, Ariel University, Ariel, Israel
| | - Keren Yosovich
- Molecular Genetics Laboratory, Wolfson Medical Center, Holon, Israel
| | - Agathe Roubertie
- Departement de Neuropediatrie, CHU Gui de Chauliac, Institut des Neurosciences de Montpellier, Montpellier, France
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy
| | - Alfons Macaya
- Vall d'Hebron Research Institute, Pediatric Neurology Research Group, Autonomous University of Barcelona, Barcelona, Spain
| | - Gali Heimer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Belén Pérez Dueñas
- Vall d'Hebron Research Institute, Pediatric Neurology Research Group, Autonomous University of Barcelona, Barcelona, Spain
| | - Deborah A Sival
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ben Pode-Shakked
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Institute for Rare Diseases, Edmond and Lily Safra Children's Hospital; Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Eduardo López-Laso
- University Hospital Reina Sofía, Pediatric Neurology Unit, IMIBIC and CIBERER, Córdoba, Spain
| | - Véronique Humbertclaude
- Service de Médecine Psychologique Enfants et Adolescents, CHU Saint Eloi, Montpellier, France
| | - Florence Riant
- AP-HP, GH Saint Louis-Lariboisière-Fernand Widal, Service de Génétique Moléculaire Neurovasculaire, Paris, France
| | - Luca Bosco
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy
| | | | - Andreea Nissenkorn
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Francesco Nicita
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesu' Children's Hospital, Rome, Italy
| | - Sharon Hassin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Bruria Ben Zeev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ayelet Zerem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Pediatric Neurology Unit TASMC, Tel-Aviv University, Israel
| | | | - Dorit Lev
- Molecular Genetics Laboratory, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - Ilan Linder
- Pediatric Epilepsy & Neurology Service, Barzilay Medical Center, Ashkelon, Israel
| | - Tally Lerman-Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lubov Blumkin
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel; Pediatric Movement Disorders Service, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| |
Collapse
|
9
|
Giunti P, Mantuano E, Frontali M. Episodic Ataxias: Faux or Real? Int J Mol Sci 2020; 21:ijms21186472. [PMID: 32899446 PMCID: PMC7555854 DOI: 10.3390/ijms21186472] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022] Open
Abstract
The term Episodic Ataxias (EA) was originally used for a few autosomal dominant diseases, characterized by attacks of cerebellar dysfunction of variable duration and frequency, often accompanied by other ictal and interictal signs. The original group subsequently grew to include other very rare EAs, frequently reported in single families, for some of which no responsible gene was found. The clinical spectrum of these diseases has been enormously amplified over time. In addition, episodes of ataxia have been described as phenotypic variants in the context of several different disorders. The whole group is somewhat confused, since a strong evidence linking the mutation to a given phenotype has not always been established. In this review we will collect and examine all instances of ataxia episodes reported so far, emphasizing those for which the pathophysiology and the clinical spectrum is best defined.
Collapse
Affiliation(s)
- Paola Giunti
- Laboratory of Neurogenetics, Department of Molecular Neuroscience, UCL Institute of Neurology, London WC2N 5DU, UK
- Correspondence: (P.G.); (M.F.)
| | - Elide Mantuano
- Laboratory of Neurogenetics, Institute of Translational Pharmacology, National Research Council of Italy, 00133 Rome, Italy;
| | - Marina Frontali
- Laboratory of Neurogenetics, Institute of Translational Pharmacology, National Research Council of Italy, 00133 Rome, Italy;
- Correspondence: (P.G.); (M.F.)
| |
Collapse
|
10
|
Horimoto Y, Hayashi E, Ito Y, Iida A, Goto Y, Kato S, Okita K, Kako T, Sato C, Tajima T, Inagaki A, Nokura K, Hibino H, Matsukawa N, Yamada K, Kabasawa H. Dopaminergic function in spinocerebellar ataxia type 6 patients with and without parkinsonism. J Neurol 2020; 267:2692-2696. [PMID: 32440919 DOI: 10.1007/s00415-020-09908-y] [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: 02/19/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although pure cerebellar ataxia is usually emphasized as the characteristic clinical feature of spinocerebellar ataxia type 6 (SCA6), parkinsonism has been repeatedly described in patients with genetically confirmed SCA6. METHODS We conducted a positron emission tomography study using a combination of [18F]fluoro-L-dopa for dopamine synthesis and [11C]raclopride for dopamine D2 receptor function on six genetically confirmed SCA6 patients, both with and without parkinsonism. To the best of our knowledge, this is the first dopamine receptor imaging study of patients with SCA6. RESULTS Most patients had somewhat decreased dopaminergic function, and this decrease was significant in the caudate nucleus. In addition, one SCA6 patient with parkinsonism had whole striatal dysfunction of both dopamine synthesis and dopamine D2 receptor function. CONCLUSIONS The pathology of SCA6 may not be restricted to the cerebellum, but may also be distributed across various regions, including in both presynaptic and postsynaptic dopaminergic neurons to some degree. Patients with SCA6 may show apparent parkinsonism after the progression of neurodegeneration.
Collapse
Affiliation(s)
- Yoshihiko Horimoto
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan.
| | - Emi Hayashi
- Department of Radiology, Nagoya City Rehabilitation Center, Nagoya, Japan.,Department of Planning and Research, Nagoya City Rehabilitation Center, Nagoya, Japan
| | - Yoshihiro Ito
- Department of Radiology, Nagoya City Rehabilitation Center, Nagoya, Japan.,Department of Planning and Research, Nagoya City Rehabilitation Center, Nagoya, Japan
| | - Akihiko Iida
- Department of Radiology, Nagoya City Rehabilitation Center, Nagoya, Japan
| | - Yoji Goto
- Department of Neurology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Shigenori Kato
- Department of Neurology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Kenji Okita
- Department of Neurology, Nagoya City University, Nagoya, Japan
| | - Tetsuharu Kako
- Department of Neurology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chikako Sato
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Toshihisa Tajima
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan.,Department of Planning and Research, Nagoya City Rehabilitation Center, Nagoya, Japan
| | - Aki Inagaki
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Kazuya Nokura
- Department of Neurology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Hiroaki Hibino
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | | | - Kazuo Yamada
- Department of Neurosurgery, Nagoya City Rehabilitation Center, Nagoya, Japan
| | - Hidehiro Kabasawa
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| |
Collapse
|
11
|
Verma AK, Khan E, Bhagwat SR, Kumar A. Exploring the Potential of Small Molecule-Based Therapeutic Approaches for Targeting Trinucleotide Repeat Disorders. Mol Neurobiol 2019; 57:566-584. [DOI: 10.1007/s12035-019-01724-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/29/2019] [Indexed: 12/18/2022]
|
12
|
Shuvaev AN, Belozor OS, Smolnikova MV, Yakovleva DA, Shuvaev AN, Kazantseva OM, Pozhilenkova EA, Mozhei OI, Kasparov S. Population genetics of spinoсerebellar ataxias caused by polyglutamine expansions. Vavilovskii Zhurnal Genet Selektsii 2019. [DOI: 10.18699/vj19.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hereditary disorders of the neuronal system are some of the most important problems of medicine in the XXI century. The most interesting representatives of this group are highly prevalent polyglutamine spinocerebellar ataxias (SCAs). It has a basement for quick progression of expansion among different groups all over the World. These diseases are SCA1, 2, 3, 6, 7 and 17, which phenotypically belong to one group due to similarities in clinics and genetics. The substrate of these genetic conditions is CAG trinucleotide repeat of Ataxin genes which may expand in the course of reproduction. For this reason a characteristic feature of these diseases is not only an increase in patient numbers, but also a qualitative change in the progression of their neurological symptoms. All these aspects are reflected in the structure of the incidence of polyglutamine SCAs, both at the global level and at the level of individual population groups. However, most scientific reports that describe the population genetics of polyglutamine SCAs are limited to quantitative indicators of a specific condition in a certain area, while the history of the occurrence and principles of the distribution of polyglutamine SCAs are poorly understood. This prevents long-term predictions of the dynamics of the disease and development of strategies for controlling the spread of mutations in the populations. In this paper we make a detailed analysis of the polyglutamine SCAs population genetics, both in the whole world and specifically in theRussian Federation. We note that for a better analysis it would be necessary to cover a wider range of populations in Africa, Asia andSouth America, which will be possible with the development of new methods for molecular genetics. Development of new methods of detection of polyglutamine SCAs will allow the scientists to better understand how they lead to the brain disease, the means of their spread in the population and to develop better methods for therapy and prevention of these diseases.
Collapse
Affiliation(s)
- A. N. Shuvaev
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky, Research Institute of Molecular Medicine and Pathobiochemistry
| | - O. S. Belozor
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky, Research Institute of Molecular Medicine and Pathobiochemistry
| | - M. V. Smolnikova
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky, Research Institute of Molecular Medicine and Pathobiochemistry;
Federal Research Center “Krasnoyarsk Science Center” of the Siberian Branch of the Russian Academy of Sciences, Scientific Research Institute of Medical Problems of the North
| | | | | | | | - E. A. Pozhilenkova
- Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky, Research Institute of Molecular Medicine and Pathobiochemistry
| | | | - S. Kasparov
- Immanuel Kant Baltic Federal University;
University of Bristol
| |
Collapse
|
13
|
Abstract
The spinocerebellar ataxias (SCAs) are a genetically heterogeneous group of autosomal dominantly inherited progressive disorders, the clinical hallmark of which is loss of balance and coordination accompanied by slurred speech; onset is most often in adult life. Genetically, SCAs are grouped as repeat expansion SCAs, such as SCA3/Machado-Joseph disease (MJD), and rare SCAs that are caused by non-repeat mutations, such as SCA5. Most SCA mutations cause prominent damage to cerebellar Purkinje neurons with consecutive cerebellar atrophy, although Purkinje neurons are only mildly affected in some SCAs. Furthermore, other parts of the nervous system, such as the spinal cord, basal ganglia and pontine nuclei in the brainstem, can be involved. As there is currently no treatment to slow or halt SCAs (many SCAs lead to premature death), the clinical care of patients with SCA focuses on managing the symptoms through physiotherapy, occupational therapy and speech therapy. Intense research has greatly expanded our understanding of the pathobiology of many SCAs, revealing that they occur via interrelated mechanisms (including proteotoxicity, RNA toxicity and ion channel dysfunction), and has led to the identification of new targets for treatment development. However, the development of effective therapies is hampered by the heterogeneity of the SCAs; specific therapeutic approaches may be required for each disease.
Collapse
|
14
|
Buijsen RAM, Toonen LJA, Gardiner SL, van Roon-Mom WMC. Genetics, Mechanisms, and Therapeutic Progress in Polyglutamine Spinocerebellar Ataxias. Neurotherapeutics 2019; 16:263-286. [PMID: 30607747 PMCID: PMC6554265 DOI: 10.1007/s13311-018-00696-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Autosomal dominant cerebellar ataxias (ADCAs) are a group of neurodegenerative disorders characterized by degeneration of the cerebellum and its connections. All ADCAs have progressive ataxia as their main clinical feature, frequently accompanied by dysarthria and oculomotor deficits. The most common spinocerebellar ataxias (SCAs) are 6 polyglutamine (polyQ) SCAs. These diseases are all caused by a CAG repeat expansion in the coding region of a gene. Currently, no curative treatment is available for any of the polyQ SCAs, but increasing knowledge on the genetics and the pathological mechanisms of these polyQ SCAs has provided promising therapeutic targets to potentially slow disease progression. Potential treatments can be divided into pharmacological and gene therapies that target the toxic downstream effects, gene therapies that target the polyQ SCA genes, and stem cell replacement therapies. Here, we will provide a review on the genetics, mechanisms, and therapeutic progress in polyglutamine spinocerebellar ataxias.
Collapse
Affiliation(s)
- Ronald A M Buijsen
- Department of Human Genetics, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Lodewijk J A Toonen
- Department of Human Genetics, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sarah L Gardiner
- Department of Human Genetics, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | |
Collapse
|
15
|
Indelicato E, Nachbauer W, Karner E, Eigentler A, Wagner M, Unterberger I, Poewe W, Delazer M, Boesch S. The neuropsychiatric phenotype in CACNA1A mutations: a retrospective single center study and review of the literature. Eur J Neurol 2018; 26:66-e7. [PMID: 30063100 DOI: 10.1111/ene.13765] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE CACNA1A encodes the α1 subunit of the neuronal calcium channel P/Q. CACNA1A mutations underlie three allelic disorders: familial hemiplegic migraine type 1 (FHM1), episodic ataxia type 2 (EA2) and spinocerebellar ataxia type 6 (SCA6). A clear-cut genotype-phenotype correlation is often lacking since clinical manifestations may overlap. Several case reports have described cognitive and behavioral features in CACNA1A disorders, but studies in larger case series are lacking. METHODS Genetically confirmed CACNA1A cases were retrieved from the database of the ataxia outpatient clinic of the Department of Neurology at Innsbruck Medical University. Clinical charts and neuropsychological test results were retrospectively analyzed. In addition, a review of the literature including only genetically confirmed cases was performed. RESULTS Forty-four CACNA1A cases were identified in our database. Delayed psychomotor milestones and poor school performance were described in seven (four FHM1, three EA2) and eight (three FHM1, five EA2) patients, respectively. Psychiatric comorbidities were diagnosed in eight patients (two FHM1, six EA2). Neuropsychological testing was available for 23 patients (11 FHM1, 10 EA2, two SCA6). Various cognitive deficits were documented in 21 cases (all patients except one SCA6). Impairments were predominantly seen in figural memory, visuoconstructive abilities and verbal fluency. In the literature, an early psychomotor delay is described in several children with EA2 and FHM1, whilst reports of cognitive and psychiatric findings from adult cases are scarce. CONCLUSIONS Neuropsychiatric manifestations are common in episodic CACNA1A disorders. In the case of otherwise unexplained developmental delay and a positive family history, CACNA1A mutations should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- E Indelicato
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - W Nachbauer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - E Karner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - A Eigentler
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - M Wagner
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - I Unterberger
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - W Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - M Delazer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - S Boesch
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
16
|
La Cognata V, Morello G, Gentile G, Cavalcanti F, Cittadella R, Conforti FL, De Marco EV, Magariello A, Muglia M, Patitucci A, Spadafora P, D’Agata V, Ruggieri M, Cavallaro S. NeuroArray: A Customized aCGH for the Analysis of Copy Number Variations in Neurological Disorders. Curr Genomics 2018; 19:431-443. [PMID: 30258275 PMCID: PMC6128384 DOI: 10.2174/1389202919666180404105451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/02/2018] [Accepted: 03/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neurological disorders are a highly heterogeneous group of pathological conditions that affect both the peripheral and the central nervous system. These pathologies are characterized by a complex and multifactorial etiology involving numerous environmental agents and genetic susceptibility factors. For this reason, the investigation of their pathogenetic basis by means of traditional methodological approaches is rather arduous. High-throughput genotyping technologies, including the microarray-based comparative genomic hybridization (aCGH), are currently replacing classical detection methods, providing powerful molecular tools to identify genomic unbalanced structural rearrangements and explore their role in the pathogenesis of many complex human diseases. METHODS In this report, we comprehensively describe the design method, the procedures, validation, and implementation of an exon-centric customized aCGH (NeuroArray 1.0), tailored to detect both single and multi-exon deletions or duplications in a large set of multi- and monogenic neurological diseases. This focused platform enables a targeted measurement of structural imbalances across the human genome, targeting the clinically relevant genes at exon-level resolution. CONCLUSION An increasing use of the NeuroArray platform may offer new insights in investigating potential overlapping gene signatures among neurological conditions and defining genotype-phenotype relationships.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sebastiano Cavallaro
- Address correspondence to this author at the Institute of Neurological Sciences, National Research Council, Via Paolo Gaifami 18, 95125, Catania, Italy; Tel: +39-095-7338111; E-mail:
| |
Collapse
|
17
|
Abstract
The familial episodic ataxias (EAs) are prototypical channelopathies in the central nervous system clinically characterized by attacks of imbalance and incoordination variably associated with progressive ataxia and variable interictal features. EA1, EA2, and EA6 are caused by mutations in ion channel- and transporter-encoding genes that regulate neuronal excitability and neurotransmission.
Collapse
Affiliation(s)
- Joanna C Jen
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
| | - Jijun Wan
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| |
Collapse
|
18
|
|
19
|
Du X, Gomez CM. Spinocerebellar [corrected] Ataxia Type 6: Molecular Mechanisms and Calcium Channel Genetics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1049:147-173. [PMID: 29427102 DOI: 10.1007/978-3-319-71779-1_7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spinocerebellar ataxia (SCA) type 6 is an autosomal dominant disease affecting cerebellar degeneration. Clinically, it is characterized by pure cerebellar dysfunction, slowly progressive unsteadiness of gait and stance, slurred speech, and abnormal eye movements with late onset. Pathological findings of SCA6 include a diffuse loss of Purkinje cells, predominantly in the cerebellar vermis. Genetically, SCA6 is caused by expansion of a trinucleotide CAG repeat in the last exon of longest isoform CACNA1A gene on chromosome 19p13.1-p13.2. Normal alleles have 4-18 repeats, while alleles causing disease contain 19-33 repeats. Due to presence of a novel internal ribosomal entry site (IRES) with the mRNA, CACNA1A encodes two structurally unrelated proteins with distinct functions within an overlapping open reading frame (ORF) of the same mRNA: (1) α1A subunit of P/Q-type voltage gated calcium channel; (2) α1ACT, a newly recognized transcription factor, with polyglutamine repeat at C-terminal end. Understanding the function of α1ACT in physiological and pathological conditions may elucidate the pathogenesis of SCA6. More importantly, the IRES, as the translational control element of α1ACT, provides a potential therapeutic target for the treatment of SCA6.
Collapse
Affiliation(s)
- Xiaofei Du
- Department of Neurology, The University of Chicago, Chicago, 60637, IL, USA
| | | |
Collapse
|
20
|
Miyazaki Y, Du X, Muramatsu SI, Gomez CM. An miRNA-mediated therapy for SCA6 blocks IRES-driven translation of the CACNA1A second cistron. Sci Transl Med 2017; 8:347ra94. [PMID: 27412786 DOI: 10.1126/scitranslmed.aaf5660] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022]
Abstract
Spinocerebellar ataxia type 6 (SCA6) is a dominantly inherited neurodegenerative disease characterized by slowly progressive ataxia and Purkinje cell degeneration. SCA6 is caused by a polyglutamine repeat expansion within a second CACNA1A gene product, α1ACT. α1ACT expression is under the control of an internal ribosomal entry site (IRES) present within the CACNA1A coding region. Whereas SCA6 allele knock-in mice show indistinguishable phenotypes from wild-type littermates, expression of SCA6-associated α1ACT (α1ACTSCA6) driven by a Purkinje cell-specific promoter in mice produces slowly progressive ataxia and cerebellar atrophy. We developed an early-onset SCA6 mouse model using an adeno-associated virus (AAV)-based gene delivery system to ectopically express CACNA1A IRES-driven α1ACTSCA6 to test the potential of CACNA1A IRES-targeting therapies. Mice expressing AAV9-mediated CACNA1A IRES-driven α1ACTSCA6 exhibited early-onset ataxia, motor deficits, and Purkinje cell degeneration. We identified miR-3191-5p as a microRNA (miRNA) that targeted CACNA1A IRES and preferentially inhibited the CACNA1A IRES-driven translation of α1ACT in an Argonaute 4 (Ago4)-dependent manner. We found that eukaryotic initiation factors (eIFs), eIF4AII and eIF4GII, interacted with the CACNA1A IRES to enhance α1ACT translation. Ago4-bound miR-3191-5p blocked the interaction of eIF4AII and eIF4GII with the CACNA1A IRES, attenuating IRES-driven α1ACT translation. Furthermore, AAV9-mediated delivery of miR-3191-5p protected mice from the ataxia, motor deficits, and Purkinje cell degeneration caused by CACNA1A IRES-driven α1ACTSCA6 We have established proof of principle that viral delivery of an miRNA can rescue a disease phenotype through modulation of cellular IRES activity in a mouse model.
Collapse
Affiliation(s)
- Yu Miyazaki
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Xiaofei Du
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - Shin-Ichi Muramatsu
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi 3290498, Japan. Center for Gene and Cell Therapy, Institute of Medical Science, University of Tokyo, Tokyo 1088639, Japan
| | | |
Collapse
|
21
|
Lindsay E, Storey E. Cognitive Changes in the Spinocerebellar Ataxias Due to Expanded Polyglutamine Tracts: A Survey of the Literature. Brain Sci 2017; 7:brainsci7070083. [PMID: 28708110 PMCID: PMC5532596 DOI: 10.3390/brainsci7070083] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022] Open
Abstract
The dominantly-inherited ataxias characterised by expanded polyglutamine tracts—spinocere bellar ataxias (SCAs) 1, 2, 3, 6, 7, 17, dentatorubral pallidoluysian atrophy (DRPLA) and, in part, SCA 8—have all been shown to result in various degrees of cognitive impairment. We survey the literature on the cognitive consequences of each disorder, attempting correlation with their published neuropathological, magnetic resonance imaging (MRI) and clinical features. We suggest several psychometric instruments for assessment of executive function, whose results are unlikely to be confounded by visual, articulatory or upper limb motor difficulties. Finally, and with acknowledgement of the inadequacies of the literature to date, we advance a tentative classification of these disorders into three groups, based on the reported severity of their cognitive impairments, and correlated with their neuropathological topography and MRI findings: group 1—SCAs 6 and 8—mild dysexecutive syndrome based on disruption of cerebello-cortical circuitry; group 2—SCAs 1, 2, 3, and 7—more extensive deficits based largely on disruption of striatocortical in addition to cerebello-cerebral circuitry; and group 3—SCA 17 and DRPLA—in which cognitive impairment severe enough to cause a dementia syndrome is a frequent feature.
Collapse
Affiliation(s)
- Evelyn Lindsay
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Commercial Road, Melbourne, VIC 3004, Australia.
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Commercial Road, Melbourne, VIC 3004, Australia.
| |
Collapse
|
22
|
Soga K, Ishikawa K, Furuya T, Iida T, Yamada T, Ando N, Ota K, Kanno-Okada H, Tanaka S, Shintaku M, Eishi Y, Mizusawa H, Yokota T. Gene dosage effect in spinocerebellar ataxia type 6 homozygotes: A clinical and neuropathological study. J Neurol Sci 2016; 373:321-328. [PMID: 28131213 DOI: 10.1016/j.jns.2016.12.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 02/07/2023]
Abstract
Spinocerebellar ataxia type 6 (SCA6) is an autosomal dominant neurodegenerative disorder. However, it remains unclear whether SCA6 shows a gene dosage effect, defined by earlier age-of-onset in homozygotes than heterozygotes. Herein, we retrospectively analyzed four homozygous SCA6 subjects from our single institution cohort of 120 SCA6 subjects. We also performed a neuropathological investigation into an SCA6 individual with compound heterozygous expansions. In the 116 heterozygotes, there was an inverse correlation of age-of-onset with the number of CAG repeats in the expanded allele, and with the total number of CAG repeats, in both normal and expanded alleles. The age-of-onset in the four homozygotes was within the 95% confidence interval of the age-of-onset versus the repeat-lengths correlations determined in the 116 heterozygotes. Nevertheless, all homozygotes had earlier onset than their parents, and showed rapid disease progression. Neuropathology revealed neuronal loss, as well as α1A-calcium channel protein aggregates in Purkinje cells, a few α1A-calcium channel protein aggregates in the neocortex and basal ganglia, and neuronal loss in Clarke's column and the globus pallidus not seen in heterozygotes. These data suggest a mild clinical and neuropathological gene dosage effect in SCA6 subjects.
Collapse
Affiliation(s)
- Kazumasa Soga
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kinya Ishikawa
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; The Center for Personalized Medicine for Healthy Aging, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Tokuro Furuya
- Department of Neurology, Kawaguchi Kogyo General Hospital, 1-18-15 Aoki, Kawaguchi, Saitama 332-0031, Japan
| | - Tadatsune Iida
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Cellular Neurobiology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tetsuo Yamada
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Laboratory of Pathology, Department of Clinical Laboratory Medicine, Bunkyo Gakuin University Graduate School of Health Care Science, 2-4-1 Mukogaoka, Bunkyo-ku, Tokyo 113-0023, Japan
| | - Noboru Ando
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kiyobumi Ota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hiromi Kanno-Okada
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan; Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido University, North 14, West 5, Kita-ku, Sapporo 060-8648, Hokkaido, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan
| | - Masayuki Shintaku
- Department of Pathology, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama, Shiga 524-8524, Japan
| | - Yoshinobu Eishi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hidehiro Mizusawa
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; The National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| |
Collapse
|
23
|
Méneret A, Roze E. Paroxysmal movement disorders: An update. Rev Neurol (Paris) 2016; 172:433-445. [PMID: 27567459 DOI: 10.1016/j.neurol.2016.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/10/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023]
Abstract
Paroxysmal movement disorders comprise both paroxysmal dyskinesia, characterized by attacks of dystonic and/or choreic movements, and episodic ataxia, defined by attacks of cerebellar ataxia. They may be primary (familial or sporadic) or secondary to an underlying cause. They can be classified according to their phenomenology (kinesigenic, non-kinesigenic or exercise-induced) or their genetic cause. The main genes involved in primary paroxysmal movement disorders include PRRT2, PNKD, SLC2A1, ATP1A3, GCH1, PARK2, ADCY5, CACNA1A and KCNA1. Many cases remain genetically undiagnosed, thereby suggesting that additional culprit genes remain to be discovered. The present report is a general overview that aims to help clinicians diagnose and treat patients with paroxysmal movement disorders.
Collapse
Affiliation(s)
- A Méneret
- Inserm U 1127, CNRS UMR 7225, Sorbonne University Group, UPMC University Paris 06 UMR S 1127, Brain and Spine Institute, ICM, 75013 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, 75013 Paris, France
| | - E Roze
- Inserm U 1127, CNRS UMR 7225, Sorbonne University Group, UPMC University Paris 06 UMR S 1127, Brain and Spine Institute, ICM, 75013 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, 75013 Paris, France.
| |
Collapse
|
24
|
Xie T, Appelbaum D, Bernard J, Padmanaban M, Pu Y, Gomez C. Evaluation of parkinsonism and striatal dopamine transporter loss in patients with spinocerebellar ataxia type 6. J Neurol 2016; 263:2302-2307. [PMID: 27544504 DOI: 10.1007/s00415-016-8261-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/07/2016] [Accepted: 08/06/2016] [Indexed: 11/29/2022]
Abstract
It is unclear whether patients with spinocerebellar ataxia type 6 (SCA6) have parkinsonism and striatal dopamine transporter (DAT) loss, based on previously small size studies without well-matched controls. A study with a larger number of patients and both age- and gender-matched healthy controls (HCs) is needed for a better answer to this question. Twelve genetically confirmed ataxic SCA6 patients (six male six female, age 65.3 ± 11.2 years), and eight age- and gender-matched HCs (five male three female, age 71.3 ± 8.6 years) were enrolled during 2013-2015 from tertiary movement disorders and ataxia clinics. Clinical assessment for parkinsonism, and qualitative and quantitative assessment of DAT level on DaTscan™ imaging were conducted in SCA6 patients compared to HCs. We found no convincing parkinsonism in SCA6 patients, given generalized bradykinesia in the context of significant ataxia in all, with mild symmetric rigidity in five without resting tremor. Furthermore, we found no striatal DAT loss in anterior, posterior, and total putamen and caudate on imaging, assessed independently by qualitative visual inspection in a blinded manner by the nuclear medicine specialist and movement disorder specialist (kappa = 1). Additional quantitative analysis on these areas did not reveal significant DAT loss either in SCA6 patients compared to HCs. We conclude that there is no convincing parkinsonism or DAT loss in SCA6 patients in this unique study with a larger than previously reported number of patients compared to both age- and gender-matched HCs, suggesting that dopaminergic dysfunction is not usually involved in SCA6.
Collapse
Affiliation(s)
- Tao Xie
- Department of Neurology, University of Chicago, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637, USA.
| | - Daniel Appelbaum
- Division of Nuclear Medicine, Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Jacqueline Bernard
- Department of Neurology, University of Chicago, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637, USA
| | - Mahesh Padmanaban
- Department of Neurology, University of Chicago, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637, USA
| | - Yonglin Pu
- Division of Nuclear Medicine, Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Christopher Gomez
- Department of Neurology, University of Chicago, 5841 S. Maryland Ave., MC 2030, Chicago, IL, 60637, USA
| |
Collapse
|
25
|
Falcon MI, Gomez CM, Chen EE, Shereen A, Solodkin A. Early Cerebellar Network Shifting in Spinocerebellar Ataxia Type 6. Cereb Cortex 2016; 26:3205-18. [PMID: 26209844 PMCID: PMC4898673 DOI: 10.1093/cercor/bhv154] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spinocerebellar ataxia 6 (SCA6), an autosomal dominant degenerative disease, is characterized by diplopia, gait ataxia, and incoordination due to severe progressive degeneration of Purkinje cells in the vestibulo- and spinocerebellum. Ocular motor deficits are common, including difficulty fixating on moving objects, nystagmus and disruption of smooth pursuit movements. In presymptomatic SCA6, there are alterations in saccades and smooth-pursuit movements. We sought to assess functional and structural changes in cerebellar connectivity associated with a visual task, hypothesizing that gradual changes would parallel disease progression. We acquired functional magnetic resonance imaging and diffusion tensor imaging data during a passive smooth-pursuit task in 14 SCA6 patients, representing a range of disease duration and severity, and performed a cross-sectional comparison of cerebellar networks compared with healthy controls. We identified a shift in activation from vermis in presymptomatic individuals to lateral cerebellum in moderate-to-severe cases. Concomitantly, effective connectivity between regions of cerebral cortex and cerebellum was at its highest in moderate cases, and disappeared in severe cases. Finally, we noted structural differences in the cerebral and cerebellar peduncles. These unique results, spanning both functional and structural domains, highlight widespread changes in SCA6 and compensatory mechanisms associated with cerebellar physiology that could be utilized in developing new therapies.
Collapse
Affiliation(s)
| | - C M Gomez
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
| | - E E Chen
- Department of Anatomy and Neurobiology
| | - A Shereen
- Department of Anatomy and Neurobiology
| | - A Solodkin
- Department of Anatomy and Neurobiology Department of Neurology, UC Irvine School of Medicine, Irvine, CA 92697, USA
| |
Collapse
|
26
|
Lee YC, Tsai PC, Guo YC, Hsiao CT, Liu GT, Liao YC, Soong BW. Spinocerebellar ataxia type 36 in the Han Chinese. NEUROLOGY-GENETICS 2016; 2:e68. [PMID: 27123487 PMCID: PMC4830187 DOI: 10.1212/nxg.0000000000000068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/01/2016] [Indexed: 12/27/2022]
Abstract
Objective: To ascertain the genetic and clinical characteristics of the GGCCTG hexanucleotide repeat expansion in the nucleolar protein 56 gene (NOP56) in patients with spinocerebellar ataxia (SCA), sporadic ataxia, or amyotrophic lateral sclerosis (ALS) in Taiwan. Methods: We conducted clinical and molecular genetic studies of 109 probands with molecularly unassigned SCA from 512 SCA pedigrees, 323 healthy controls, 502 patients with sporadic ataxia syndromes, and 144 patients with ALS. Repeat-primed PCR assays and PCR-fragment analysis for the number of short hexanucleotide repeats (<40 units) were performed to ascertain NOP56 hexanucleotide repeat expansion. Genotyping included 8 microsatellite markers and 17 single nucleotide polymorphisms flanking NOP56 and covering a region of 1.8 Mb to assess a possible founder effect. Results: Eleven individuals from 3 SCA pedigrees have the NOP56 repeat expansions. The 3 pedigrees share a common haplotype spanning 5.3 kb flanking the NOP56 repeat expansions, suggesting a founder effect of spinocerebellar ataxia type 36 (SCA36) in the Han Chinese. The average age at symptom onset was 44.8 ± 3.8 years with truncal ataxia as the initial manifestation. Common features included slowly progressive truncal/limb ataxia, dysarthria, generalized hyperreflexia, and hearing impairment. Evidence of lower motor neuron involvement, including atrophy and fasciculation in the limb muscles and tongue, was mostly found in patients with prolonged disease duration. NOP56 repeat expansion was not detected in controls or patients with sporadic ataxic syndromes or ALS. Conclusions: SCA36 is an uncommon subtype, which accounted for 0.6% (3/512) of SCA cases in the Han Chinese population.
Collapse
Affiliation(s)
- Yi-Chung Lee
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Chien Tsai
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Yuh-Cherng Guo
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Tsung Hsiao
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Guan-Ting Liu
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Yi-Chu Liao
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| | - Bing-Wen Soong
- Department of Neurology (Y.-C. Lee, C.-T.H., G.-T.L., Y.-C. Liao, B.-W.S.), Taipei Veterans General Hospital, Taiwan; Department of Neurology (Y.-C. Lee, P.-C.T., Y.-C. Liao, B.-W.S.), Institute of Clinical Medicine (Y.-C.G.), and Brain Research Center (Y.-C. Lee, P.-C.T., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurology (Y.-C.G.), and School of Medicine (Y.-C.G.), College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
27
|
Wang X, Wang H, Xia Y, Jiang H, Shen L, Wang S, Shen R, Xu Q, Luo X, Tang B. Spinocerebellar ataxia type 6: Systematic patho-anatomical study reveals different phylogenetically defined regions of the cerebellum and neural pathways undergo different evolutions of the degenerative process. Neuropathology 2016; 30:501-14. [PMID: 20113406 DOI: 10.1111/j.1440-1789.2009.01094.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spinocerebellar ataxia type 6 is a late onset autosomal dominantly inherited ataxic disorder, and previous patho-anatomical studies have only reported neurodegeneration in SCA6 as being confined to the cerebellar cortex, dentate nucleus and inferior olive. However, the characteristics of cerebellar symptoms and many poorly understood "extracerebellar" symptoms reveal the three cerebellar regions and the corresponding precerebellar nuclei may undergo differing evolution of the degenerative process, and a more widespread brainstem degeneration in SCA6. We carried out a detailed immunohistochemical study in two SCA6 patients who had rather early onset and short disease duration with 25 CAG repeats, which is atypical for SCA-6. We investigated the severity of neurodegeneration in each of the cerebellar regions and the corresponding precerebellar nuclei, and further characterize the extent of brain degeneration. This study confirmed that vestibulocerebellar, spinocerebellum and pontocerebellar are consistent targets of the pathological process of SCA6, but the severity of neurodegeneration in each of them was different. Vestibulocerebellum and the inferior cerebellar peduncle undergo the most severe neurodegeneration, while neurodegeneration in the pontocerebellar is less severe. Furthermore, we observed obvious neurodegeneration in layers II and III of the primary motor cortex, vestibular nuclei, inferior olivary nucleus, nucleus proprius and posterior spinocerebellar tract. Our detailed postmortem findings confirmed that SCA6 was not a simple "pure" cerebellar disease, but a complex neurodegenerative disease in which the three cerebellar regions underwent different evolutions of neurodegeneration process, and the corresponding precerebellar nuclei and the neural pathway were all involved.
Collapse
Affiliation(s)
- Xuejing Wang
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Hui Wang
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Yujun Xia
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Shoubiao Wang
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Ruowu Shen
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Xuegang Luo
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital,Department of Anatomy & Neurobiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, andDepartment of Anatomy, Qing Dao University, QingDao, Shandong, China
| |
Collapse
|
28
|
Long-term disease progression in spinocerebellar ataxia types 1, 2, 3, and 6: a longitudinal cohort study. Lancet Neurol 2015; 14:1101-8. [DOI: 10.1016/s1474-4422(15)00202-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/02/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
|
29
|
Olszewska DA, Walsh R, Lynch T. SCA 6 with Writer's Cramp: The Phenotype Expanded. Mov Disord Clin Pract 2015; 3:83-86. [PMID: 30713900 DOI: 10.1002/mdc3.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/27/2022] Open
Abstract
Spinocerebellar ataxia type 6 (SCA6) presents typically with a pure cerebellar syndrome. Only 1 SCA 6 patient with writer's cramp has been reported on and a family history of ataxia and writer's cramp has never been reported on. Two other SCA6 patients with a shoulder girdle/hand dystonia and unspecified upper-limb dystonia with a family history of ataxia have been reported on. We report on the largest family with SCA6 and writer's cramp. The proband developed dysarthria, ataxia, and writer's cramp by age 37. His father presented with ataxia at 55, followed by writer's cramp and dysarthria. The proband's brother developed ataxia at 41, followed by dysarthria and writer's cramp. A paternal uncle (deceased; not examined) and 58-yr-old brother both developed pure ataxia (genetic testing is pending). This large family with complex movement disorder demonstrates that it is important to consider SCA6 in a patient presenting with an ataxia and writer's cramp and supports cerebellum involvement in dystonia.
Collapse
Affiliation(s)
- Diana Angelika Olszewska
- Department of Neurology at the Dublin Neurological Institute Mater Misericordiae University Hospital Dublin Ireland
| | - Richard Walsh
- Department of Neurology at the Dublin at the Adelaide and Meath Hospital, Dublin National Children's Hospital Tallaght, Dublin Ireland
| | - Tim Lynch
- Department of Neurology at the Dublin Neurological Institute Mater Misericordiae University Hospital Dublin Ireland
| |
Collapse
|
30
|
CACNA1A haploinsufficiency causes cognitive impairment, autism and epileptic encephalopathy with mild cerebellar symptoms. Eur J Hum Genet 2015; 23:1505-12. [PMID: 25735478 DOI: 10.1038/ejhg.2015.21] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 01/25/2023] Open
Abstract
CACNA1A loss-of-function mutations classically present as episodic ataxia type 2 (EA2), with brief episodes of ataxia and nystagmus, or with progressive spinocerebellar ataxia (SCA6). A minority of patients carrying CACNA1A mutations develops epilepsy. Non-motor symptoms associated with these mutations are often overlooked. In this study, we report 16 affected individuals from four unrelated families presenting with a spectrum of cognitive impairment including intellectual deficiency, executive dysfunction, ADHD and/or autism, as well as childhood-onset epileptic encephalopathy with refractory absence epilepsy, febrile seizures, downbeat nystagmus and episodic ataxia. Sequencing revealed one CACNA1A gene deletion, two deleterious CACNA1A point mutations including one known stop-gain and one new frameshift variant and a new splice-site variant. This report illustrates the phenotypic heterogeneity of CACNA1A loss-of-function mutations and stresses the cognitive and epileptic manifestations caused by the loss of CaV2.1 channels function, presumably affecting cerebellar, cortical and limbic networks.
Collapse
|
31
|
Matilla-Dueñas A, Ashizawa T, Brice A, Magri S, McFarland KN, Pandolfo M, Pulst SM, Riess O, Rubinsztein DC, Schmidt J, Schmidt T, Scoles DR, Stevanin G, Taroni F, Underwood BR, Sánchez I. Consensus paper: pathological mechanisms underlying neurodegeneration in spinocerebellar ataxias. CEREBELLUM (LONDON, ENGLAND) 2014; 13:269-302. [PMID: 24307138 PMCID: PMC3943639 DOI: 10.1007/s12311-013-0539-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intensive scientific research devoted in the recent years to understand the molecular mechanisms or neurodegeneration in spinocerebellar ataxias (SCAs) are identifying new pathways and targets providing new insights and a better understanding of the molecular pathogenesis in these diseases. In this consensus manuscript, the authors discuss their current views on the identified molecular processes causing or modulating the neurodegenerative phenotype in spinocerebellar ataxias with the common opinion of translating the new knowledge acquired into candidate targets for therapy. The following topics are discussed: transcription dysregulation, protein aggregation, autophagy, ion channels, the role of mitochondria, RNA toxicity, modulators of neurodegeneration and current therapeutic approaches. Overall point of consensus includes the common vision of neurodegeneration in SCAs as a multifactorial, progressive and reversible process, at least in early stages. Specific points of consensus include the role of the dysregulation of protein folding, transcription, bioenergetics, calcium handling and eventual cell death with apoptotic features of neurons during SCA disease progression. Unresolved questions include how the dysregulation of these pathways triggers the onset of symptoms and mediates disease progression since this understanding may allow effective treatments of SCAs within the window of reversibility to prevent early neuronal damage. Common opinions also include the need for clinical detection of early neuronal dysfunction, for more basic research to decipher the early neurodegenerative process in SCAs in order to give rise to new concepts for treatment strategies and for the translation of the results to preclinical studies and, thereafter, in clinical practice.
Collapse
Affiliation(s)
- A Matilla-Dueñas
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), Ctra. de Can Ruti, Camí de les Escoles s/n, Badalona, Barcelona, Spain,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW A systematic approach to the history and examination allows the physician to diagnose the most common vestibular disorders of the brain or inner ear. However, some less common disorders require a specific familiarity so that they are not misdiagnosed as one of the more common disorders,treated inappropriately, or misattributed to a psychogenic etiology. This article describes four of the less common disorders that can present with a primary problem of dizziness and imbalance: (1) mal de débarquement syndrome, (2) bilateral vestibulopathy, (3) cerebellar ataxia, and (4) vestibular schwannomas (ie, acoustic neuromas). RECENT FINDINGS Associated clinical features of mal de débarquement syndrome have recently been investigated to clarify the spectrum of the syndrome. The combination of cerebellar ataxia, neuropathy, and vestibular areflexia (bilateral vestibulopathy) has been summated into a new syndrome. Further refinement of ocular motor features of cerebellar ataxia can narrow genetic testing requirements. Vestibular schwannomas remain an uncommon etiology for isolated dizziness; recent imaging studies have helped quantify the low yield of screening MRI protocols for the evaluation of undefined dizziness. SUMMARY A working knowledge of these less common disorders will help the physician make the diagnosis efficiently by gathering key elements of the history and fine-tuning diagnostic testing.
Collapse
Affiliation(s)
- Yoon-Hee Cha
- David Geffen School of Medicine, Department of Neurology, 710 Westwood Plaza Box 951769, Los Angeles, CA 90095, USA.
| |
Collapse
|
33
|
Fujioka S, Sundal C, Wszolek ZK. Autosomal dominant cerebellar ataxia type III: a review of the phenotypic and genotypic characteristics. Orphanet J Rare Dis 2013; 8:14. [PMID: 23331413 PMCID: PMC3558377 DOI: 10.1186/1750-1172-8-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 01/16/2013] [Indexed: 12/26/2022] Open
Abstract
Autosomal Dominant Cerebellar Ataxia (ADCA) Type III is a type of spinocerebellar ataxia (SCA) classically characterized by pure cerebellar ataxia and occasionally by non-cerebellar signs such as pyramidal signs, ophthalmoplegia, and tremor. The onset of symptoms typically occurs in adulthood; however, a minority of patients develop clinical features in adolescence. The incidence of ADCA Type III is unknown. ADCA Type III consists of six subtypes, SCA5, SCA6, SCA11, SCA26, SCA30, and SCA31. The subtype SCA6 is the most common. These subtypes are associated with four causative genes and two loci. The severity of symptoms and age of onset can vary between each SCA subtype and even between families with the same subtype. SCA5 and SCA11 are caused by specific gene mutations such as missense, inframe deletions, and frameshift insertions or deletions. SCA6 is caused by trinucleotide CAG repeat expansions encoding large uninterrupted glutamine tracts. SCA31 is caused by repeat expansions that fall outside of the protein-coding region of the disease gene. Currently, there are no specific gene mutations associated with SCA26 or SCA30, though there is a confirmed locus for each subtype. This disease is mainly diagnosed via genetic testing; however, differential diagnoses include pure cerebellar ataxia and non-cerebellar features in addition to ataxia. Although not fatal, ADCA Type III may cause dysphagia and falls, which reduce the quality of life of the patients and may in turn shorten the lifespan. The therapy for ADCA Type III is supportive and includes occupational and speech modalities. There is no cure for ADCA Type III, but a number of recent studies have highlighted novel therapies, which bring hope for future curative treatments.
Collapse
Affiliation(s)
- Shinsuke Fujioka
- Department of Neurology at Mayo Clinic, 4500 San Pablo Road Cannaday Bldg 2-E, Jacksonville, FL 32224, USA
| | | | | |
Collapse
|
34
|
Scherzed W, Brunt ER, Heinsen H, de Vos RA, Seidel K, Bürk K, Schöls L, Auburger G, Del Turco D, Deller T, Korf HW, den Dunnen WF, Rüb U. Pathoanatomy of cerebellar degeneration in spinocerebellar ataxia type 2 (SCA2) and type 3 (SCA3). THE CEREBELLUM 2012; 11:749-60. [PMID: 22198871 DOI: 10.1007/s12311-011-0340-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The cerebellum is one of the well-known targets of the pathological processes underlying spinocerebellar ataxia type 2 (SCA2) and type 3 (SCA3). Despite its pivotal role for the clinical pictures of these polyglutamine ataxias, no pathoanatomical studies of serial tissue sections through the cerebellum have been performed in SCA2 and SCA3 so far. Detailed pathoanatomical data are an important prerequisite for the identification of the initial events of the underlying disease processes of SCA2 and SCA3 and the reconstruction of its spread through the brain. In the present study, we performed a pathoanatomical investigation of serial thick tissue sections through the cerebellum of clinically diagnosed and genetically confirmed SCA2 and SCA3 patients. This study demonstrates that the cerebellar Purkinje cell layer and all four deep cerebellar nuclei consistently undergo considerable neuronal loss in SCA2 and SCA3. These cerebellar findings contribute substantially to the pathogenesis of clinical symptoms (i.e., dysarthria, intention tremor, oculomotor dysfunctions) of SCA2 and SCA3 patients and may facilitate the identification of the initial pathological alterations of the pathological processes of SCA2 and SCA3 and reconstruction of its spread through the brain.
Collapse
Affiliation(s)
- W Scherzed
- Institute of Clinical Neuroanatomy, Dr. Senckenberg Anatomy, Goethe-University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Furtado S, Das S, Suchowersky O. A review of the inherited ataxias: recent advances in genetic, clinical and neuropathologic aspects. Parkinsonism Relat Disord 2012; 4:161-9. [PMID: 18591106 DOI: 10.1016/s1353-8020(98)00030-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/1998] [Accepted: 10/01/1998] [Indexed: 12/01/2022]
Abstract
Inherited ataxias are a heterogeneous group of disorders characterized by autosomal dominant and recessive inheritance. Recent advances in genetic research have resulted in an improved comprehension of their clinical presentation. Autosomal dominant cerebellar ataxias (ADCAs) include spinocerebellar ataxias (SCAs) and dentatorubral-pallidoluysian atrophy (DRPLA); six of these have been found to be trinucleotide repeat disorders. Episodic ataxia, types 1 and 2, are at present recognized to be channelopathies, caused by point mutations. Friedreich's ataxia (FA) which is an autosomal recessive disorder, resulting from a a unique trinucleotide repeat, is now recognized to have a wide age of onset and clinical spectrum. Ataxia-telangiectasia (AT), also an autosomal recessive cerebellar ataxia, is characterized by immunodeficiency. In this article, the genetic and clinical characteristics of these diseases are reviewed in detail.
Collapse
Affiliation(s)
- S Furtado
- Department of Clinical Neurosciences, University of Calgary, Area 3, UCMC, 3350 Hospital Drive, Calgary NW Alta, Canada T2N 4N1
| | | | | |
Collapse
|
36
|
Abstract
The autosomal dominant spinocerebellar ataxias (SCA) are a genetically heterogeneous group of neurodegenerative disorders characterized by progressive motor incoordination, in some cases with ataxia alone and in others in association with additional progressive neurological deficits. Spinocerebellar ataxia type 6 (SCA6) is the prototype of a pure cerebellar ataxia, associated with a severe form of progressive ataxia and cerebellar dysfunction. SCA6, originally classified as such by Zhuchenko et al. (1997), is caused by a CAG repeat expansion in the CACNA1A gene which encodes the α1A subunit of the P/Q-type voltage-gated calcium channel. SCA6 is one of ten polyglutamine-encoding CAG nucleotide repeat expansion disorders comprising other neurodegenerative disorders such as Huntington's disease. The present review describes clinical, genetic, and pathological manifestations associated with this illness. Currently, there is no treatment for this neurodegenerative disease. Successful therapeutic strategies must target a valid pathological mechanism; thus, understanding the underlying mechanisms of disease is crucial to finding a proper treatment. Hence, this chapter will discuss as well the molecular mechanisms possibly associated with SCA6 pathology and their implication for the development of future treatment.
Collapse
Affiliation(s)
- Ana Solodkin
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 606337, USA.
| | | |
Collapse
|
37
|
Chan E, Charles P, Ribai P, Goizet C, Marelli C, Vincitorio CM, Bayon AL, Guyant-Maréchal L, Vandenberghe N, Anheim M, Devos D, Freeman L, Ber IL, N'Guyen K, Tchikviladzé M, Labauge P, Hannequin D, Brice A, Durr A, du Montcel ST. Quantitative assessment of the evolution of cerebellar signs in spinocerebellar ataxias. Mov Disord 2011; 26:534-8. [DOI: 10.1002/mds.23531] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/08/2010] [Accepted: 10/21/2010] [Indexed: 11/09/2022] Open
|
38
|
Gierga K, Schelhaas HJ, Brunt ER, Seidel K, Scherzed W, Egensperger R, de Vos RAI, den Dunnen W, Ippel PF, Petrasch-Parwez E, Deller T, Schöls L, Rüb U. Spinocerebellar ataxia type 6 (SCA6): neurodegeneration goes beyond the known brain predilection sites. Neuropathol Appl Neurobiol 2009; 35:515-27. [DOI: 10.1111/j.1365-2990.2009.01015.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
39
|
Teive HAG, Munhoz RP, Raskin S, Werneck LC. Spinocerebellar ataxia type 6 in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:691-4. [PMID: 18949263 DOI: 10.1590/s0004-282x2008000500015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/30/2008] [Indexed: 11/22/2022]
Abstract
Spinocerebellar ataxia type 6 (SCA 6) is an autosomal dominant cerebellar ataxia caused by CAG repeat expansion in the SCA6 gene, a alpha 1A voltage-dependent calcium channel subunit gene on chromosome 19p13. SCA-6 is characterized predominantly by slowly progressive pure cerebellar ataxia with late onset. We report three index patients, with pure, late onset, cerebellar ataxia, belonging to three different Brazilian families, all of them with Japanese ancestry, from Hokkaido island of Japan.
Collapse
Affiliation(s)
- Hélio A G Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
| | | | | | | |
Collapse
|
40
|
Sugaya K, Matsubara S. Nucleation of protein aggregation kinetics as a basis for genotype-phenotype correlations in polyglutamine diseases. Mol Neurodegener 2009; 4:29. [PMID: 19602294 PMCID: PMC2716343 DOI: 10.1186/1750-1326-4-29] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 07/15/2009] [Indexed: 11/10/2022] Open
Abstract
Recent studies of inherited neurodegenerative disorders have suggested a linkage between the propensity toward aggregation of mutant protein and disease onset. This is particularly apparent for polyglutamine (polyQ) diseases caused by expansion of CAG-trinucleotide repeats. However, a quantitative framework for relating aggregation kinetics with molecular mechanisms of neurodegeneration initiation is lacking. Here, using the repeat-length-dependent age-of-onset in polyQ diseases, we derived a mathematical model based on nucleation of aggregation kinetics to describe genotype-phenotype correlations, and validated the model using both in vitro data and clinical data. Instead of describing polyQ aggregation kinetics with a derivative equation, our model divided age-of-onset (equivalent to the time required for aggregation) into two processes: nucleation lag time (a first-order exponential function of CAG-repeat length) and elongation time. With the exception of spinocerebellar ataxia (SCA) 3, the relation between CAG-repeat length and age-of-onset in all examined polyQ diseases, including Huntington's disease, dentatorubral-pallidoluysian atrophy and SCA1, -2, -6 and -7, could be well explained by three parameters derived from linear regression analysis based on the nucleated growth polymerization model. These parameters composed of probability of nucleation at an individual repeat, a protein concentration associated factor, and elongation time predict the overall features of neurodegeneration initiation, including constant risk for cell death, toxic polyQ species, main pathological subcellular site and the contribution of cellular factors. Our model also presents an alternative therapeutic strategy according to the distinct subcellular loci by the finding that nuclear localization of soluble mutant protein monomers itself has great impact on disease onset.
Collapse
Affiliation(s)
- Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo 183-0042, Japan.
| | | |
Collapse
|
41
|
Hirano R, Takashima H, Okubo R, Okamoto Y, Maki Y, Ishida S, Suehara M, Hokezu Y, Arimura K. Clinical and genetic characterization of 16q-linked autosomal dominant spinocerebellar ataxia in South Kyushu, Japan. J Hum Genet 2009; 54:377-81. [DOI: 10.1038/jhg.2009.44] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
42
|
Klockgether T. The clinical diagnosis of autosomal dominant spinocerebellar ataxias. THE CEREBELLUM 2009; 7:101-5. [PMID: 18418679 DOI: 10.1007/s12311-008-0023-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The spinocerebellar ataxias (SCAs) are a heterogeneous group of autosomal dominantly inherited progressive ataxia diseases. Up to now, almost 30 different gene loci have been found. In 14 of them, the underlying mutations have been identified. The more common SCAs, SCA1, 2, 3 and 6 are due to translated CAG repeat expansions that code for an elongated polyglutamine tract within the respective proteins. These diseases belong to a larger group of polyglutamine disorders that also includes Huntington's disease. Epidemiological studies conducted in different European regions found prevalence rates of SCAs ranging from 0.9 to 3.0:100,000. In all SCAs, ataxia is the prominent symptom. However, the majority have a complex phenotype in which ataxia is accompanied by varying non-ataxia symptoms. In all ataxia patients with proven or suspected autosomal dominant mode of inheritance, the available molecular genetic tests for SCA mutations should be performed. Depending on the geographical origin of the family, these tests will lead to positive diagnostic results in at least half of the families.
Collapse
Affiliation(s)
- Thomas Klockgether
- Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.
| |
Collapse
|
43
|
Yu-Wai-Man P, Gorman G, Bateman DE, Leigh RJ, Chinnery PF. Vertigo and vestibular abnormalities in spinocerebellar ataxia type 6. J Neurol 2009; 256:78-82. [PMID: 19224313 DOI: 10.1007/s00415-009-0068-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 06/30/2008] [Accepted: 07/24/2008] [Indexed: 11/30/2022]
Abstract
Spinocerebellar ataxia type 6 (SCA6) is a calcium channelopathy due to a pathological CAG repeat expansion in CACNL1A4. Patients frequently describe paroxysmal vertigo early in the disease course, but it is not clear whether this is central or labyrinthine in origin. To address this issue we studied 21 SCA6 patients. Symptoms of vertigo were defined using a structured questionnaire. Signs were recorded during a standardised bed-side vestibular examination that included systematic positional testing with Frenzel goggles.Brief, recurrent attacks of vertigo occurred in 13 patients, usually preceding the onset of ataxia. Nystagmus was observed behind Frenzel goggles in 14 patients, and was induced either during positional testing, or head shaking in 20 patients. Only one patient had findings typical of benign paroxysmal positional vertigo (BPPV). Combined downbeat and horizontal gaze-evoked nystagmus ("side-pocket") was the most common form, occurring most commonly in supine and head-hanging positions, and following horizontal head-shaking. Nystagmus beating away from the ground (apogeotropic) occurred in 9 patients as they lay on their side.In conclusion, vertigo and abnormalities on bedside vestibular examination are common in SCA6, with forms of nystagmus typical of cerebellar, rather than labyrinthine, disease. These findings demonstrate phenotypic overlap between SCA6 and episodic ataxia type 2, which are both due to mutations in CACNL1A4.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, School of Neurology, Neurobiology and Psychiatry, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | | | | | | | | |
Collapse
|
44
|
Ataxia in a son and mother. Mov Disord 2008. [DOI: 10.3109/9780203008454-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
|
46
|
Yabe I, Kitagawa M, Suzuki Y, Fujiwara K, Wada T, Tsubuku T, Takeichi N, Sakushima K, Soma H, Tsuji S, Niino M, Saitoh S, Sasaki H. Downbeat positioning nystagmus is a common clinical feature despite variable phenotypes in an FHM1 family. J Neurol 2008; 255:1541-4. [DOI: 10.1007/s00415-008-0970-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/05/2008] [Accepted: 04/11/2008] [Indexed: 11/24/2022]
|
47
|
Kurokawa-Kuroda T, Ogata K, Suga R, Goto Y, Taniwaki T, Kira JI, Tobimatsu S. Altered soleus responses to magnetic stimulation in pure cerebellar ataxia. Clin Neurophysiol 2007; 118:1198-203. [PMID: 17452005 DOI: 10.1016/j.clinph.2007.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 03/02/2007] [Accepted: 03/07/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Transcranial magnetic stimulation (TMS) over the leg motor area elicits a soleus primary response (SPR) and a soleus late response (SLR). We evaluated the influence of the cerebellofugal pathway on the SPR and SLR in patients with 'pure' cerebellar ataxia. METHODS SPRs and SLRs were recorded from 11 healthy subjects and 9 patients with 'pure' cerebellar cortical degeneration; 5 with spinocerebellar ataxia type 6 (SCA6), and 4 with late cortical cerebellar ataxia (LCCA). In addition, three patients with localized cerebellar lesions were tested. RESULTS The SPR latency was significantly longer in patients than in controls, but primary responses in the tibialis anterior muscle were normal. The frequency of abnormal SLR was 38.9% in the supine position and 83.3% in the standing position. Two out of three patients with localized cerebellar lesions also showed abnormal SLR. CONCLUSIONS Altered SPRs in patients may result from a dysfunction of the primary motor cortex caused by crossed cerebello-cerebral diaschisis. In addition, our results suggest that 'pure' cerebellar degeneration involves the mechanism responsible for evoking SLR which is related to the control of posture. SIGNIFICANCE SLR can be a useful neurophysiological parameter for evaluating cerebellofugal function.
Collapse
Affiliation(s)
- Tomomi Kurokawa-Kuroda
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Spinocerebellar ataxia type 6 (SCA6) is a neurodegenerative disorder caused by abnormal expansions of a trinucleotide CAG repeat in exon 47 of the CACNA1A gene, which encodes the alpha1A subunit of the P/Q-type voltage-gated calcium channel. The CAG repeat expansion is translated into an elongated polyglutamine tract in the carboxyl terminus of the alpha1A subunit. The alpha1A subunit is the main pore-forming subunit of the P/Q-type calcium channel. Patients with SCA6 suffer from a severe form of progressive ataxia and cerebellar dysfunction. Design of treatments for this disorder will depend on better definition of the mechanism of disease. As a disease arising from a mutation in an ion channel gene, SCA6 may behave as an ion channelopathy, and may respond to attempts to modulate or correct ion channel function. Alternatively, as a disease in which the mutant protein contains an expanded polyglutamine tract, SCA6 may respond to the targets of drug therapies developed for Huntington's disease and other polyglutamine disorders. In this review we will compare SCA6 to other polyglutamine diseases and channelopathies, and we will highlight recent advances in our understanding of alpha1A subunits and SCA6 pathology. We also propose a mechanism for how two seemingly divergent hypotheses can be combined into a cohesive model for disease progression.
Collapse
Affiliation(s)
- Holly B Kordasiewicz
- Ludwig Institute for Cancer Research, University of California at San Diego, La Jolla, California 92093, USA
| | | |
Collapse
|
49
|
Abstract
Huntington's disease is an autosomal-dominant, progressive neurodegenerative disorder with a distinct phenotype, including chorea and dystonia, incoordination, cognitive decline, and behavioural difficulties. Typically, onset of symptoms is in middle-age after affected individuals have had children, but the disorder can manifest at any time between infancy and senescence. The mutant protein in Huntington's disease--huntingtin--results from an expanded CAG repeat leading to a polyglutamine strand of variable length at the N-terminus. Evidence suggests that this tail confers a toxic gain of function. The precise pathophysiological mechanisms of Huntington's disease are poorly understood, but research in transgenic animal models of the disorder is providing insight into causative factors and potential treatments.
Collapse
Affiliation(s)
- Francis O Walker
- Department of Neurology, Wake Forest University, Medical Center Blvd, Winston Salem, NC 27157, USA.
| |
Collapse
|
50
|
Ouyang Y, Sakoe K, Shimazaki H, Namekawa M, Ogawa T, Ando Y, Kawakami T, Kaneko J, Hasegawa Y, Yoshizawa K, Amino T, Ishikawa K, Mizusawa H, Nakano I, Takiyama Y. 16q-linked autosomal dominant cerebellar ataxia: a clinical and genetic study. J Neurol Sci 2006; 247:180-6. [PMID: 16780885 DOI: 10.1016/j.jns.2006.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 03/24/2006] [Accepted: 04/19/2006] [Indexed: 12/30/2022]
Abstract
The autosomal dominant cerebellar ataxias (ADCAs) comprise a genetically and clinically heterogenous group of neurodegenerative disorders. Very recently, a C-to-T single nucleotide substitution in the puratrophin-1 gene was found to be strongly associated with a form of ADCA linked to chromosome 16q22.1 (16q-linked ADCA; OMIM 600223). We found the C-to-T substitution in the puratrophin-1 gene in 20 patients with ataxia (16 heterozygotes and four homozygotes) and four asymptomatic carriers in 9 of 24 families with an unknown type of ADCA. We also found two cases with 16q-linked ADCA among 43 sporadic patients with late-onset cortical cerebellar atrophy (LCCA). The mean age at onset in the 22 patients was 61.8 years, and that of homozygous patients was lower than that of heterozygous ones in one family. Neurological examination revealed that the majority of our patients showed exaggerated deep tendon reflexes in addition to the cardinal symptom of cerebellar ataxia (100%), and 37.5% of them had sensorineural hearing impairment, whereas sensory axonal neuropathy was absent. The frequency of 16q-linked ADCA was about 1/10 of our series of 110 ADCA families, making it the third most frequent ADCA in Japan.
Collapse
Affiliation(s)
- Y Ouyang
- Department of Neurology, Jichi Medical School, Tochigi 329-0498, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|