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Montanaro D, Vavla M, Frijia F, Coi A, Baratto A, Pasquariello R, Stefan C, Martinuzzi A. Metabolite profile in hereditary spastic paraplegia analyzed using magnetic resonance spectroscopy: a cross-sectional analysis in a longitudinal study. Front Neurosci 2024; 18:1416093. [PMID: 39193522 PMCID: PMC11347332 DOI: 10.3389/fnins.2024.1416093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/11/2024] [Indexed: 08/29/2024] Open
Abstract
Background Hereditary Spastic Paraplegias (HSP) are genetic neurodegenerative disorders affecting the corticospinal tract. No established neuroimaging biomarker is associated with this condition. Methods A total of 46 patients affected by HSP, genetically and clinically evaluated and tested with SPRS scores, and 46 healthy controls (HC) matched by age and gender underwent a single-voxel Magnetic Resonance Spectroscopy sampling (MRS) of bilateral pre-central and pre-frontal regions. MRS data were analyzed cross-sectionally (at T0 and T1) and longitudinally (T0 vs. T1). Results Statistically significant data showed that T0 mI/Cr in the pre-central areas of HSP patients was higher than in HC. In the left (L) pre-central area, NAA/Cr was significantly lower in HSP than in HC. In the right (R) pre-frontal area, NAA/Cr was significantly lower in HSP patients than in HC. HSP SPG4 subjects had significantly lower Cho/Cr concentrations in the L pre-central area compared to HC. Among the HSP subjects, non-SPG4 patients had significantly higher mI/Cr in the L pre-central area compared to SPG4 patients. In the R pre-frontal area, NAA/Cr was reduced, and ml/Cr was higher in non-SPG4 patients compared to SPG4 patients. Comparing "pure" and "complex" forms, NAA/Cr was higher in pHSP than in cHSP in the R pre-central and R pre-frontal areas. The longitudinal analysis, which involved fewer patients (n = 30), showed an increase in mI/Cr concentration in the L pre-frontal area among HSP subjects with respect to baseline. The patients had significantly higher SPRS scores at follow-up, with a significant positive correlation between SPRS scores and mI/Cr in the L pre-central area, while in bilateral pre-frontal areas, lower SPRS scores corresponded to higher NAA/Cr concentrations. To explore the discriminating power of MRS in correctly identifying HSP and controls, an inference tree methodology classified HSP subjects and controls with an overall accuracy of 73.9%, a sensitivity of 87.0%, and a specificity of 60.9%. Conclusion This pilot study indicates that brain MRS is a valuable approach that could potentially serve as an objective biomarker in HSP.
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Affiliation(s)
- Domenico Montanaro
- U.O. Dipartimentale e Servizio Autonomo di Risonanza Magnetica, Dipartimento di Neuroscienze dell’Età Evolutiva, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Marinela Vavla
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, Padova, Italy
- Department of Neurorehabilitation, IRCCS E. Medea Scientific Institute, Conegliano, Italy
| | - Francesca Frijia
- Bioengineering Unit, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessandra Baratto
- Department of Radiology, S. Maria dei Battuti Hospital- Conegliano, Treviso, Italy
| | - Rosa Pasquariello
- U.O. Dipartimentale e Servizio Autonomo di Risonanza Magnetica, Dipartimento di Neuroscienze dell’Età Evolutiva, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Cristina Stefan
- Department of Neurorehabilitation, IRCCS E. Medea Scientific Institute, Conegliano, Italy
| | - Andrea Martinuzzi
- Department of Neurorehabilitation, IRCCS E. Medea Scientific Institute, Conegliano, Italy
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Siow SF, Waters A, Coward S, Wali G, Ng K, Sue CM, Kumar KR. Outcome measures for hereditary spastic paraplegia clinical trials: Learnings from an Australian HSP center. J Neurol Sci 2024; 462:123100. [PMID: 38914513 DOI: 10.1016/j.jns.2024.123100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/04/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Sue Faye Siow
- Department of Clinical Genetics, Royal North Shore Hospital, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia; Department of Neurogenetics, Royal North Shore Hospital, NSW, Australia.
| | - Amy Waters
- Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, NSW, Australia
| | - Sharon Coward
- Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, NSW, Australia
| | - Gautam Wali
- Sydney Medical School, The University of Sydney, NSW, Australia; Department of Neurogenetics, Royal North Shore Hospital, NSW, Australia; Neuroscience Research Australia, University of New South Wales, NSW, Australia
| | - Karl Ng
- Sydney Medical School, The University of Sydney, NSW, Australia; Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital, NSW, Australia
| | - Carolyn M Sue
- Department of Neurogenetics, Royal North Shore Hospital, NSW, Australia; Neuroscience Research Australia, University of New South Wales, NSW, Australia; Faculty of Medicine and Health, University of New South Wales Sydney, NSW, Australia
| | - Kishore R Kumar
- Sydney Medical School, The University of Sydney, NSW, Australia; Translational Neurogenomics Group, Genomics and Inherited Disease Program, Garvan Institute of Medical Research, NSW, Australia; Molecular Medicine Laboratory and Department of Neurology, Concord Repatriation General Hospital, NSW, Australia
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Diella E, D’Angelo MG, Stefan C, Girardi G, Morganti R, Martinuzzi A, Biffi E. Validation of the Italian version of a patient-reported outcome measure for Hereditary Spastic Paraplegia. PLoS One 2024; 19:e0301452. [PMID: 38557877 PMCID: PMC10984402 DOI: 10.1371/journal.pone.0301452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND AIM Patient-reported outcome measures (PROMs) are recognized as valuable measures in the clinical setting. In 2018 we developed the Italian version of the "Hereditary Spastic Paraplegia-Self Notion and Perception Questionnaire" (HSP-SNAP), a disease-specific questionnaire that collects personal perception on motor symptoms related to HSP such as stiffness, weakness, imbalance, reduced endurance, fatigue and pain. In this study our primary aim was to assess the questionnaire validity and reliability. Our secondary aim was to characterize the symptoms "perceived" by patients with HSP and compare them with those "perceived" by age-matched healthy subjects. METHODS The 12-item HSP-SNAP questionnaire was submitted to 20 external judges for comprehensibility and to 15 external judges for content validity assessment. We recruited 40 subjects with HSP and asked them to fill the questionnaire twice for test-retest procedure. They also completed the Medical Outcome Survey Short Form (SF-36) and were evaluated by the Spastic Paraplegia Rating Scale and the Six-Minute Walk Test. We also recruited 44 healthy subjects who completed the HSP-SNAP once to test score variability. RESULTS The HSP-SNAP content validity index was high (0.8±0.1) and the test-retest analysis showed high reliability (ICC = 0.94). The mean HSP-SNAP score (score range 0-48) of the HSP group was 22.2±7.8, which was significantly lower than healthy subjects (43.1±6.3). The most commonly perceived symptom was stiffness, followed by weakness and imbalance. CONCLUSION Although HSP-SNAP does not investigate non-motor symptoms and we validated only its Italian version, it showed good validity and reliability and it could be used in combination with other objective outcome measures for clinical purposes or as endpoints for future clinical rehabilitation studies. TRIAL REGISTRATION Trial Registration: ClinicalTrial.gov, NCT04256681. Registered 3 February 2020.
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Affiliation(s)
- Eleonora Diella
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Cristina Stefan
- Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Treviso, Italy
| | - Giulia Girardi
- Scientific Institute, IRCCS E. Medea, Pieve di Soligo, Treviso, Italy
| | - Roberta Morganti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Emilia Biffi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
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Dalin D, Wiesmeier IK, Heimbach B, Weiller C, Maurer C. Postural control deficits due to bilateral pyramidal tract lesions exemplified by hereditary spastic paraplegia (HSP) originate from increased feedback time delay and reduced long-term error corrections. Front Hum Neurosci 2023; 17:1229055. [PMID: 38116238 PMCID: PMC10728727 DOI: 10.3389/fnhum.2023.1229055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Pyramidal tract lesions determine the clinical syndrome of Hereditary Spastic Paraplegia (HSP). The clinical impairments of HSP are typically exemplified by their deficits in mobility, leading to falls and injuries. The first aim of this study was to identify the cause for postural abnormalities caused by pyramidal tract lesions in HSP. The second aim was to specify the effect of treadmill training for postural abnormalities. We examined nine HSP patients before and after treadmill training, as well as nine healthy control subjects during perturbed and unperturbed stance. We found that HSP was associated with larger sway amplitudes and velocities. Body excursions following platform tilts were larger, and upper body excursions showed a phase lead. Model-based analysis detected a greater time delay and a reduced long-term error correction of postural reactions in the center of mass. HSP patients performed significantly better in clinical assessments after treadmill training. In addition, treadmill training reduced sway amplitudes and body excursions, most likely by increasing positional and velocity error correction gain as a compensatory mechanism, while the time delay and long-term error correction gain remained largely unaffected. Moreover, the upper body's phase lead was reduced. We conclude that HSP leads to very specific postural impairments. While postural control generally benefits from treadmill training, the effect seems to mainly rely on compensatory mechanisms, whereas the original deficits are not affected significantly.
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Affiliation(s)
- Daniela Dalin
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Isabella Katharina Wiesmeier
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Bernhard Heimbach
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cornelius Weiller
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Maurer
- Department of Neurology and Neurophysiology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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Siow SF, Yeow D, Rudaks LI, Jia F, Wali G, Sue CM, Kumar KR. Outcome Measures and Biomarkers for Clinical Trials in Hereditary Spastic Paraplegia: A Scoping Review. Genes (Basel) 2023; 14:1756. [PMID: 37761896 PMCID: PMC10530989 DOI: 10.3390/genes14091756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Hereditary spastic paraplegia (HSP) is characterized by progressive lower limb spasticity. There is no disease-modifying treatment currently available. Therefore, standardized, validated outcome measures to facilitate clinical trials are urgently needed. We performed a scoping review of outcome measures and biomarkers for HSP to provide recommendations for future studies and identify areas for further research. We searched Embase, Medline, Scopus, Web of Science, and the Central Cochrane database. Seventy studies met the inclusion criteria, and eighty-three outcome measures were identified. The Spastic Paraplegia Rating Scale (SPRS) was the most widely used (27 studies), followed by the modified Ashworth Scale (18 studies) and magnetic resonance imaging (17 studies). Patient-reported outcome measures (PROMs) were infrequently used to assess treatment outcomes (28% of interventional studies). Diffusion tensor imaging, gait analysis and neurofilament light chain levels were the most promising biomarkers in terms of being able to differentiate patients from controls and correlate with clinical disease severity. Overall, we found variability and inconsistencies in use of outcome measures with a paucity of longitudinal data. We highlight the need for (1) a standardized set of core outcome measures, (2) validation of existing biomarkers, and (3) inclusion of PROMs in HSP clinical trials.
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Affiliation(s)
- Sue-Faye Siow
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards 2065, Australia
| | - Dennis Yeow
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Neuroscience Research Australia, University of New South Wales, Randwick 2031, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst 2010, Australia
- Translational Neurogenomics Group, Molecular Medicine Laboratory and Department of Neurology, Concord Hospital, Concord 2139, Australia
- Neurodegenerative Service, Prince of Wales Hospital, Randwick 2031, Australia
| | - Laura I. Rudaks
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards 2065, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst 2010, Australia
- Translational Neurogenomics Group, Molecular Medicine Laboratory and Department of Neurology, Concord Hospital, Concord 2139, Australia
| | - Fangzhi Jia
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
| | - Gautam Wali
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Neuroscience Research Australia, University of New South Wales, Randwick 2031, Australia
| | - Carolyn M. Sue
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Neuroscience Research Australia, University of New South Wales, Randwick 2031, Australia
- Neurodegenerative Service, Prince of Wales Hospital, Randwick 2031, Australia
- School of Clinical Medicine, UNSW Medicine & Health, University of New South Wales, Kensington 2052, Australia
| | - Kishore R. Kumar
- Sydney Medical School, University of Sydney, Camperdown 2050, Australia (C.M.S.)
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst 2010, Australia
- Translational Neurogenomics Group, Molecular Medicine Laboratory and Department of Neurology, Concord Hospital, Concord 2139, Australia
- School of Clinical Medicine, UNSW Medicine & Health, University of New South Wales, Kensington 2052, Australia
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Jacinto-Scudeiro LA, Rothe-Neves R, Dos Santos VB, Machado GD, Burguêz D, Padovani MMP, Ayres A, Rech RS, González-Salazar C, Junior MCF, Saute JAM, Olchik MR. Dysarthria in hereditary spastic paraplegia type 4. Clinics (Sao Paulo) 2023; 78:100128. [PMID: 36473366 PMCID: PMC9723923 DOI: 10.1016/j.clinsp.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. METHODS Cross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). RESULTS In the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects' performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. CONCLUSION Dysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.
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Affiliation(s)
- Lais Alves Jacinto-Scudeiro
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rui Rothe-Neves
- Phonetics Laboratory of the Faculty of Letters, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Gustavo Dariva Machado
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daniela Burguêz
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Annelise Ayres
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rafaela Soares Rech
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carelis González-Salazar
- Postgraduate Program in Medical Pathophysiology, Universidade Estadual de Campinas, São Paulo, SP, Brazil
| | | | - Jonas Alex Morales Saute
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Internal Medicine Department, Faculdade de Medicina Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maira Rozenfeld Olchik
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Surgery and Orthopedics, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Costamagna D, Casters V, Beltrà M, Sampaolesi M, Van Campenhout A, Ortibus E, Desloovere K, Duelen R. Autologous iPSC-Derived Human Neuromuscular Junction to Model the Pathophysiology of Hereditary Spastic Paraplegia. Cells 2022; 11:3351. [PMID: 36359747 PMCID: PMC9655384 DOI: 10.3390/cells11213351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/27/2023] Open
Abstract
Hereditary spastic paraplegia (HSP) is a heterogeneous group of genetic neurodegenerative disorders, characterized by progressive lower limb spasticity and weakness resulting from retrograde axonal degeneration of motor neurons (MNs). Here, we generated in vitro human neuromuscular junctions (NMJs) from five HSP patient-specific induced pluripotent stem cell (hiPSC) lines, by means of microfluidic strategy, to model disease-relevant neuropathologic processes. The strength of our NMJ model lies in the generation of lower MNs and myotubes from autologous hiPSC origin, maintaining the genetic background of the HSP patient donors in both cell types and in the cellular organization due to the microfluidic devices. Three patients characterized by a mutation in the SPG3a gene, encoding the ATLASTIN GTPase 1 protein, and two patients with a mutation in the SPG4 gene, encoding the SPASTIN protein, were included in this study. Differentiation of the HSP-derived lines gave rise to lower MNs that could recapitulate pathological hallmarks, such as axonal swellings with accumulation of Acetyl-α-TUBULIN and reduction of SPASTIN levels. Furthermore, NMJs from HSP-derived lines were lower in number and in contact point complexity, denoting an impaired NMJ profile, also confirmed by some alterations in genes encoding for proteins associated with microtubules and responsible for axonal transport. Considering the complexity of HSP, these patient-derived neuronal and skeletal muscle cell co-cultures offer unique tools to study the pathologic mechanisms and explore novel treatment options for rescuing axonal defects and diverse cellular processes, including membrane trafficking, intracellular motility and protein degradation in HSP.
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Affiliation(s)
- Domiziana Costamagna
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Valérie Casters
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Marc Beltrà
- Department of Clinical and Biological Sciences, University of Torino, 10125 Torino, Italy
| | - Maurilio Sampaolesi
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Locomotor and Neurological Disorder, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Els Ortibus
- Locomotor and Neurological Disorder, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Pediatric Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Robin Duelen
- Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
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Mulkerrin G, França MC, Lope J, Tan EL, Bede P. Neuroimaging in hereditary spastic paraplegias: from qualitative cues to precision biomarkers. Expert Rev Mol Diagn 2022; 22:745-760. [PMID: 36042576 DOI: 10.1080/14737159.2022.2118048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION : Hereditary spastic paraplegias (HSP) include a clinically and genetically heterogeneous group of conditions. Novel imaging modalities have been increasingly applied to HSP cohorts which helps to quantitatively evaluate the integrity of specific anatomical structures and develop monitoring markers for both clinical care and future clinical trials. AREAS COVERED : Advances in HSP imaging are systematically reviewed with a focus on cohort sizes, imaging modalities, study design, clinical correlates, methodological approaches, and key findings. EXPERT OPINION : A wide range of imaging techniques have been recently applied to HSP cohorts. Common shortcomings of existing studies include the evaluation of genetically unconfirmed or admixed cohorts, limited sample sizes, unimodal imaging approaches, lack of postmortem validation, and a limited clinical battery, often exclusively focusing on motor aspects of the condition. A number of innovative methodological approaches have also be identified, such as robust longitudinal study designs, the implementation of multimodal imaging protocols, complementary cognitive assessments, and the comparison of HSP cohorts to MND cohorts. Collaborative multicentre initiatives may overcome sample limitations, and comprehensive clinical profiling with motor, extrapyramidal, cerebellar, and neuropsychological assessments would permit systematic clinico-radiological correlations. Academic achievements in HSP imaging have the potential to be developed into viable clinical applications to expedite the diagnosis and monitor disease progression.
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Affiliation(s)
| | - Marcondes C França
- Department of Neurology, The State University of Campinas, São Paulo, Brazil
| | - Jasmin Lope
- Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Ee Ling Tan
- Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Peter Bede
- Department of Neurology, St James's Hospital, Dublin, Ireland.,Computational Neuroimaging Group, Trinity College Dublin, Ireland
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The Puzzle of Hereditary Spastic Paraplegia: From Epidemiology to Treatment. Int J Mol Sci 2022; 23:ijms23147665. [PMID: 35887006 PMCID: PMC9321931 DOI: 10.3390/ijms23147665] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 01/03/2023] Open
Abstract
Inherited neurodegenerative pathology characterized by lower muscle tone and increasing spasticity in the lower limbs is termed hereditary spastic paraplegia (HSP). HSP is associated with changes in about 80 genes and their products involved in various biochemical pathways, such as lipid droplet formation, endoplasmic reticulum shaping, axon transport, endosome trafficking, and mitochondrial function. With the inheritance patterns of autosomal dominant, autosomal recessive, X-linked recessive, and mitochondrial inheritance, HSP is prevalent around the globe at a rate of 1–5 cases in every 100,000 individuals. Recent technology and medical interventions somewhat aid in recognizing and managing the malaise. However, HSP still lacks an appropriate and adequate therapeutic approach. Current therapies are based on the clinical manifestations observed in the patients, for example, smoothing the relaxant spastic muscle and physiotherapies. The limited clinical trial studies contribute to the absence of specific pharmaceuticals for HSPs. Our current work briefly explains the causative genes, epidemiology, underlying mechanism, and the management approach undertaken to date. We have also mentioned the latest approved drugs to summarise the available knowledge on therapeutic strategies for HSP.
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Sáenz‐Farret M, Lang AE, Kalia L, Cunha I, Sousa M, Kuhlman G, Ganos C, Munhoz RP, Fasano A, Piña‐Avilés CE, Zúñiga‐Ramírez C. SPG7
and movement disorders: beyond the spastic paraplegia. Mov Disord Clin Pract 2022; 9:522-529. [PMID: 35586535 PMCID: PMC9092757 DOI: 10.1002/mdc3.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Spastic paraplegia type 7 (SPG7) mutations can present either as a pure form or a complex phenotype with movement disorders. Objective Describe the main features of subjects with SPG7 mutations associated with movement disorders. Methods We analyzed the clinical and paraclinical information of subjects with SPG7 mutations associated with movement disorders. Results Sixteen affected subjects from 11 families were identified. Male sex predominated (10 of 16) and the mean age at onset was 41.25 ± 16.1 years. A cerebellar syndrome was the most frequent clinical movement disorder phenotype (7 of 16); however, parkinsonism (2 of 16), dystonia (1 of 16), and mixed phenotypes between them were also seen. The "ears of the lynx" sign was found in four subjects. A total of nine SPG7 variants were found, of which the most frequent was the c.1529C > T (p.Ala510Val). Conclusion This case series expands the motor phenotype associated with SPG7 mutations. Clinicians must consider this entity in single or familial cases with combined movement disorders.
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Affiliation(s)
- Michel Sáenz‐Farret
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | - Lorraine Kalia
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | - Inês Cunha
- Neurology Department Coimbra Hospital and Universitary Centre
| | - Mário Sousa
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Greg Kuhlman
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin Berlin Germany
| | - Renato P. Munhoz
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology University of Toronto
- Krembil Brain Institute Toronto Ontario Canada
| | | | - Carlos Zúñiga‐Ramírez
- Movement Disorders and Neurodegenerative Diseases Unit Hospital Civil de Guadalajara “Fray Antonio Alcalde”. Guadalajara Mexico
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11
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Doleckova K, Roth J, Stellmachova J, Gescheidt T, Sigut V, Houska P, Jech R, Zech M, Vyhnalek M, Vyhnalkova E, Seeman P, Meszarosova AU. SPG11: clinical and genetic features of seven Czech patients and literature review. Neurol Res 2022; 44:379-389. [DOI: 10.1080/01616412.2021.1975224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kristyna Doleckova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague
| | - Jan Roth
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague
| | - Julia Stellmachova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czechia
| | - Tomas Gescheidt
- Department of Neurology, St. Anne´s University Hospital, Brno, Czechia
| | | | - Pavel Houska
- Department of Neurology, Strakonice Hospital, Strakonice, Czechia
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague
| | - Michael Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
- Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Martin Vyhnalek
- Department of Neurology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague
| | - Emilie Vyhnalkova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague
| | - Pavel Seeman
- Department of Paediatric Neurology, Neurogenetic Laboratory, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague
| | - Anna Uhrova Meszarosova
- Department of Paediatric Neurology, Neurogenetic Laboratory, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague
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12
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Do JG, Kim BJ, Kim NS, Sung DH. Hereditary Spastic Paraplegia in Koreans: Clinical Characteristics and Factors Influencing the Disease Severity. J Clin Neurol 2022; 18:343-350. [PMID: 35196750 PMCID: PMC9163939 DOI: 10.3988/jcn.2022.18.3.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background and Purpose Hereditary spastic paraplegia (HSP) progresses over time and is associated with locomotive dysfunction. Understanding the factors affecting disease severity and locomotive function is important in HSP. This study investigated the factors influencing disease severity and ambulation status of HSP. Methods We consecutively enrolled 109 Korean patients (64 males, and 45 females)from 84 families with a clinical diagnosis of HSP. HSP was primarily diagnosed based on clinical criteria including clinical findings, family history, and supported by genetic studies. Epidemiological and clinical features of the patients were analyzed, and the Spastic Paraplegia Rating Scale (SPRS) score and ambulatory status were used to evaluate disease severity. Results Ninety-two (84.4%) patients had pure HSP, and 55 (50.4%) had a dominant family history. Thirty-one (28.4%) patients required a mobility aid for locomotion. A Kaplan-Meier analysis showed that HSP patients lost their independent gait ability after a median disease duration of 34 years. Those with an age at onset of ≤18 years had a longer median independent walking time. Pure HSP is characterized by predominant bilateral lower extremity weakness and spasticity, whereas complicated HSP presents more complex neurological findings such as ocular and bulbar symptoms, ataxia, and cognitive impairment. Complicated HSP was significantly correlated with the SPRS mobility score (β=3.70, 95% confidence interval=0.45–6.94). The age at onset and disease duration were significantly correlated with disease severity, and they were significant predictors of the use of a mobility aid (p<0.05). Conclusions These findings suggest that a later age at onset and longer disease duration are significant factors affecting the disease severity and ambulatory function in patients with HSP. These findings can help clinicians to identify subjects at risk of locomotive impairment.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam-Soon Kim
- Rare Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea.,Department of Functional Genomics, Korea Research Institute of Bioscience and Biotechnology School of Bioscience, University of Science and Technology (UST), Daejeon, Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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13
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Brighente SF, Vicuña P, Rodrigues Louzada AL, Giordani GM, Fussiger H, dos Santos MAR, Cubillos-Arcila DM, Winckler PB, Saute JAM. Evoked potentials as biomarkers of hereditary spastic paraplegias: A case-control study. PLoS One 2021; 16:e0259397. [PMID: 34847171 PMCID: PMC8631666 DOI: 10.1371/journal.pone.0259397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The Hereditary Spastic Paraplegias (HSP) are a group of genetic diseases that lead to slow deterioration of locomotion. Clinical scales seem to have low sensitivity in detecting disease progression, making the search for additional biomarkers a paramount task. This study aims to evaluate the role of evoked potentials (EPs) as disease biomarkers of HSPs. Methods A single center cross-sectional case-control study was performed, in which 18 individuals with genetic diagnosis of HSP and 21 healthy controls were evaluated. Motor evoked potentials (MEP) obtained with transcranial magnetic stimulation and somatosensory evoked potentials (SSEP) were performed in lower (LL) and upper limbs (UL). Results Central motor conduction time in lower limbs (CMCT-LL) was prolonged in HSP subjects, with marked reductions in MEP-LL amplitudes when compared to the control group (p<0.001 for both comparisons). CMCT-UL was 3.59ms (95% CI: 0.73 to 6.46; p = 0.015) prolonged and MEP-UL amplitudes were reduced (p = 0.008) in the HSP group. SSEP-LL latencies were prolonged in HSP subjects when compared to controls (p<0.001), with no statistically significant differences for upper limbs (p = 0.147). SSEP-UL and SSEP-LL latencies presented moderate to strong correlations with age at onset (Rho = 0.613, p = 0.012) and disease duration (Rho = 0.835, p<0.001), respectively. Similar results were obtained for the SPG4 subgroups of patients. Conclusion Motor and somatosensory evoked potentials can adequately differentiate HSP individuals from controls. MEP were severely affected in HSP subjects and SSEP-LL latencies were prolonged, with longer latencies being related to more severe disease. Future longitudinal studies should address if SSEP is a sensitive disease progression biomarker for HSP.
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Affiliation(s)
- Samanta Ferraresi Brighente
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paul Vicuña
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela Marchisio Giordani
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helena Fussiger
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Diana Maria Cubillos-Arcila
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pablo Brea Winckler
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Jonas Alex Morales Saute
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
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14
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NGS in Hereditary Ataxia: When Rare Becomes Frequent. Int J Mol Sci 2021; 22:ijms22168490. [PMID: 34445196 PMCID: PMC8395181 DOI: 10.3390/ijms22168490] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
The term hereditary ataxia (HA) refers to a heterogeneous group of neurological disorders with multiple genetic etiologies and a wide spectrum of ataxia-dominated phenotypes. Massive gene analysis in next-generation sequencing has entered the HA scenario, broadening our genetic and clinical knowledge of these conditions. In this study, we employed a targeted resequencing panel (TRP) in a large and highly heterogeneous cohort of 377 patients with a clinical diagnosis of HA, but no molecular diagnosis on routine genetic tests. We obtained a positive result (genetic diagnosis) in 33.2% of the patients, a rate significantly higher than those reported in similar studies employing TRP (average 19.4%), and in line with those performed using exome sequencing (ES, average 34.6%). Moreover, 15.6% of the patients had an uncertain molecular diagnosis. STUB1, PRKCG, and SPG7 were the most common causative genes. A comparison with published literature data showed that our panel would have identified 97% of the positive cases reported in previous TRP-based studies and 92% of those diagnosed by ES. Proper use of multigene panels, when combined with detailed phenotypic data, seems to be even more efficient than ES in clinical practice.
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Mackay-Sim A. Hereditary Spastic Paraplegia: From Genes, Cells and Networks to Novel Pathways for Drug Discovery. Brain Sci 2021; 11:brainsci11030403. [PMID: 33810178 PMCID: PMC8004882 DOI: 10.3390/brainsci11030403] [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: 02/05/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022] Open
Abstract
Hereditary spastic paraplegia (HSP) is a diverse group of Mendelian genetic disorders affecting the upper motor neurons, specifically degeneration of their distal axons in the corticospinal tract. Currently, there are 80 genes or genomic loci (genomic regions for which the causative gene has not been identified) associated with HSP diagnosis. HSP is therefore genetically very heterogeneous. Finding treatments for the HSPs is a daunting task: a rare disease made rarer by so many causative genes and many potential mutations in those genes in individual patients. Personalized medicine through genetic correction may be possible, but impractical as a generalized treatment strategy. The ideal treatments would be small molecules that are effective for people with different causative mutations. This requires identification of disease-associated cell dysfunctions shared across genotypes despite the large number of HSP genes that suggest a wide diversity of molecular and cellular mechanisms. This review highlights the shared dysfunctional phenotypes in patient-derived cells from patients with different causative mutations and uses bioinformatic analyses of the HSP genes to identify novel cell functions as potential targets for future drug treatments for multiple genotypes.
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Affiliation(s)
- Alan Mackay-Sim
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111, Australia
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16
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Ardolino G, Bocci T, Nigro M, Vergari M, Di Fonzo A, Bonato S, Cogiamanian F, Cortese F, Cova I, Barbieri S, Priori A. Spinal direct current stimulation (tsDCS) in hereditary spastic paraplegias (HSP): A sham-controlled crossover study. J Spinal Cord Med 2021; 44:46-53. [PMID: 30508408 PMCID: PMC7919872 DOI: 10.1080/10790268.2018.1543926] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Hereditary spastic paraplegia (HSP) represents a heterogeneous group of neurodegenerative diseases characterized by progressive spasticity and lower limb weakness. We assessed the effects of transcutaneous spinal direct current stimulation (tsDCS) in HSP.Design: A double-blind, randomized, crossover and sham-controlled study.Setting: Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan.Participants: eleven patients with HSP (six men, mean age ± SD: 37.3 ± 8.1 years), eight affected by spastin/SPG4,1 by atlastin1/SPG3a, 1 by paraplegin/SPG7 and 1 by ZFYVE26/SPG15.Interventions: tsDCS (anodal or sham, 2.0 mA, 20', five days) delivered over the thoracic spinal cord (T10-T12).Outcome measures: Motor-evoked potentials (MEPs), the H-reflex (Hr), F-waves, the Ashworth scale for clinical spasticity, the Five Minutes Walking test and the Spastic Paraplegia Rating Scale (SPRS) were assessed. Patients were evaluated before tsDCS (T0), at the end of the stimulation (T1), after one week (T2), one month (T3) and two months (T4).Results: The score of the Ashworth scale improved in the anodal compared with sham group, up to two months following the end of stimulation (T1, P = .0137; T4, P = .0244), whereas the Five Minutes Walking test and SPRS did not differ between the two groups. Among neurophysiological measures, both anodal and sham tsDCS left Hr, F-waves and MEPs unchanged over time.Conclusions: Anodal tsDCS significantly decreases spasticity and might be a complementary strategy for the treatment of spasticity in HSP.
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Affiliation(s)
- Gianluca Ardolino
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Bocci
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, Pisa University Medical School, Pisa, Italy,“Aldo Ravelli” Center for Neurotechnology and Experiental Brain Therapeutics, Department of Health Sciences, University of Milan & ASST Santi Paolo e Carlo, Milan, Italy
| | - Martina Nigro
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vergari
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Bonato
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Cogiamanian
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Cortese
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Cova
- Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Neuropathophysiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Correspondence to: Alberto Priori, Department of Health Sciences, University of Milan, Via Antonio Di Rudinì 8, 20142Milan, Italy. mailto:
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17
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Vavla M, Montanaro D, Pizzighello S, Frijia F, Arrigoni F, Baratto A, Piccoli G, Paparella G, Martinuzzi A. Brain Magnetic Spectroscopy Imaging and Hereditary Spastic Paraplegia: A Focused Systematic Review on Current Landmarks and Future Perspectives. Front Neurol 2020; 11:515. [PMID: 32765386 PMCID: PMC7381200 DOI: 10.3389/fneur.2020.00515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive neuroimaging technique used to investigate in vivo brain metabolites. MRS could provide a sensitive tool for the study of hereditary spastic paraplegia (HSP) by helping to unveil the underlying biochemical mechanisms and monitoring response to treatment. This focused systematic review aimed to summarize the brain metabolite findings in studies performed in genetically determined HSP. The second aim was to provide a critical analysis and recommendations for well-designed protocols for future studies. Fourteen MRS studies have been analyzed with overall 61 HSP patients, falling within a wide range of age at onset, disease duration, and age at the MRS scan, including children and adults. The genetic diagnosis included several subtypes (SPG2/3/4/5/10/11/28/31/54). SPG11 and SPG54 have been more frequently investigated. The MRS methodology included different MR field strength, not easily comparable spectra areas varying from whole brain to various cortical areas, brain stem and cerebellum sampling. No consistency in disease severity and other outcome measures was observed. The main MRS findings corresponded to the white matter metabolite abnormalities in the corticospinal tracts. In summary, this focused review provides insights on the current knowledge of brain metabolites in HSP and, in particular, in SPG11 and SPG54. Despite the inhomogeneity of the studies to date reported, brain metabolites as assessed by MRS could represent potentially useful diagnostic markers and prognostic indicators of disease progression in HSP. Specific recommendations regarding the MRS technical protocol, CNS area sampling, study design, and applicability of findings are given.
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Affiliation(s)
- Marinela Vavla
- SOS Neuromotor Unit, Department of Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Treviso, Italy
- SOS Neuromotor Unit, Department of Conegliano, Scientific Institute, IRCCS E. Medea, Treviso, Italy
- Department of Women's and Children's Health, University of Padova, Padua, Italy
- *Correspondence: Marinela Vavla ;
| | - Domenico Montanaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - Silvia Pizzighello
- SOS Neuromotor Unit, Department of Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Treviso, Italy
| | - Francesca Frijia
- U.O.C Bioengineering and Clinical Technology, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Alessandra Baratto
- Department of Radiology S. Maria dei Battuti Hospital-Conegliano, Treviso, Italy
| | - Gianluca Piccoli
- Department of Radiology S. Maria dei Battuti Hospital-Conegliano, Treviso, Italy
| | - Gabriella Paparella
- SOS Neuromotor Unit, Department of Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Treviso, Italy
| | - Andrea Martinuzzi
- SOS Neuromotor Unit, Department of Pieve di Soligo, Scientific Institute, IRCCS E. Medea, Treviso, Italy
- SOS Neuromotor Unit, Department of Conegliano, Scientific Institute, IRCCS E. Medea, Treviso, Italy
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18
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Montanaro D, Vavla M, Frijia F, Aghakhanyan G, Baratto A, Coi A, Stefan C, Girardi G, Paparella G, De Cori S, Totaro P, Lombardo F, Piccoli G, Martinuzzi A. Multimodal MRI Longitudinal Assessment of White and Gray Matter in Different SPG Types of Hereditary Spastic Paraparesis. Front Neurosci 2020; 14:325. [PMID: 32581663 PMCID: PMC7287014 DOI: 10.3389/fnins.2020.00325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/19/2020] [Indexed: 01/18/2023] Open
Abstract
Hereditary spastic paraplegias (HSP) are a group of genetically and clinically heterogeneous neurologic disorders. Hereby we describe a relatively large group of patients (pts) affected by HSP studied at baseline (31 pts) and at follow-up (mean period 28.9 ± 8.4 months; 23 pts) with multimodal advanced MRI: high-resolution T1 images for voxel-based morphometry (VBM) analysis, magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI). An age-matched healthy control (HC) group underwent the same neuroimaging protocol in a time schedule matched with the HSP patients. At baseline, VBM showed gray matter (GM) reduction in HSP in the right pre-frontal cortex and bilaterally in the thalami. MRS at baseline depicted in HSP patients compared to the HC group reduction of NAA/Cr ratio in the right pre-frontal region, increase of Cho/Cr ratio in the right pre-central regions, and increase of mI/Cr ratio on the left pre-central area. At cross-sectional follow-up analysis and longitudinal evaluation, no VBM and MRS statistically significant results were obtained. Tract-based spatial statistics (TBSS) analysis showed widespread DTI brain white matter (WM) alterations in patients compared to HC at baseline, which are characterized by reduction of fractional anisotropy (FA) and increase of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity, as confirmed on cross-analysis of the follow-up dataset. A longitudinal analysis with TBSS in HSP patients did not show significant variations, while upon applying region-based analysis we found increased FA and decreased MD and AD in specific brain WM fiber complex during follow-up. The changes were not correlated with the clinical presentation (pure vs complicated HSP), motor function, and motility indexes or history of specific treatments (botulinum toxin). In conclusion, the cross-sectional analysis of the multiparametric MRI data in our HSP patients confirmed the non-prominent involvement of the cortex in the primary motor regions but rather of other more associative areas. On the contrary, DTI demonstrated a widespread involvement of the brain WM, including the primary motor regions, which was confirmed at follow-up. The longitudinal analysis revealed an apparent inversion of tendency when considering the expected evolution of a neurodegenerative process: we detected an increase of FA and a decrease of MD and AD. These time-related modifications may suggest a repair attempt by the residual central WM fibers, which requires confirmation with a larger group of patients and with a longer time interval.
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Affiliation(s)
- Domenico Montanaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - M Vavla
- Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
| | - F Frijia
- U.O.C Bioengineering and Clinical Technology, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - G Aghakhanyan
- Department of Translational Research on New Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - A Baratto
- Department of Radiology S. Maria dei Battuti Hospital - Conegliano, ULSS2-Marca Trevigiana, Conegliano, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - C Stefan
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - G Girardi
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - G Paparella
- Acquired Neuropsychological Disease Rehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Pieve di Soligo, Italy
| | - S De Cori
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - P Totaro
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - F Lombardo
- U.O.C. Risonanza Magnetica Specialistica e Neuroradiologia, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - G Piccoli
- Department of Radiology S. Maria dei Battuti Hospital - Conegliano, ULSS2-Marca Trevigiana, Conegliano, Italy
| | - Andrea Martinuzzi
- Severe Developmental Disabilities Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Italy
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Vavla M, Paparella G, Papayannis A, Pascuzzo R, Girardi G, Pellegrini F, Capello G, Prosdocimo G, Martinuzzi A. Optical Coherence Tomography in a Cohort of Genetically Defined Hereditary Spastic Paraplegia: A Brief Research Report. Front Neurol 2019; 10:1193. [PMID: 31824395 PMCID: PMC6884025 DOI: 10.3389/fneur.2019.01193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: In-vivo objective documentation of pathological changes in neurodegenerative disease is a major aim to possibly improve our ability to monitor disease progression and response to treatment. Temporal thinning of the retinal nerve fiber layer (RNFL) thickness shown by spectral domain optical coherence tomography (SD-OCT) has been reported in association with the complex forms in hereditary spastic paraplegia (HSP). We performed an assessment of the RNFL thickness in a group of HSP patients, including a longitudinal follow-up in a subgroup. Our aim was to measure and compare the changes and correlate them to clinical progression. Materials and Methods: Twenty-three HSP patients were recruited and studied with the SD-OCT including papillary and macular scan by Spectralis. The clinical severity was assessed using the Spastic Paraplegia Rating Scale. Results: Thinning of the superior, nasal and inferior quadrants bilaterally were observed compared to the normative data in both pure and complicated forms, that were clearly pathological only in a proportion of cases. Thinning correlated with age and disease duration, but not with clinical severity. The longitudinal study (n = 9) showed no significant change compared to the baseline data for the period of observation (mean 10.7 months). Conclusions: RFNL is frequently thinned in HSP with no specific recognizable pattern of quadrants involved and SPG types. The small sample size and the short follow-up time showed no clear progression. Although SD-OCT appraisal of RFNL deserves to be explored in neurodegenerative conditions, it might not be suitable for use as a biomarker in HSP as it appears not to be specific to this condition and can be a feature of aging.
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Affiliation(s)
- Marinela Vavla
- SOS Neuromotor Unit, Scientific Institute, IRCCS E. Medea, Conegliano, Italy
| | - Gabriella Paparella
- SOS Neuromotor Unit, Scientific Institute, IRCCS E. Medea, Conegliano, Italy
| | | | - Riccardo Pascuzzo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulia Girardi
- SOS Neuromotor Unit, Scientific Institute, IRCCS E. Medea, Conegliano, Italy
| | | | - Gianluca Capello
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianni Prosdocimo
- Department of Ophthalmology, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Andrea Martinuzzi
- SOS Neuromotor Unit, Scientific Institute, IRCCS E. Medea, Conegliano, Italy
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Erfanian Omidvar M, Torkamandi S, Rezaei S, Alipoor B, Omrani MD, Darvish H, Ghaedi H. Genotype-phenotype associations in hereditary spastic paraplegia: a systematic review and meta-analysis on 13,570 patients. J Neurol 2019; 268:2065-2082. [PMID: 31745725 DOI: 10.1007/s00415-019-09633-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 12/13/2022]
Abstract
AIMS The hereditary spastic paraplegias (HSPs) are a heterogeneous group of inherited neurodegenerative disorders. Although, several genotype-phenotype studies have carried out on HSPs, the association between genotypes and clinical phenotypes remain incomplete since most studies are small in size or restricted to a few genes. Accordingly, this study provides the systematic meta-analysis of genotype-phenotype associations in HSP. METHODS AND RESULTS We retrieved literature on genotype-phenotype associations in patients with HSP and mutated SPAST, REEP1, ATL1, SPG11, SPG15, SPG7, SPG35, SPG54, SPG5. In total, 147 studies with 13,570 HSP patients were included in our meta-analysis. The frequency of mutations in SPAST (25%) was higher than REEP1 (3%), as well as ATL1 (5%) in AD-HSP patients. As for AR-HSP patients, the rates of mutations in SPG11 (18%), SPG15 (7%) and SPG7 (13%) were higher than SPG5 (5%), as well as SPG35 (8%) and SPG54 (7%). The mean age of AD-HSP onset for ATL1 mutation-positive patients was earlier than patients with SPAST, REEP1 mutations. Also, the tendency toward younger age at AR-HSP onset for SPG35 was higher than other mutated genes. It is noteworthy that the mean age at HSP onset ranged from infancy to adulthood. As for the gender distribution, the male proportion in SPG7-HSP (90%) and REEP1-HSP (78%) was markedly high. The frequency of symptoms was varied among patients with different mutated genes. The rates of LL weakness, superficial sensory abnormalities, neuropathy, and deep sensory impairment were noticeably high in REEP1 mutations carriers. Also, in AR-HSP patients with SPG11 mutations, the presentation of symptoms including pes cavus, Neuropathy, and UL spasticity was higher. CONCLUSION Our comprehensive genotype-phenotype assessment of available data displays that the mean age at disease onset and particular sub-phenotypes are associated with specific mutated genes which might be beneficial for a diagnostic procedure and differentiation of the specific mutated genes phenotype among diverse forms of HSP.
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Affiliation(s)
- Maryam Erfanian Omidvar
- Department of Medical Laboratory Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Torkamandi
- Department of Medical Genetics and Immunology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Somaye Rezaei
- Department of Neurology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Behnam Alipoor
- Department of Laboratory Sciences, Faculty of Parmedicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mir Davood Omrani
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, IR, Iran
| | - Hossein Darvish
- Department of Medical Genetics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Ghaedi
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, IR, Iran.
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21
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List J, Kohl Z, Winkler J, Marxreiter F, Doerfler A, Schmidt MA. Ascending Axonal Degeneration of the Corticospinal Tract in Pure Hereditary Spastic Paraplegia: A Cross-Sectional DTI Study. Brain Sci 2019; 9:brainsci9100268. [PMID: 31601037 PMCID: PMC6827077 DOI: 10.3390/brainsci9100268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: To identify structural white matter alterations in patients with pure hereditary spastic paraplegia (HSP) using high angular resolution diffusion tensor imaging (DTI). Methods: We examined 37 individuals with high resolution DTI, 20 patients with pure forms of hereditary spastic paraplegia and 17 age and gender matched healthy controls. DTI was performed using a 3 T clinical scanner with whole brain tract-based spatial statistical (TBSS) analysis of the obtained fractional anisotropy (FA) data as well as a region-of-interest (ROI)-based analysis of affected tracts including the cervical spinal cord. We further conducted correlation analyses between DTI data and clinical characteristics. Results: TBSS analysis in HSP patients showed significantly decreased fractional anisotropy of the corpus callosum and the corticospinal tract compared to healthy controls. ROI-based analysis confirmed significantly lower FA in HSP compared to controls in the internal capsule (0.77 vs. 0.80, p = 0.048), the corpus callosum (0.84 vs. 0.87, p = 0.048) and the cervical spinal cord (0.72 vs. 0.79, p = 0.003). FA values of the cervical spinal cord significantly correlated with disease duration. Conclusion: DTI metrics of the corticospinal tract from the internal capsule to the cervical spine suggest microstructural damage and axonal degeneration of motor neurons. The CST at the level of the cervical spinal cord is thereby more severely affected than the intracranial part of the CST, suggesting an ascending axonal degeneration of the CST. Since there is a significant correlation with disease duration, FA may serve as a future progression marker for assessment of the disease course in HSP.
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Affiliation(s)
- Julia List
- Departments of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Zacharias Kohl
- Departments of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Juergen Winkler
- Departments of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Franz Marxreiter
- Departments of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Arnd Doerfler
- Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Manuel A Schmidt
- Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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22
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Siow SF, Cameron Smail R, Ng K, Kumar KR, Sue CM. Motor Evoked Potentials in Hereditary Spastic Paraplegia-A Systematic Review. Front Neurol 2019; 10:967. [PMID: 31620065 PMCID: PMC6759520 DOI: 10.3389/fneur.2019.00967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Hereditary Spastic Paraplegia (HSP) is a slowly progressive neurodegenerative disorder with no disease modifying treatment. Potential therapeutic approaches are emerging and large-scale clinical drug trials for patients with HSP are imminent. A sensitive biomarker to measure the drug efficacy in these trials is required. Motor evoked potentials (MEPs) are a potential biomarker for HSP as they assess the central motor pathways and can be standardized with set protocols and guidelines. Objectives: We performed a systematic review to investigate the utility of MEPs as a diagnostic and disease severity biomarker for HSP. Search Methods: Systematic searches of PubMed, Embase, Medline, and Scopus were performed. Selection Criteria: Studies reporting on central motor conduction time measured with MEPs in adult and pediatric patients with HSP were included. We excluded studies in non-HSP patient cohorts, not in English, not original research, and unpublished journal articles. Data Collection and analysis: Search results were de-duplicated and screened according to the inclusion and exclusion criteria. The included papers were reviewed independently by two reviewers and data was collected on patient cohorts, test methods, results, and study quality. Results were analyzed using descriptive methods. Results: Of the 882 search results, 32 studies were included in the review. The most common finding was absent or prolonged lower limb (LL) central motor conduction time (CMCT) in patients with HSP (78% of patients studied). Quality assessment revealed variability in study methodology and reporting of results. Variations included patient cohorts of various genotypes as well as variations in equipment and techniques used. Aside from CMCT, none of the MEP parameter measures correlated with disease severity and many did not show significant difference between HSP patients and controls. Conclusion: Systematic review of MEP studies in HSP patient cohorts demonstrated mixed findings. Lower limb CMCT was the most promising parameter in terms of differentiating HSP patients from controls, with one study demonstrating a weak correlation with clinical disease severity. It is possible that the lack of consistency in study methodologies and small patient cohorts have contributed to the variable findings. A longitudinal study of MEPs in a large cohort of HSP patients with the same genotype will help clarify the utility of MEPs as a biomarker for disease severity and use in clinical trials.
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Affiliation(s)
- Sue-Faye Siow
- Department of Neurogenetics, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Neurology and Neurophysiology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ruaridh Cameron Smail
- Department of Neurology and Neurophysiology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Karl Ng
- Department of Neurology and Neurophysiology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kishore R Kumar
- Department of Neurogenetics, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia.,Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Molecular Medicine Laboratory, Concord Hospital, Sydney, NSW, Australia
| | - Carolyn M Sue
- Department of Neurogenetics, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Neurology and Neurophysiology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Northern Clinical School, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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23
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Sartori RDG, Marelli M, D'Angelo MG, Delle Fave A. Autonomy level and quality of everyday experience of people with Hereditary Spastic Paraplegia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e850-e860. [PMID: 31313875 DOI: 10.1111/hsc.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/11/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
In the health domain, well-being is primarily assessed as autonomy and mental distress, whereas the quality of daily experience is rarely investigated. In this study, the relationship between autonomy levels and daily experience was explored. Thirty-five Italian adults with Hereditary Spastic Paraplegia provided for one week real-time descriptions of daily activities and associated experiences through the Experience Sampling Method procedure. Participants were grouped based on autonomy levels assessed through Barthel Index. The relationships between activity typologies, the experiential dimensions, perceived challenges and skills, and autonomy level were analysed. Participants' predominant activities were personal care, associated with global disengagement, and leisure, associated with high control and desirability, but low perceived relevance. During social interactions participants reported engagement and emotional well-being, and during productive activities high activation but negative affect. Multi-level analysis highlighted that this association between activity type and experiential patterns recurred across autonomy levels. In addition, perceived challenges in the activity were lower that perceived personal skills across activities and autonomy levels. Findings suggest that persons with motor disabilities, regardless of their autonomy level, would benefit from more challenging opportunities for action in daily life, in order to attain well-being through active skill mobilisation.
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Affiliation(s)
- Raffaela D G Sartori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milano, Italy
| | - Marco Marelli
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Maria Grazia D'Angelo
- Scientific Institute, IRCCS E. Medea, NeuroMuscular Unit, Bosisio Parini, Lecco, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
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24
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Hereditary spastic paraplegia: from diagnosis to emerging therapeutic approaches. Lancet Neurol 2019; 18:1136-1146. [PMID: 31377012 DOI: 10.1016/s1474-4422(19)30235-2] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 12/16/2022]
Abstract
Hereditary spastic paraplegia (HSP) describes a heterogeneous group of genetic neurodegenerative diseases characterised by progressive spasticity of the lower limbs. The pathogenic mechanism, associated clinical features, and imaging abnormalities vary substantially according to the affected gene and differentiating HSP from other genetic diseases associated with spasticity can be challenging. Next generation sequencing-based gene panels are now widely available but have limitations and a molecular diagnosis is not made in most suspected cases. Symptomatic management continues to evolve but with a greater understanding of the pathophysiological basis of individual HSP subtypes there are emerging opportunities to provide targeted molecular therapies and personalised medicine.
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25
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Jacinto-Scudeiro LA, Dariva Machado G, Ayres A, Burguêz D, Polese-Bonato M, González-Salazar C, Siebert M, Cavalcante França M, Olchik MR, Morales Saute JA. Are Cognitive Changes in Hereditary Spastic Paraplegias Restricted to Complicated Forms? Front Neurol 2019; 10:508. [PMID: 31231294 PMCID: PMC6558376 DOI: 10.3389/fneur.2019.00508] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Little is known about the cognitive profile of Hereditary Spastic Paraplegias (HSP), where most scientific attention has been given to motor features related to corticospinal tract degeneration. Objectives: We aimed to perform a broad characterization of the cognitive functions of patients with pure and complicated HSP as well as to determine the frequency of abnormal cognitive performances in the studied subtypes. Methods: A two-center cross-sectional case-control study was performed. All individuals underwent cognitive assessment through screening tests (Mini Mental State Examination—MEEM and Montreal Cognitive Assessment—MOCA) and tests to assess specific cognitive functions (Verbal fluency with phonological restriction—FAS; Verbal categorical fluency—FAS-cat and Rey's Verbal Auditory Learning Test -RAVLT). Results: Fifty four patients with genetically confirmed HSP diagnosis, 36 with spastic paraplegia type 4 (SPG4), 5 SPG11, 4 SPG5, 4 cerebrotendinous xanthomatosis (CTX), 3 SPG7 and 2 SPG3A, and 10 healthy, unrelated control subjects, with similar age, sex, and education participated in the study. SPG4 patients had worse performances in MOCA, FAS, FAS-cat, and RAVLT when compared to controls. Most SPG4 patients presented cognitive changes not compatible with dementia, performing poorly in memory, attention and executive functions. SPG5 patients scored lower in executive functions and memory, and SPG7 patients performed poorly on memory tasks. All evaluated cognitive functions were markedly altered in CTX and SPG11 patients. Conclusions: Cognitive abnormalities are frequent in HSP, being more severe in complicated forms. However, cognitive impairments of pure HSPs might impact patients' lives, decreasing families' socioeconomic status and contributing to the overall disease burden.
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Affiliation(s)
- Laís Alves Jacinto-Scudeiro
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Dariva Machado
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Annelise Ayres
- Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Daniela Burguêz
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Marcia Polese-Bonato
- Graduate Program in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carelis González-Salazar
- Graduate program in Medical Physiopathology, School of Medical Science, Universidade Estadual de Campinas, Campinas, Brazil
| | - Marina Siebert
- Graduate program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Unit of Laboratorial Research/Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Maira Rozenfeld Olchik
- Department of Surgery and Orthopedics, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jonas Alex Morales Saute
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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26
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Rudenskaya GE, Kadnikova VA, Ryzhkova OP. [Common forms of hereditary spastic paraplegias]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:94-104. [PMID: 30874534 DOI: 10.17116/jnevro201911902194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A group of hereditary spastic paraplegias includes about 80 spastic paraplegia genes (SPG): forms with identified (almost 70) or only mapped (about 10) genes. Methods of next generation sequencing (NGS), along with new SPG discovering, modify knowledge about earlier delineated SPG. Clinical and genetic characteristics of common autosomal dominant (SPG4, SPG3, SPG31) and autosomal recessive (SPG11, SPG7, SPG15) forms are presented.
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Affiliation(s)
| | - V A Kadnikova
- Research Centre for Medical Genetics, Moscow, Russia
| | - O P Ryzhkova
- Research Centre for Medical Genetics, Moscow, Russia
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27
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da Graça FF, de Rezende TJR, Vasconcellos LFR, Pedroso JL, Barsottini OGP, França MC. Neuroimaging in Hereditary Spastic Paraplegias: Current Use and Future Perspectives. Front Neurol 2019; 9:1117. [PMID: 30713518 PMCID: PMC6346681 DOI: 10.3389/fneur.2018.01117] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022] Open
Abstract
Hereditary spastic paraplegias (HSP) are a large group of genetic diseases characterized by progressive degeneration of the long tracts of the spinal cord, namely the corticospinal tracts and dorsal columns. Genotypic and phenotypic heterogeneity is a hallmark of this group of diseases, which makes proper diagnosis and management often challenging. In this scenario, magnetic resonance imaging (MRI) emerges as a valuable tool to assist in the exclusion of mimicking disorders and in the detailed phenotypic characterization. Some neuroradiological signs have been reported in specific subtypes of HSP and are therefore helpful to guide genetic testing/interpretation. In addition, advanced MRI techniques enable detection of subtle structural abnormalities not visible on routine scans in the spinal cord and brain of subjects with HSP. In particular, quantitative spinal cord morphometry and diffusion tensor imaging look promising tools to uncover the pathophysiology and to track progression of these diseases. In the current review article, we discuss the current use and future perspectives of MRI in the context of HSP.
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Affiliation(s)
- Felipe Franco da Graça
- Department of Neurology and Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - José Luiz Pedroso
- Department of Neurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Marcondes C França
- Department of Neurology and Neuroimaging Laboratory, University of Campinas (UNICAMP), Campinas, Brazil
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28
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D'Amore A, Tessa A, Casali C, Dotti MT, Filla A, Silvestri G, Antenora A, Astrea G, Barghigiani M, Battini R, Battisti C, Bruno I, Cereda C, Dato C, Di Iorio G, Donadio V, Felicori M, Fini N, Fiorillo C, Gallone S, Gemignani F, Gigli GL, Graziano C, Guerrini R, Gurrieri F, Kariminejad A, Lieto M, Marques LourenḈo C, Malandrini A, Mandich P, Marcotulli C, Mari F, Massacesi L, Melone MAB, Mignarri A, Milone R, Musumeci O, Pegoraro E, Perna A, Petrucci A, Pini A, Pochiero F, Pons MR, Ricca I, Rossi S, Seri M, Stanzial F, Tinelli F, Toscano A, Valente M, Federico A, Rubegni A, Santorelli FM. Next Generation Molecular Diagnosis of Hereditary Spastic Paraplegias: An Italian Cross-Sectional Study. Front Neurol 2018; 9:981. [PMID: 30564185 PMCID: PMC6289125 DOI: 10.3389/fneur.2018.00981] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022] Open
Abstract
Hereditary spastic paraplegia (HSP) refers to a group of genetically heterogeneous neurodegenerative motor neuron disorders characterized by progressive age-dependent loss of corticospinal motor tract function, lower limb spasticity, and weakness. Recent clinical use of next generation sequencing (NGS) methodologies suggests that they facilitate the diagnostic approach to HSP, but the power of NGS as a first-tier diagnostic procedure is unclear. The larger-than-expected genetic heterogeneity-there are over 80 potential disease-associated genes-and frequent overlap with other clinical conditions affecting the motor system make a molecular diagnosis in HSP cumbersome and time consuming. In a single-center, cross-sectional study, spanning 4 years, 239 subjects with a clinical diagnosis of HSP underwent molecular screening of a large set of genes, using two different customized NGS panels. The latest version of our targeted sequencing panel (SpastiSure3.0) comprises 118 genes known to be associated with HSP. Using an in-house validated bioinformatics pipeline and several in silico tools to predict mutation pathogenicity, we obtained a positive diagnostic yield of 29% (70/239), whereas variants of unknown significance (VUS) were found in 86 patients (36%), and 83 cases remained unsolved. This study is among the largest screenings of consecutive HSP index cases enrolled in real-life clinical-diagnostic settings. Its results corroborate NGS as a modern, first-step procedure for molecular diagnosis of HSP. It also disclosed a significant number of new mutations in ultra-rare genes, expanding the clinical spectrum, and genetic landscape of HSP, at least in Italy.
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Affiliation(s)
- Angelica D'Amore
- Molecular Medicine, Pisa, Italy.,Department of Biology, University of Pisa, Pisa, Italy
| | | | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Gabriella Silvestri
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonella Antenora
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | | | | | | | - Carla Battisti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Irene Bruno
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Cristina Cereda
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Clemente Dato
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Di Iorio
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna-UOC Clinica Neurologica, Bologna, Italy
| | - Monica Felicori
- Istituto delle Scienze Neurologiche di Bologna-UOC Neuropsichiatria Infantile, Bologna, Italy
| | - Nicola Fini
- Department of Neurosciences, Sant'Agostino-Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Chiara Fiorillo
- Pediatric Neurology and Neuromuscular Disorders, University of Genoa and Istituto Giannina Gaslini, Genova, Italy
| | - Salvatore Gallone
- Neurology I, Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Gian Luigi Gigli
- Neurology Clinic, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Claudio Graziano
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Florence, Italy
| | - Fiorella Gurrieri
- Institute of Genomic Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Ariana Kariminejad
- Clinical Genetics, Kariminejad-Najmabadi Pathology & Genetics Research Center, Tehran, Iran
| | - Maria Lieto
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Charles Marques LourenḈo
- Neurogenetics Division, Clinics Hospital of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Medical Genetics, University of Genoa, Genoa, Italy.,Medical Genetics Unit, Department of Diagnosis, Pathology and Treatments of High Technological Complexity, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Mari
- Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Maria A B Melone
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Andrea Mignarri
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Roberta Milone
- Child Neuropsychiatry, ULSS 7 Pedemontana, Vicenza, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Alessia Perna
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonella Pini
- Istituto delle Scienze Neurologiche di Bologna-UOC Neuropsichiatria Infantile, Bologna, Italy
| | - Francesca Pochiero
- Metabolic and Muscular Unit, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Maria Roser Pons
- First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | | | - Salvatore Rossi
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Seri
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Franco Stanzial
- Clinical Genetics Service and South Tyrol Coordination Center for Rare Diseases, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | | | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariarosaria Valente
- Neurology Clinic, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
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Serrao M, Rinaldi M, Ranavolo A, Lacquaniti F, Martino G, Leonardi L, Conte C, Varrecchia T, Draicchio F, Coppola G, Casali C, Pierelli F. Gait Patterns in Patients with Hereditary Spastic Paraparesis. PLoS One 2016; 11:e0164623. [PMID: 27732632 PMCID: PMC5061421 DOI: 10.1371/journal.pone.0164623] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background Spastic gait is a key feature in patients with hereditary spastic paraparesis, but the gait characterization and the relationship between the gait impairment and clinical characteristics have not been investigated. Objectives To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking. Methods We evaluated fifty patients by computerized gait analysis and compared them to healthy participants. We computed time-distance parameters of walking and the range of angular motion at hip, knee, and ankle joints, and at the trunk and pelvis. Lower limb joint moments and muscle co-activation values were also evaluated. Results We identified three distinct subgroups of patients based on the range of motion values. Subgroup one was characterized by reduced hip, knee, and ankle joint range of motion. These patients were the most severely affected from a clinical standpoint, had the highest spasticity, and walked at the slowest speed. Subgroup three was characterized by an increased hip joint range of motion, but knee and ankle joint range of motion values close to control values. These patients were the most mildly affected and had the highest walking speed. Finally, subgroup two showed reduced knee and ankle joint range of motion, and hip range of motion values close to control values. Disease severity and gait speed in subgroup two were between those of subgroups one and three. Conclusions We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data. Distinguishing specific features in the gait patterns of these patients may help tailor pharmacological and rehabilitative treatments and may help evaluate therapeutic effects over time.
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Affiliation(s)
- Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
- * E-mail:
| | | | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Francesco Lacquaniti
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Martino
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Rome, Italy
| | - Luca Leonardi
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | | | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Gianluca Coppola
- G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- IRCCS, Neuromed, Pozzilli, Isernia, Italy
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