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Malisky JS, Cavalcante-Leão BL, Severiano MI, dos Santos GJB, Teive HAG, José MR, de Araújo CM, Zeigelboim BS. Evaluation of Quality of Life After Use the Virtual Reality in Patients with Neurodegenerative Disease. Int Arch Otorhinolaryngol 2024; 28:e523-e529. [PMID: 38974627 PMCID: PMC11226250 DOI: 10.1055/s-0044-1785681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/28/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases. Objective To evaluate the living standard of patients with SCA, by applying the Vestibular Disorders Activities of Daily Living Scale (VADL) and Activitiesspecific Balance Confidence Scale (ABC) questionnaires. Methods An uncontrolled clinical trial study was conducted with 28 patients who underwent anamnesis, ENT evaluation, and vestibular assessment and the application of questionnaires VADL and ABC before and after rehabilitation with virtual reality. Results The vestibular exam was altered in 64.3% of the cases. The result between the correlation of the VADL and ABC questionnaires showed significant results in all cases (p < 0.005). The correlation between the ages and disease length with the VADL and ABC questionnaires was significant in the T3 assessment (p = 0.015). The correlation between the disease length and the VADL questionnaire was significant in all cases (p < 0.005). The comparison of the vestibular rehabilitation result (T1 to T2) showed a significant difference for all the applied games, except for the ski slalom. The comparison of the vestibular rehabilitation result (T1 to T3) showed significant difference for all the applied games (p < 0.005) (1st assessment before the start of rehabilitation designated T1, after 10 rehabilitation sessions, considered T2 and, at the end of 20 rehabilitation sessions, called T3). Conclusion We can point out a direct improvement in the living standard, reflected by the reduction of falls, better balance, and march, contributing to a higher self-confidence in patients in daily activities.
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Affiliation(s)
- Jéssica Spricigo Malisky
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Bianca Lopes Cavalcante-Leão
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | | | | | - Hélio Augusto Guizoni Teive
- Department of Neurology, Movement Disorders Unit, Hospital das Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Maria Renata José
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Cristiano Miranda de Araújo
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
| | - Bianca Simone Zeigelboim
- Department of Otoneurology, Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná (UTP), Curitiba, PR, Brazil
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Rahman MA, Orfali R, Dave N, Lam E, Naguib N, Nam YW, Zhang M. K Ca 2.2 (KCNN2): A physiologically and therapeutically important potassium channel. J Neurosci Res 2023; 101:1699-1710. [PMID: 37466411 PMCID: PMC10932612 DOI: 10.1002/jnr.25233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023]
Abstract
One group of the K+ ion channels, the small-conductance Ca2+ -activated potassium channels (KCa 2.x, also known as SK channels family), is widely expressed in neurons as well as the heart, endothelial cells, etc. They are named small-conductance Ca2+ -activated potassium channels (SK channels) due to their comparatively low single-channel conductance of about ~10 pS. These channels are insensitive to changes in membrane potential and are activated solely by rises in the intracellular Ca2+ . According to the phylogenic research done on the KCa 2.x channels family, there are three channels' subtypes: KCa 2.1, KCa 2.2, and KCa 2.3, which are encoded by KCNN1, KCNN2, and KCNN3 genes, respectively. The KCa 2.x channels regulate neuronal excitability and responsiveness to synaptic input patterns. KCa 2.x channels inhibit excitatory postsynaptic potentials (EPSPs) in neuronal dendrites and contribute to the medium afterhyperpolarization (mAHP) that follows the action potential bursts. Multiple brain regions, including the hippocampus, express the KCa 2.2 channel encoded by the KCNN2 gene on chromosome 5. Of particular interest, rat cerebellar Purkinje cells express KCa 2.2 channels, which are crucial for various cellular processes during development and maturation. Patients with a loss-of-function of KCNN2 mutations typically exhibit extrapyramidal symptoms, cerebellar ataxia, motor and language developmental delays, and intellectual disabilities. Studies have revealed that autosomal dominant neurodevelopmental movement disorders resembling rodent symptoms are caused by heterozygous loss-of-function mutations, which are most likely to induce KCNN2 haploinsufficiency. The KCa 2.2 channel is a promising drug target for spinocerebellar ataxias (SCAs). SCAs exhibit the dysregulation of firing in cerebellar Purkinje cells which is one of the first signs of pathology. Thus, selective KCa 2.2 modulators are promising potential therapeutics for SCAs.
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Affiliation(s)
- Mohammad Asikur Rahman
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Razan Orfali
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Nikita Dave
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Elyn Lam
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Nadeen Naguib
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Young-Woo Nam
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
| | - Miao Zhang
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California 92618, USA
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Chen S, Li S, Liu Y, She R, Jiang W. Spastic paraplegia is the main manifestation of a spinocerebellar ataxia type 8 lineage in China: a case report and review of literature. Front Hum Neurosci 2023; 17:1198309. [PMID: 37529405 PMCID: PMC10388100 DOI: 10.3389/fnhum.2023.1198309] [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: 04/01/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
The diagnosis and treatment of cerebellar atrophy remain challenging owing to its nonspecific symptoms and laboratory indicators. Three patients with spinocerebellar ataxia type 8 caused by ATXN8OS were found among the 16 people in the studied family. The clinical manifestations of the patients included progressive spastic paraplegia of the lower extremities, mild ataxia, mild cognitive impairment, and cerebellar atrophy. After administering antispasmodic rehabilitation treatment, using oral drugs, botulinum toxin injection, baclofen pump, and other systems in our hospital, the patients' lower extremity spasticity was significantly relieved. To our knowledge, till date, this is the first domestic report of spinocerebellar ataxia type 8 affecting a family, caused by ATXN8OS with spasticity onset in early childhood. Manifestations of the disease included spastic dyskinesia (in early disease stages) and cerebellar atrophy. Through systematic rehabilitation, the daily life of patients with this movement disorder was improved. This case report adds to the literature on spinocerebellar ataxia type 8 by summarizing its features.
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Cabeza-Ruiz R, Velázquez-Pérez L, Pérez-Rodríguez R, Reetz K. ConvNets for automatic detection of polyglutamine SCAs from brain MRIs: state of the art applications. Med Biol Eng Comput 2023; 61:1-24. [PMID: 36385616 DOI: 10.1007/s11517-022-02714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Polyglutamine spinocerebellar ataxias (polyQ SCAs) are a group of neurodegenerative diseases, clinically and genetically heterogeneous, characterized by loss of balance and motor coordination due to dysfunction of the cerebellum and its connections. The diagnosis of each type of polyQ SCA, alongside with genetic tests, includes medical images analysis, and its automation may help specialists to distinguish between each type. Convolutional neural networks (ConvNets or CNNs) have been recently used for medical image processing, with outstanding results. In this work, we present the main clinical and imaging features of polyglutamine SCAs, and the basics of CNNs. Finally, we review studies that have used this approach to automatically process brain medical images and may be applied to SCAs detection. We conclude by discussing the possible limitations and opportunities of using ConvNets for SCAs diagnose in the future.
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Affiliation(s)
| | - Luis Velázquez-Pérez
- Cuban Academy of Sciences, La Habana, Cuba
- Center for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba
| | - Roberto Pérez-Rodríguez
- CAD/CAM Study Center, University of Holguín, Holguín, Cuba
- Cuban Academy of Sciences, La Habana, Cuba
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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Sonakar AK, Shamim U, Srivastava MP, Faruq M, Srivastava AK. SCA2 in the Indian population: Unified haplotype and variable phenotypic patterns in a large case series. Parkinsonism Relat Disord 2021; 89:139-145. [PMID: 34298214 DOI: 10.1016/j.parkreldis.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinocerebellar ataxia-2 is one of the most prevalent SCA type across the world and one of the commonest in India. We aimed to characterize SCA2 patients both clinically and genetically (ATXN2-CAG repeats and its haplotypic background). METHODS A total of 436 SCA2 patients were recruited consecutively comprising individuals of multiple ethnicities and two large multigenerational families. A detailed clinical evaluation and genetic analysis for CAG repeat length estimation and two marker based haplotype analysis [rs695871 and rs695872 located 177 bp and 106 bp upstream of CAG sequence in Exon 1 of ATXN2] was performed. RESULTS Generalized limb ataxia and slow saccades were prevalent features in majority of our patients, while hyporeflexia and extrapyramidal features were less commonly observed manifestations. Slow ocular saccades, upper limb ataxia and tremor showed significant associations with age of onset, CAG repeat length and disease duration. We observed a 100% association of C-C haplotype with the expanded ATXN2 repeats. CONCLUSION This study represents the largest study of SCA2 Indian patients that highlights the clinico-genetic manifestations and haplotype analysis. A significant proportion of patients have not shown the characteristic slow saccades and hyporeflexia thus indicating the influences of other factors in modulation of the disease which warrants further investigations. The observation of CC haplotype in all our SCA2 patients indicates a common origin across all Indian sub populations and that also indicate a common global founder event in the past.
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Affiliation(s)
- Akhilesh K Sonakar
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Uzma Shamim
- Genomics and Molecular Medicine, CSIR - Institute of Genomics and Integrative Biology, Delhi, 110007, India
| | - Mv Padma Srivastava
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mohd Faruq
- Genomics and Molecular Medicine, CSIR - Institute of Genomics and Integrative Biology, Delhi, 110007, India.
| | - Achal K Srivastava
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Lin CW, Fan CH, Chang YC, Hsieh-Li HM. ERK activation precedes Purkinje cell loss in mice with Spinocerebellar ataxia type 17. Neurosci Lett 2020; 738:135337. [PMID: 32877710 DOI: 10.1016/j.neulet.2020.135337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022]
Abstract
Spinocerebellar ataxia type 17 (SCA17) is an autosomal dominant neurodegenerative disease caused by CAG expansion in the gene encoding the TATA-binding protein (TBP). The neurological features of SCA17 are Purkinje cell loss and gliosis. We have generated SCA17 transgenic mice which recapitulate the patients' phenotypes and are suitable for the study of the SCA17 pathomechanism. Our previous study identified the activation of mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) occurred in the SCA17 cerebella, this study aims to study the role of ERK activation in SCA17. The levels of pERK, calbindin, and gliosis markers on the mouse cerebellum at 4-8 weeks old were analyzed to elucidate the correlation among behavioral performance, ERK activation and Purkinje cell degeneration. The motor incoordination was initiated in SCA17 mice at 6 weeks old. We found that the presence of TBP nuclear aggregation and microglia activation were observed at 4 weeks old. Gliosis of astrocytes and Bergmann glia, pERK, Bax/Bcl2 ratio, and caspase-3 were significantly increased in the 6-week-old SCA17 mouse cerebellum. In addition to the polyglutamine-protein aggregation in Purkinje cells caused apoptosis cell-autonomously, a significant body of evidence have shown that ERK pathways involves in neuronal apoptosis. Our study showed that the activation of ERK in the astrocytes and Bergmann glia was identified as preceding motor deficits, which suggest the elevated gliosis by ERK activation may contribute to neuronal apoptosis in SCA17 mice.
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Affiliation(s)
- Chia-Wei Lin
- Department of Life Science, National Taiwan Normal University, Taiwan
| | - Chia-Hao Fan
- Department of Life Science, National Taiwan Normal University, Taiwan
| | - Ya-Chin Chang
- Department of Pharmacy, Taiwan Adventist Hospital, Taiwan
| | - Hsiu Mei Hsieh-Li
- Department of Life Science, National Taiwan Normal University, Taiwan.
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Leite CDMBA, Schieferdecker MEM, Frehner C, Munhoz RP, Ashizawa T, Teive HAG. Body composition in Spinocerebellar ataxia type 3 and 10 patients: Comparative study with control group. Nutr Neurosci 2020; 23:49-54. [PMID: 29734917 PMCID: PMC6996146 DOI: 10.1080/1028415x.2018.1469282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative genetic diseases characterized by movement disorders that can affect nutritional status and body composition. This study sought to assess body composition in SCA3 and SCA10 patients. Methods: Anthropometric assessments and bioelectric impedance analysis were performed in 46 SCA3 and SCA10 patients and 76 controls of both genders. Results: Of the patients, 69.6% had SCA3 and 58.7% were women. SCA3 patients had significantly lower percentages of body fat (%BF) than controls (15.0 ± 6.1 vs. 20.6 ± 7.1; p=0.014) and (22.4 ± 6.9 vs. 30.1 ± 6.0; p<0.001), respectively. Among the women, there was a statistically significant difference in %BF between SCA3 and SCA10 patients (22.4 ± 6.9 vs. 32.4 ± 4.9; p<0.001). Male and female SCA3 patients had significantly lower fat-free mass (FFM) than controls [50.6 kg (46.9-54.7) vs. 58.6 kg (52.6-63.9); p=0.001] and [38.2 kg (35.1-42.6) vs. 42.8 kg (39.7-46.1); p=0.004], respectively. Male SCA10 patients also had lower FFM than controls [51.2 kg (47.1-55.4) vs. (52.6-63.9); p=0.008]. Female SCA10 patients had significantly higher FFM than controls and SCA3 patients [45.0 kg (43.3-45.6) vs. 42.8 kg (39.7-46.1); p=0.004] and [45.0 kg (43.3-45.6) vs. 38.2 kg (35.1-42.6); p=0.004], respectively. There was moderate correlation (-0.42) between disease duration and muscle mass (MM), and weak (-0.38) between SARA (Scale for the Assessment and Rating of Ataxia) and MM in SCA3. In SCA10, there was no significant correlation between these variables. Conclusion: Female SCA3 patients had more body composition changes than female SCA10 patients, mainly in relation to FFM. SCA3 and SCA10 patients need nutritional follow-up to minimize body compartment changes.
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Affiliation(s)
| | | | - Caroline Frehner
- Multi-professional residence Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Renato P. Munhoz
- Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network, Toronto, Canada
| | - Tetsuo Ashizawa
- Neuroscience Research Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Hélio A. G. Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil
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Curcumin protects purkinje neurons, ameliorates motor function and reduces cerebellar atrophy in rat model of cerebellar ataxia induced by 3-AP. J Chem Neuroanat 2019; 102:101706. [DOI: 10.1016/j.jchemneu.2019.101706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 01/03/2023]
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9
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Catai LMP, Camargo CHF, Moro A, Ribas G, Raskin S, Teive HAG. Dystonia in Patients with Spinocerebellar Ataxia 3 - Machado-Joseph disease: An Underestimated Diagnosis? Open Neurol J 2018; 12:41-49. [PMID: 30008965 PMCID: PMC6008980 DOI: 10.2174/1874205x01812010041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 02/08/2023] Open
Abstract
Background Spinocerebellar Ataxia type 3 (SCA3) or Machado-Joseph Disease (MJD) is characterized by cerebellar, central and peripheral symptoms, including movement disorders. Dystonia can be classified as hereditary and neurodegenerative when present in SCA3. Objective The objective of this study was to evaluate the dystonia characteristics in patients with MJD. Method We identified all SCA3 patients with dystonia from the SCA3 HC-UFPR database, between December 2015 and December 2016.Their medical records were reviewed to verify the diagnosis of dystonia and obtain demographic and clinical data. Standardized evaluation was carried out through the classification of Movement Disorders Society of 2013 and Burke Fahn-Marsden scale (BFM). Results Amongst the presenting some common characteristics, 381 patients with SCA3, 14 (3.7%) subjects presented dystonia: 5 blepharospasm, 1 cervical dystonia, 3 oromandibular, 3 multifocal and 2 generalized dystonia. Regarding dystonia's subtypes, 71.4% had SCA3 subtype I and 28.6% SCA3 subtype II. The average age of the disease onset was 40±10.7 years; the SCA3 disease duration was 11.86± 6.13 years; the CAG repeat lengths ranged from 75 to 78, and the BFM scores ranged from 1.0 to 40. There was no correlation between the dystonia severity and CAG repeat lengths or the SCA3 clinical evolution. Conclusion Dystonia in SCA3 is frequent and displays highly variable clinical profiles and severity grades. Dystonia is therefore a present symptom in SCA3, which may precede the SCA3 classic symptoms. Dystonia diagnosis is yet to be properly recognized within SCA3 patient.
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Affiliation(s)
- Ligia Maria Perrucci Catai
- Botulinum Toxin Unit, Hospital Universitário, State University of Ponta Grossa, Ponta Grossa, Brazil.,Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Adriana Moro
- Paraná Association for Parkinson's Disease, Curitiba, Brazil
| | - Gustavo Ribas
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Salmo Raskin
- Group for Advanced Molecular Investigation, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Genetika-Centro de Aconselhamento e Laboratório de Genética, Curitiba, Brazil
| | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Kang SL, Shaikh AG, Ghasia FF. Vergence and Strabismus in Neurodegenerative Disorders. Front Neurol 2018; 9:299. [PMID: 29867716 PMCID: PMC5964131 DOI: 10.3389/fneur.2018.00299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/18/2018] [Indexed: 01/03/2023] Open
Abstract
Maintaining proper eye alignment is necessary to generate a cohesive visual image. This involves the coordination of complex neural networks, which can become impaired by various neurodegenerative diseases. When the vergence system is affected, this can result in strabismus and disorienting diplopia. While previous studies have detailed the effect of these disorders on other eye movements, such as saccades, relatively little is known about strabismus. Here, we focus on the prevalence, clinical characteristics, and treatment of strabismus and disorders of vergence in Parkinson’s disease, spinocerebellar ataxia, Huntington disease, and multiple system atrophy. We find that vergence abnormalities may be more common in these disorders than previously thought. In Parkinson’s disease, the evidence suggests that strabismus is related to convergence insufficiency; however, it is responsive to dopamine replacement therapy and can, therefore, fluctuate with medication “on” and “off” periods throughout the day. Diplopia is also established as a side effect of deep brain stimulation and is thought to be related to stimulation of the subthalamic nucleus and extraocular motor nucleus among other structures. In regards to the spinocerebellar ataxias, oculomotor symptoms are common in many subtypes, but diplopia is most common in SCA3 also known as Machado–Joseph disease. Ophthalmoplegia and vergence insufficiency have both been implicated in strabismus in these patients, but cannot fully explain the properties of the strabismus, suggesting the involvement of other structures as well. Strabismus has not been reported as a common finding in Huntington disease or atypical parkinsonian syndromes and more studies are needed to determine how these disorders affect binocular alignment.
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Affiliation(s)
- Sarah L Kang
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Aasef G Shaikh
- Case Western Reserve University School of Medicine, Cleveland, OH, United States.,Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Fatema F Ghasia
- Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States.,Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
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Resveratrol Protects Purkinje Neurons and Restores Muscle Activity in Rat Model of Cerebellar Ataxia. J Mol Neurosci 2018; 65:35-42. [DOI: 10.1007/s12031-018-1065-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/11/2018] [Indexed: 11/25/2022]
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12
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Stem Cell-Based Therapies for Polyglutamine Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1049:439-466. [DOI: 10.1007/978-3-319-71779-1_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Santos G, Zeigelboim DBS, Severiano M, Teive H, Liberalesso P, Marques J, Cordeiro M. Feasibility of virtual reality-based balance rehabilitation in adults with spinocerebellar ataxia: a prospective observational study. HEARING, BALANCE AND COMMUNICATION 2017. [DOI: 10.1080/21695717.2017.1381490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Geslaine Santos
- Instituto Federal de Educacao Ciencia e Tecnologia do Parana, Curitiba, Brazil
| | | | - Maria Severiano
- Instituto Federal de Educacao Ciencia e Tecnologia do Parana, Curitiba, Brazil
| | - Hélio Teive
- Department of Neurology, Universidade Federal do Parana, Curitiba, Brazil
| | | | - Jair Marques
- Department of Otoneurology, Universidade Tuiuti do Parana, Curitiba, Brazil
| | - Mara Cordeiro
- Instituto de Pesquisa Pele Pequeno Principe, Curitiba, Brazil
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Abstract
Background Cognitive and psychiatric dysfunction has been described in several
neurodegenerative diseases but has not been systematically evaluated in
spinocerebellar ataxia type 10 (SCA10). Objective The aim of the present study was to investigate the core cognitive features
in a large cohort of Brazilian patients with SCA10, comparing the results
against a healthy control group. Methods Twenty-eight SCA10 and 28 healthy subjects were prospectively assessed
regarding cognitive function and psychiatric disorders at the Movement
Disorders Unit of the Federal University of Paraná between February
2012 and October 2014. Results The SCA10 group had worse depression scores, as well as cognitive
performance, when compared to healthy individuals. Conclusion Our study showed mild cognitive and mood dysfunctions in patients with SCA10,
consistent with the symptoms reported in the Cerebellar Cognitive Affective
Syndrome described by Schmahmann JD in 1998. The description of these
findings is an important clinical phenomenon that may guide physicians in
specific disease management and improve quality of life of these
patients.
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Affiliation(s)
- Adriana Moro
- PhD, Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Curitiba, PR, Brazil
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15
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Teive HAG, Moro A, Arruda WO, Raskin S, Teive GMG, Dallabrida N, Munhoz RP. Itajaí, Santa Catarina - Azorean ancestry and spinocerebellar ataxia type 3. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:858-860. [PMID: 27759814 DOI: 10.1590/0004-282x20160125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/13/2016] [Indexed: 11/22/2022]
Abstract
The authors present a historical review of spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD), the most common form of spinocerebellar ataxia in Brazil, and consider the high frequency of cases in families from Itajaí, a city on the coast of the state of Santa Catarina with a large population of Portuguese/Azorean descent.
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Affiliation(s)
- Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brasil
| | - Adriana Moro
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brasil
| | - Walter O Arruda
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Distúrbios do Movimento, Curitiba PR, Brasil
| | | | - Gladys M G Teive
- Universidade Estadual de Santa Catarina, Centro de Ciências Humanas e Educação, Florianópolis SC, Brasil
| | | | - Renato P Munhoz
- University of Toronto, Toronto Western Hospital, Movement Disorders Centre, Ontário ON, Canada
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16
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Rueda AD, Pedroso JL, Truksinas E, Do Prado GF, Coelho FM, Barsottini OG. Polysomnography findings in spinocerebellar ataxia type 6. J Sleep Res 2016; 25:720-723. [PMID: 27377205 DOI: 10.1111/jsr.12439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
Spinocerebellar ataxia type 6 (SCA6) is usually described as a pure ataxia syndrome. However, SCA6 patients may have sleep complaints. In this paper, sleep disorders were investigated in patients with SCA6. Twelve SCA6 patients and 12 subjects matched by gender, age and body mass index (control group) underwent polysomnography and clinical investigation for sleep disorders. SCA6 had a higher frequency of snoring (P = 0.01), a higher index of awakening due to respiratory events (P = 0.003) and central apnea events during sleep (P = 0.024), a longer sleep Stage N1 (P = 0.02) and a lower sleep Stage N3 (P = 0.05) in SCA6 patients than in control subjects. SCA6 patients had a reduction in slow wave sleep and a higher frequency of snoring and respiratory disorders during sleep when compared to the control group.
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Affiliation(s)
- Adriana D Rueda
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José L Pedroso
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eveli Truksinas
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gilmar F Do Prado
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernando M Coelho
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Orlando G Barsottini
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, Brazil
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Pulido-Valdeolivas I, Gómez-Andrés D, Sanz-Gallego I, Rausell E, Arpa J. Patterns of motor signs in spinocerebellar ataxia type 3 at the start of follow-up in a reference unit. CEREBELLUM & ATAXIAS 2016; 3:4. [PMID: 26909158 PMCID: PMC4763420 DOI: 10.1186/s40673-016-0042-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/23/2016] [Indexed: 12/19/2022]
Abstract
Background Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disorder that affects the cerebellar system and other subcortical regions of the brain. As for other cerebellar diseases, the severity of this type of ataxia can be assessed with the Scale for Assessment and Rating of Ataxia (SARA) which gives a total score that reflects functional impairment out of 8 cerebellar function tests. SCA3 patients score profile is heterogeneous on at the start of follow up. This study investigates possible patterns in those profiles and analyses the impact of other usually concurrent signs of impairment of extracerebellar motor systems in that profile variability by means of multivariate statistical approaches. Methods Seventeen patients with SCA3 underwent systematic anamnesis, neurological and SARA assessment, visual evaluation of 123I-Ioflupane (DaTSCAN) single-photon emission computed tomography (SPECT) imaging and electrophysiological studies (nerve conduction and electromyography). Patterns in the profiles of SARA item scores were investigated by hierarchical clustering after multivariate correspondence analysis. A network analysis was used to represent relationships between SARA item scores, clinical, genetic and neurological examination parameters as well as abnormalities of DaTSCAN SPECT imaging and electrophysiological studies. Results The most frequently altered SARA items in all patients are gait and stance, and three profiles of SCA3 patients can be distinguished depending mainly on their degree of impairment in those two items. Other SARA items like the score on heel-shin slide contribute less to the classification. Network analysis shows that SARA item scores configure a single domain that is independent of the size of the mutated expanded allele and age of onset, which are, in turn closely and inversely correlated. The severity of cerebellar dysfunction is correlated with longer disease duration, altered visual evaluation of DaTSCAN SPECT imaging and decreased patellar reflexes. Neither the presence of pyramidal or extrapyramidal signs nor the intensity of polyneuropathy is correlated with the SARA items scores. Conclusions Pattern recognition approaches are useful tools to describe clinical phenotypes of ataxias and to identify particular configurations of cerebellar signs. Electronic supplementary material The online version of this article (doi:10.1186/s40673-016-0042-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irene Pulido-Valdeolivas
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain ; Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - David Gómez-Andrés
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain ; Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Estrella Rausell
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain ; Trastornos del Desarrollo y Maduración Neurológica (TRADESMA), IdiPaz-UAM, Madrid, Spain
| | - Javier Arpa
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain
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Zeigelboim BS, de Carvalho HAS, Teive HAG, Liberalesso PBN, Jurkiewicz AL, da Silva Abdulmassih EM, Marques JM, Cordeiro ML. Central auditory processing in patients with spinocerebellar ataxia. Hear Res 2015; 327:235-44. [PMID: 26183435 DOI: 10.1016/j.heares.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autosomal dominant spinocerebellar ataxias (SCAs) are a group of rare and heterogeneous neurodegenerative diseases characterized by the presence of progressive cerebellar ataxia. Although the symptomatology of SCAs is well known, information regarding central auditory functioning in these patients is lacking. Therefore, we assessed the central auditory processing disorders (CAPD) in patients with different subtypes of SCA. METHODS In a retrospective cross-sectional study, we subjected 43 patients with SCAs to otorhinolaryngological, audiological, Brainstem Auditory Evoked Potential (BAEP) and acoustic immittance evaluations as well as CAPD tests, namely the Standard Spondaic Word (SSW) and the Random Gap Detection Test (RGDT). RESULTS Most patients (83.7%) reported an imbalance when walking; many reported difficulty speaking (48.8%), dizziness (41.8%), and dysphagia (39.5%). In the audiometric test, 14/43 patients (32.5%) presented alterations, including 4/12 patients with SCA3 (33.3%), 1/8 patients with SCA2 (12.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 3/6 patients with SCA10 (50%), and 3/14 patients with an undetermined type of SCA (21.4%). In the BAEP test, 20/43 patients (46.5%) presented alterations (11.6% na orelha esquerda e 34.9% bilateralmente), including 7/12 patients with SCA3 (58.3%), 5/8 patients with SCA2 (62.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 4/6 patients with SCA10 (66.7%), and 2/14 patients with an undetermined type of SCA (14.2%). In the SSW, 22/40 patients (55%) presented alterations (2.5% in the right ear, 15% in the left ear, and 37.5% bilaterally), including 6/10 patients (60%) with SCA3, 3/8 (37.5%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 8/14 (57.1%) with an undetermined type SCA. For the RGDT, 30/40 patients (75%) presented alterations, including 8/10 (80%) with SCA3, 6/8 (75%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 9/14 (64.3%) with an undetermined type of SCA. In immittance testing, 19/43 patients (44.1%) presented alterations, including 6/12 (50%) with SCA3, 4/8 (50%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 2/6 (33.3%) with SCA10, and 4/14 (28.6%) with an undetermined type of SCA. CONCLUSIONS A majority of patients exhibited SSW test deficits, with a predominance of bilateralism, and three-fourths had impaired RGDT performance, pointing to difficulties with binaural integration and temporal resolution. Assessment of CAPD is important for therapeutic follow ups in patients with SCA.
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Affiliation(s)
| | | | - Hélio Afonso Ghizoni Teive
- Neurology Service, Department of Clinical Medical, Clinical Hospital, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | - Mara Lúcia Cordeiro
- Neurosciences Research Group, Pelé Little Prince Research Institute, Curitiba, Brazil; Faculdades Little Prince, Curitiba, Brazil; Department of Psychiatry and Biobehavioral Sciences of the David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
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Chen JW, Zhao L, Zhang F, Li L, Gu YH, Zhou JY, Zhang H, Meng M, Zhang KH, Le WD, Dong CB. Clinical Characteristics, Radiological Features and Gene Mutation in 10 Chinese Families with Spinocerebellar Ataxias. Chin Med J (Engl) 2015; 128:1714-23. [PMID: 26112709 PMCID: PMC4733707 DOI: 10.4103/0366-6999.159340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs. Methods: In this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado–Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed. Results: We found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset. Conclusions: Collectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chun-Bo Dong
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
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Parkinsonism in spinocerebellar ataxia. BIOMED RESEARCH INTERNATIONAL 2015; 2015:125273. [PMID: 25866756 PMCID: PMC4383270 DOI: 10.1155/2015/125273] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/29/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
Spinocerebellar ataxia (SCA) presents heterogeneous clinical phenotypes, and parkinsonism is reported in diverse SCA subtypes. Both levodopa responsive Parkinson disease (PD) like phenotype and atypical parkinsonism have been described especially in SCA2, SCA3, and SCA17 with geographic differences in prevalence. SCA2 is the most frequently reported subtype of SCA related to parkinsonism worldwide. Parkinsonism in SCA2 has unique genetic characteristics, such as low number of expansions and interrupted structures, which may explain the sporadic cases with low penetrance. Parkinsonism in SCA17 is more remarkable in Asian populations especially in Korea. In addition, an unclear cutoff of the pathologic range is the key issue in SCA17 related parkinsonism. SCA3 is more common in western cohorts. SCA6 and SCA8 have also been reported with a PD-like phenotype. Herein, we reviewed the epidemiologic, clinical, genetic, and pathologic features of parkinsonism in SCAs.
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Moro A, Munhoz RP, Arruda WO, Raskin S, Moscovich M, Teive HAG. Spinocerebellar ataxia type 3: subphenotypes in a cohort of Brazilian patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 72:659-62. [PMID: 25252228 DOI: 10.1590/0004-282x20140129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/08/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED Spinocerebellar ataxia type 3 (SCA3) involves cerebellar, pyramidal, extrapyramidal, motor neuron and oculomotor systems with strong phenotypic heterogeneity, that lead us to classify the disorder into different clinical subtypes according to the predominantly affected motor systems. METHOD The series comprises 167 SCA3 patients belonging to 68 pedigrees, studied from 1989-2013. These patients were categorized into seven different subphenotypes. RESULTS SCA3 cases were clustered according to the predominant clinical features. Three most common forms were subphenotype 2, characterized by ataxia and pyramidal symptom was observed in 67.5%, subphenotype 3 with ataxia and peripheral signs in 13.3%, and subphenotype 6 with pure cerebellar syndrome in 7.2%. CONCLUSION Our study was the first to systematically classify SCA3 into seven subphenotypes. This classification may be particularly useful for determination of a more specific and direct phenotype/genotype correlation in future studies.
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Affiliation(s)
- Adriana Moro
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Renato P Munhoz
- Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Walter O Arruda
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Mariana Moscovich
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Hélio A G Teive
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Subramony S, Moscovich M, Ashizawa T. Genetics and Clinical Features of Inherited Ataxias. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Albuquerque MVCD, Pedroso JL, Braga Neto P, Barsottini OGP. Phenotype variability and early onset ataxia symptoms in spinocerebellar ataxia type 7: comparison and correlation with other spinocerebellar ataxias. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:18-21. [DOI: 10.1590/0004-282x20140192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022]
Abstract
The spinocerebellar ataxias (SCA) are a group of neurodegenerative disorders characterized by heterogeneous clinical presentation. Spinocerebellar ataxia type 7 (SCA7) is caused by an abnormal CAG repeat expansion and includes cerebellar signs associated with visual loss and ophthalmoplegia. Marked anticipation and dynamic mutation is observed in SCA7. Moreover, phenotype variability and very early onset of symptoms may occur. In this article, a large series of Brazilian patients with different SCA subtypes was evaluated, and we compared the age of onset of SCA7 with other SCA. From the 26 patients with SCA7, 4 manifested their symptoms before 10-year-old. Also, occasionally the parents may have the onset of symptoms after their children. In conclusion, our study highlights the genetic anticipation phenomenon that occurs in SCA7 families. Patients with very early onset ataxia in the context of a remarkable family history, must be considered and tested for SCA7.
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Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Federal de São Paulo, Brazil; Universidade Estadual do Ceará, Brazil
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Moro A, Munhoz RP, Moscovich M, Arruda WO, Raskin S, Teive HAG. Movement disorders in spinocerebellar ataxias in a cohort of Brazilian patients. Eur Neurol 2014; 72:360-2. [PMID: 25322786 DOI: 10.1159/000365285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Movement disorders (MDs) are well recognized in all subtypes of spinocerebellar ataxias (SCA), but phenomenology and frequency vary widely. METHODS Three hundred seventy-eight patients, from 169 Brazilian families, with SCAs were assessed with neurological examination and molecular genetic testing. RESULTS Dystonia was the most common movement disorder, found in 5.5% of all patients, particularly in SCA3. We observed Parkinsonian features in 6.6% of SCA3 patients, and myoclonus in two patients of our cohort. CONCLUSIONS Our study demonstrated that MDs are major extracerebellar manifestations of SCA. The observed phenotypes in addition to ataxia may provide significant clues for a particular SCA genotype.
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Affiliation(s)
- Adriana Moro
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba PR, Brazil
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26
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Li J, Hu X, Chen Q, Zhang Y, Zhang Y, Hu G. A Chinese Benign Adult Familial Myoclonic Epilepsy Pedigree Suggesting Linkage to Chromosome 5p15.31–p15.1. Cell Biochem Biophys 2014; 69:627-31. [DOI: 10.1007/s12013-014-9843-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martins CP, Rodrigues EDC, Oliveira LASD. Abordagem fisioterapêutica da ataxia espinocerebelar: uma revisão sistemática. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000300015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A ataxia espinocerebelar (SCA) é uma afecção hereditária que cursa com a degeneração progressiva do cerebelo e suas vias, causando alterações do equilíbrio e de outras funções. O efeito das abordagens da fisioterapia no tratamento da SCA e a qualidade metodológica desses estudos foram analisados. Foi investigado ainda se os benefícios alcançados com o tratamento são retidos. As intervenções encontradas incluem treino do equilíbrio, marcha e coordenação; fortalecimento; caneleiras nos membros durante exercícios e aplicação de estimulação magnética transcraniana. A retenção das melhoras obtidas com o tratamento foi relacionada ao grau de evolução da SCA e à continuidade da prática de exercícios. Porém, novos estudos com maior rigor científico são necessários para eleger as abordagens mais adequadas para o tratamento de portadores de SCA.
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Zeigelboim BS, Teive HAG, Santos RS, Arruda WO, Jurkiewicz AL, Mengelberg H, França D, Marques JM. Audiological evaluation in spinocerebellar ataxia. Codas 2013; 25:351-7. [PMID: 24413425 DOI: 10.1590/s2317-17822013005000001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/06/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe the audiological and electrophysiological results in patients with spinocerebellar ataxia (SCA). METHODS Retrospective and cross-sectional studies were performed. Forty-three patients were assessed using the following procedures: anamnesis and otolaryngologic exam, pure tone audiometry, acoustic immittance measures and brainstem auditory evoked potential (BAEP). RESULTS Patients showed gait abnormality (83.7%), speech disorder (48.8%), dizziness (41.8%) and dysphagia (39.5%). Hearing loss was referred in 27.9% of the cases; in the audiometric exams, 14 patients (32.5%) presented disorders; in SCA 3, 33.3%; in SCA 2, 12.5%; in SCA 4, 100.0%; in SCA 6, 100.0%; in SCA 7, 100.0%; in SCA 10, 50.0%; and in undetermined SCA, 21.4%. In BAEP, 20 patients (46.5%) were abnormal, being 58.3% in SCA 3, 62.5% in SCA 2, 100.0% in SCA 6, 100.0% in SCA 7, 66.7% in SCA 10 and 14.2% in undetermined SCA. While in acoustic immittance, 19 patients (44.1%) presented disorders, being 50.0% in SCA 3, 50.0% in SCA 2, 100.0% in SCA 4, 100.0% in SCA 6, 100.0% in SCA 7, 33.3% in SCA 10 and 28.5% in undetermined SCA. CONCLUSION The most evident abnormalities in the audiological evaluation were the predominance of the down-sloping audiometric configuration beginning at 4 kHz bilaterally and the bilateral absence of acoustic reflex at the frequencies of 3 and 4 kHz. In the electrophysiological evaluation, 50% of the patients showed abnormalities with prevalence of an increase of the latency of waves I, II and V and of the interval in the interpeaks I-III, I-V and III-V.
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Zeigelboim BS, Souza SDD, Mengelberg H, Teive HAG, Liberalesso PBN. Reabilitação vestibular com realidade virtual na ataxia espinocerebelar. AUDIOLOGY: COMMUNICATION RESEARCH 2013. [DOI: 10.1590/s2317-64312013000200013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo do estudo foi verificar os benefícios da reabilitação vestibular (RV) com realidade virtual, por meio de avaliação pré e pós-aplicação da Escala de Equilíbrio de Berg (EEB), em quatro casos de ataxia espinocerebelar (AEC). Os casos foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular e aplicação da EEB pré e pós-RV, com a realidade virtual representada por meio da utilização de jogos do equipamento Wii Fit. Os casos retratam quatro pacientes com diagnóstico genético de AEC (dois tipo 2, um tipo 3 e um em investigação), sendo três do gênero feminino e um do gênero masculino, na faixa etária de 30 a 62 anos. Os pacientes referiram sintomas otoneurológicos e, no exame vestibular, observou-se a presença de nistagmo semiespontâneo com características centrais, ausência de nistagmo pós-rotatório, hiporreflexia e preponderância direcional do nistagmo assimétrica à prova calórica. Nos casos 1 e 2, os pacientes referiram melhora na coordenação dos movimentos e do equilíbrio corporal, independente do escore na EEB ter demonstrado médio risco para queda, antes e após a realização dos exercícios. No caso 3, o paciente apresentou melhora do escore na EEB, bem como do equilíbrio, apresentando baixo risco para queda. O caso 4 não evidenciou melhora na avaliação após a execução dos exercícios. Este estudo de caso demonstrou a possibilidade da aplicação dos exercícios de RV com estímulos virtuais na AEC, com melhora da coordenação motora e do equilíbrio postural.
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Magaña JJ, Velázquez-Pérez L, Cisneros B. Spinocerebellar ataxia type 2: clinical presentation, molecular mechanisms, and therapeutic perspectives. Mol Neurobiol 2012; 47:90-104. [PMID: 22996397 DOI: 10.1007/s12035-012-8348-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/05/2012] [Indexed: 12/13/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant genetic disease characterized by cerebellar dysfunction associated with slow saccades, early hyporeflexia, severe tremor of postural or action type, peripheral neuropathy, cognitive disorders, and other multisystemic features. SCA2, one of the most common ataxias worldwide, is caused by the expansion of a CAG triplet repeat located in the N-terminal coding region of the ATXN2 gene, which results in the incorporation of a segment of polyglutamines in the mutant protein, being longer expansions associated with earlier onset and more sever disease in subsequent generations. In this review, we offer a detailed description of the clinical manifestations of SCA2 and compile the experimental evidence showing the participation of ataxin-2 in crucial cellular processes, including messenger RNA maturation and translation, and endocytosis. In addition, we discuss in the light of present data the potential molecular mechanisms underlying SCA2 pathogenesis. The mutant protein exhibits a toxic gain of function that is mainly attributed to the generation of neuronal inclusions of phosphorylated and/or proteolytic cleaved mutant ataxin-2, which might alter normal ataxin-2 function, leading to cell dysfunction and death of target cells. In the final part of this review, we discuss the perspectives of development of therapeutic strategies for SCA2. Based on previous experience with other polyglutamine disorders and considering the molecular basis of SCA2 pathogenesis, a nuclei-acid-based strategy focused on the specific silencing of the dominant disease allele that preserves the expression of the wild-type allele is highly desirable and might prevent toxic neurodegenerative sequelae.
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Affiliation(s)
- J J Magaña
- Department of Genetics, National Rehabilitation Institute (INR), Mexico City, Mexico
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Pikkarainen M, Hartikainen P, Soininen H, Alafuzoff I. Distribution and pattern of pathology in subjects with familial or sporadic late-onset cerebellar ataxia as assessed by p62/sequestosome immunohistochemistry. THE CEREBELLUM 2012; 10:720-31. [PMID: 21544590 DOI: 10.1007/s12311-011-0281-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We investigated whether ubiquitin-binding protein p62/sequestosome-1 could be utilized to evaluate the pathology seen in patients with a clinical diagnosis of progressive late-onset cerebellar ataxia (LOCA). p62-immunoreactive (IR) lesions were assessed by means of immunohistochemistry in the brains of six LOCA cases, one with the spinocerebellar ataxia type 1 mutation (SCA1), ages at death ranging from 46 to 56 years. All cases fulfilled the criteria of olivopontocerebellar atrophy (OPCA), i.e., displaying cell loss in the predilection brain areas. One case, genetics unknown, exhibited p62-IR neuronal intranuclear inclusions (NIs). Similar NIs were labeled with the 1C2 antibody that recognizes proteins containing large polyglutamine stretches. In this case, also fused in sarcoma-IR NIs were seen. In the remaining LOCA cases, including the case with the SCA1 mutation, different kinds of nuclear and cytoplasmic p62 and 1C2 labeling but no NIs were seen. The immunoreactivity and distribution of lesions while applying p62 and 1C2 immunohistochemistry varied in our six LOCA cases fulfilling the criteria of OPCA. In all cases except in the SCA1, diffuse nuclear p62 labeling was seen, not previously reported in SCA or other neurodegenerative disorders. Due to the variability noted here as well as the limited number of cases, no assessment of progression and distributional pattern of pathology could be conducted. Based on a literature search, it is apparent that there is a need for clinico-pathologic-genetical studies of LOCA, especially to obtain a deeper understanding of the regional distribution and progression of pathology.
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Affiliation(s)
- Maria Pikkarainen
- Department of Clinical Medicine, Unit of Neurology, University of Eastern Finland, Kuopio, Finland
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A newly identified locus for benign adult familial myoclonic epilepsy on chromosome 3q26.32-3q28. Eur J Hum Genet 2012; 21:225-8. [PMID: 22713812 DOI: 10.1038/ejhg.2012.133] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Benign Adult Familial Myoclonic Epilepsy (BAFME) is an autosomal dominant disorder characterized by adult-onset cortical tremor or action myoclonus predominantly in the upper limbs, and generalized seizures. We investigated a Thai BAFME family. Clinical and electrophysiological studies revealed that 13 were affected with BAFME. There were a total of 24 individuals studied. Genetic analysis by genome-wide linkage study (GWLS) was performed using 400 microsatellite markers and excluded linkage of the previous BAFME loci, 8q23.3-q24.1, and 2p11.1-q12.2. GWLS showed that the disease-associated region in our Thai family was linked to a newly identified locus on chromosome 3q26.32-3q28. This locus represents the fourth chromosomal region for BAFME.
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Ouyang Y, He Z, Li L, Qin X, Zhao Y, Yuan L. Spinocerebellar ataxia type 31 exists in northeast China. J Neurol Sci 2012; 316:164-7. [PMID: 22353852 DOI: 10.1016/j.jns.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Spinocerebellar ataxia type 31 (SCA31), is a recently defined subtype of autosomal dominant cerebellar ataxia (ADCA) characterized by late-onset pure cerebellar ataxia. SCA31 is common in Japan but whether or not it exists in other countries is still unclear. In this study, the authors describe a sporadic Chinese patient with SCA31. Although the cardinal clinical features, i.e., late-onset cerebellar ataxia and hearing impairment in our sporadic patient were similar to those described previously in Japan, mild axonal sensorimotor neuropathy was identified in our SCA31 patient, which is somewhat distinct from most prior reports of the disease. This is the first report of SCA31 in China; thus, extending the ethnic association beyond families of Japanese origin. In addition, our study suggests that the clinical features of SCA31 might be broader than previously thought.
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Affiliation(s)
- Yi Ouyang
- Department of Neurology, First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
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Zeigelboim BS, Dumke C, Klagenberg KF, Mengelberg H. [Spinocerebellar ataxia type 7]. ACTA ACUST UNITED AC 2012; 23:183-6. [PMID: 21829936 DOI: 10.1590/s2179-64912011000200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 05/04/2011] [Indexed: 11/22/2022]
Abstract
The aim of this study was to verify the possible alterations observed in a case of spinocerebellar ataxia type 7. The patient was referred to the Laboratory of Neurotology of Universidade Tuiuti do Paraná (Brazil), and was submitted to the following procedures: anamnesis, otoscopy, auditory and vestibular assessments. The case described is a 34-year-old woman with a genetic diagnosis of spinocerebellar ataxia type 7, who referred imbalance when walking, speech difficulties, headache, dizziness, and dysphagia. The audiological evaluation showed normal hearing thresholds and tympanometric curve type "A", with bilateral presence of stapedius reflex. In the vestibular evaluation, it was observed the presence of spontaneous and gaze nystagmus with central characteristics, altered optokinetic nystagmus and pendular tracking, and hyperreflexia during the caloric test. Labyrinth alterations were found, indicating central vestibular system affection and evidencing the importance of this evaluation. The existence of a possible relationship between the findings and the neurotological symptoms presented by the patient leads us to a new issue, that is, the importance of the applicability of rehabilitation exercises that act in central structures of neuroplasticity. These exercises accelerate and stimulate natural compensation mechanisms, which may provide the patient with ataxia a better performance of its functions.
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Affiliation(s)
- Bianca Simone Zeigelboim
- Curso de Fonoaudiologia e Programa de Pós-graduação em Distúrbios da Comunicação, Universidade Tuiuti do Paraná – UTP – Curitiba (PR), Brasil.
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Teive HAG, Munhoz RP, Arruda WO, Lopes-Cendes I, Raskin S, Werneck LC, Ashizawa T. Spinocerebellar ataxias: genotype-phenotype correlations in 104 Brazilian families. Clinics (Sao Paulo) 2012; 67:443-9. [PMID: 22666787 PMCID: PMC3351252 DOI: 10.6061/clinics/2012(05)07] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/16/2012] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Spinocerebellar ataxias are neurodegenerative disorders involving the cerebellum and its connections. There are more than 30 distinct subtypes, 16 of which are associated with an identified gene. The aim of the current study was to evaluate a large group of patients from 104 Brazilian families with spinocerebellar ataxias. METHODS We studied 150 patients from 104 families with spinocerebellar ataxias who had received molecular genetic testing for spinocerebellar ataxia types 1, 2, 3, 6, 7, 8, 10, 12, 17, and dentatorubral-pallidoluysian atrophy. A statistical analysis of the results was performed using basic descriptive statistics and the correlation coefficient (r), Student's t-test, chi-square test, and Yates' correction. The statistical significance level was established for p-values <0.05. RESULTS The results show that the most common subtype was spinocerebellar ataxia 3, which was followed by spinocerebellar ataxia 10. Moreover, the comparison between patients with spinocerebellar ataxia 3, spinocerebellar ataxia 10, and other types of spinocerebellar ataxia revealed distinct clinical features for each type. In patients with spinocerebellar ataxia 3, the phenotype was highly pleomorphic, although the most common signs of disease included cerebellar ataxia (CA), ophthalmoplegia, diplopia, eyelid retraction, facial fasciculation, pyramidal signs, and peripheral neuropathy. In patients with spinocerebellar ataxia 10, the phenotype was also rather distinct and consisted of pure cerebellar ataxia and abnormal saccadic eye movement as well as ocular dysmetria. Patients with spinocerebellar ataxias 2 and 7 presented highly suggestive features of cerebellar ataxia, including slow saccadic ocular movements and areflexia in spinocerebellar ataxia 2 and visual loss in spinocerebellar ataxia 7. CONCLUSIONS Spinocerebellar ataxia 3 was the most common subtype examined, followed by spinocerebellar ataxia 10. Patients with spinocerebellar ataxia 2 and 7 demonstrated highly suggestive features, whereas the phenotype of spinocerebellar ataxia 3 patients was highly pleomorphic and spinocerebellar ataxia 10 patients exhibited pure cerebellar ataxia. Epilepsy was absent in all of the patients with spinocerebellar ataxia 10 in this series.
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Affiliation(s)
- Hélio A G Teive
- Hospital de Clínicas, Federal University of Paraná, Internal Medicine Department, Neurology Service, Movement Disorders Unit, Curitiba/PR, Brazil.
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Zeigelboim BS, Teive HA, Sampaio R, Jurkiewicz AL, Liberalesso PB. Electronystagmography findings in spinocerebellar ataxia type 3 (SCA3) and type 2 (SCA2). ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:760-5. [PMID: 22042177 DOI: 10.1590/s0004-282x2011000600007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/13/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To describe the alterations observed in electronystagmography (ENG) of patients with spinocerebellar ataxia (SCA) types 2 and 3. METHOD: Sixteen patients were studied and the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluations. RESULTS: The clinical findings in the entire group of patients were: gait disturbances (93.75%), dysarthria (43.75%), headache (43.75%), dizziness (37.50%) and dysphagia (37.50%). In the vestibular exam, the rotatory (62.50%) and caloric (75%) tests were among those which presented the largest indexes of abnormalities; the presence of alterations in the exams was 87.50%, with a predominance of central vestibular disorders in 68.75% of the exams. CONCLUSION: Vestibular exams could be an auxiliary tool to investigate SCAs, besides a precise clinical approach and, particularly, molecular genetic tests.
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Affiliation(s)
| | | | - Rosane Sampaio
- Tuiuti University of Paraná, Brazil; Federal University of Paraná, Brazil
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Zhang MJ, Sun JJ, Qian L, Liu Z, Zhang Z, Cao W, Li W, Xu Y. Human umbilical mesenchymal stem cells enhance the expression of neurotrophic factors and protect ataxic mice. Brain Res 2011; 1402:122-31. [PMID: 21683345 DOI: 10.1016/j.brainres.2011.05.055] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/23/2011] [Accepted: 05/24/2011] [Indexed: 12/11/2022]
Abstract
Cerebellar ataxias, which comprise a wide spectrum of progressive disorders, are incurable at present. It has been reported that human umbilical mesenchymal stem cell (HU-MSC) transplantation has a protective effect on neurodegenerative diseases. In this study, we investigated the effect of HU-MSCs on ataxic mice induced by cytosine beta-D-arabinofuranoside (Ara-C). The ataxic mouse received an intravenous injection of 2×10(6) HU-MSCs once a week for three consecutive weeks. Neurological function was scored weekly by rotarod test and open field test. The mouse cerebellar volume and weight were also measured. The apoptotic cells, pathological alternations and distribution of HU-MSCs were determined by TUNEL assay and immunohistochemistry staining respectively. Double immunostaining was carried out to investigate the dynamics of HU-MSCs in the host animals. Neurotrophic factors in cerebellar tissue and serum were measured by Q-PCR and ELISA. Our results showed that HU-MSCs implantation significantly improved the motor skills of ataxic mice 8 weeks after application. HU-MSCs also alleviated cerebellar atrophy and decreased the number of apoptotic cells in the therapeutic group. Implanted HU-MSCs stayed in cerebellum for at least three months with no obvious differentiation. HU-MSC treated mice had enhanced expression of insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) in cerebellum extraction and blood serum. Double immunostaining revealed that a few MAB1287 positive cells co-localized with IGF-1 or VEGF express cells. Our results suggest that HU-MSC treatment is capable of alleviating the motor impairments and cerebellar atrophy in the ataxic mouse model, probably via promoting particular neurotrophic factors.
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Affiliation(s)
- Mei-Juan Zhang
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China
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Traoré M, Coulibaly T, Meilleur KG, La Pean A, Sangaré M, Landouré G, Mochel F, Karambé M, Guinto CO, Fischbeck KH. Clinical and genetic analysis of spinocerebellar ataxia in Mali. Eur J Neurol 2011; 18:1269-71. [PMID: 21418439 DOI: 10.1111/j.1468-1331.2011.03376.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autosomal dominant cerebellar ataxia, currently denominated spinocerebellar ataxia (SCAs), represents a heterogeneous group of neurodegenerative disorders affecting the cerebellum and its connections. We describe the clinical and molecular findings in 16 patients originating from Malian families, who suffer from progressive cerebellar ataxia syndrome. METHODS AND RESULTS Molecular analysis allows genetic profiles of SCA to be distinguished. In seven patients, SCA type 2 (CAG) mutation was expanded from 39 to 43 repeats. SCA type 7 (CAG) mutation was confirmed in six patients. Mutations were expanded from 49 to 59 repeats. In three patients, SCA type3 was diagnosed and CAG mutation was expanded to 73 repeats. CONCLUSIONS Our data suggest that the most frequent types of SCA are SCA2 and SCA7. However, further studies are needed to confirm these preliminary results.
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Affiliation(s)
- M Traoré
- Department of Neurology, Point G Hospital, Bamako, Mali.
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