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Batheja V, Fish M, Balar AB, Hedge S, Hogg JP, Lakhani DA, Khan M. Spinocerebellar ataxia-type 34: A case report and brief review of the literature. Radiol Case Rep 2023; 18:3954-3958. [PMID: 37680663 PMCID: PMC10480451 DOI: 10.1016/j.radcr.2023.08.055] [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: 05/16/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Neurodegenerative disorders are classified as a group of diseases with progressive loss of neurons secondary to aggregation of misfolded proteins. A few of these neurodegenerative diseases have been associated with degeneration of the transverse pontocerebellar tracts and median pontine raphe nuclei. This specific neuron degeneration results in the radiologic hot cross bun sign (HCBS) on MRI T2 imaging and helps narrow down the differential diagnosis. While multiple system atrophy has a higher prevalence of the HCBS than other neurodegenerative diseases, the sign has also been described with other neurodegenerative disorders such as spinocerebellar ataxia (SCA), and variant Creutzfeldt-Jakob disease. Here, we present a case of spinocerebellar ataxia type 34 with a characteristic hot-cross bun sign and provide a brief review of the literature.
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Affiliation(s)
- Vivek Batheja
- Department of Medicine, George Washington University Hospital, Washington, DC, USA
| | - Morgan Fish
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Aneri B. Balar
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | - Siddhi Hedge
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Jeffery P. Hogg
- Department of Radiology, West Virginia University, Morgantown, WV, USA
| | | | - Musharaf Khan
- Department of Radiology, West Virginia University, Morgantown, WV, USA
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Radhakrishnan V, Gallea C, Valabregue R, Krishnan S, Kesavadas C, Thomas B, James P, Menon R, Kishore A. Cerebellar and basal ganglia structural connections in humans: Effect of aging and relation with memory and learning. Front Aging Neurosci 2023; 15:1019239. [PMID: 36776439 PMCID: PMC9908607 DOI: 10.3389/fnagi.2023.1019239] [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: 08/14/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction The cerebellum and basal ganglia were initially considered anatomically distinct regions, each connected via thalamic relays which project to the same cerebral cortical targets, such as the motor cortex. In the last two decades, transneuronal viral transport studies in non-human primates showed bidirectional connections between the cerebellum and basal ganglia at the subcortical level, without involving the cerebral cortical motor areas. These findings have significant implications for our understanding of neurodevelopmental and neurodegenerative diseases. While these subcortical connections were established in smaller studies on humans, their evolution with natural aging is less understood. Methods In this study, we validated and expanded the previous findings of the structural connectivity within the cerebellum-basal ganglia subcortical network, in a larger dataset of 64 subjects, across different age ranges. Tractography and fixel-based analysis were performed on the 3 T diffusion-weighted dataset using Mrtrix3 software, considering fiber density and cross-section as indicators of axonal integrity. Tractography of the well-established cerebello-thalamo-cortical tract was conducted as a control. We tested the relationship between the structural white matter integrity of these connections with aging and with the performance in different domains of Addenbrooke's Cognitive Examination. Results Tractography analysis isolated connections from the dentate nucleus to the contralateral putamen via the thalamus, and reciprocal tracts from the subthalamic nucleus to the contralateral cerebellar cortex via the pontine nuclei. Control tracts of cerebello-thalamo-cortical tracts were also isolated, including associative cerebello-prefrontal tracts. A negative linear relationship was found between the fiber density of both the ascending and descending cerebellum-basal ganglia tracts and age. Considering the cognitive assessments, the fiber density values of cerebello-thalamo-putaminal tracts correlated with the registration/learning domain scores. In addition, the fiber density values of cerebello-frontal and subthalamo-cerebellar (Crus II) tracts correlated with the cognitive assessment scores from the memory domain. Conclusion We validated the structural connectivity within the cerebellum-basal ganglia reciprocal network, in a larger dataset of human subjects, across wider age range. The structural features of the subcortical cerebello-basal ganglia tracts in human subjects display age-related neurodegeneration. Individual morphological variability of cerebellar tracts to the striatum and prefrontal cortex was associated with different cognitive functions, suggesting a functional contribution of cerebellar tracts to cognitive decline with aging. This study offers new perspectives to consider the functional role of these pathways in motor learning and the pathophysiology of movement disorders involving the cerebellum and striatum.
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Affiliation(s)
- Vineeth Radhakrishnan
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Cecile Gallea
- INSERM, CNRS, Paris Brain Institute, Sorbonne Université, Paris, France
| | - Romain Valabregue
- INSERM, CNRS, Paris Brain Institute, Sorbonne Université, Paris, France
| | - Syam Krishnan
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Praveen James
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ramshekhar Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Asha Kishore
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India,Parkinson and Movement Disorder Centre, Department of Neurology, Aster Medcity, Kochi, India,*Correspondence: Asha Kishore, ✉
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3
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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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Naidoo AK, Wells CD, Rugbeer Y, Naidoo N. The "Hot Cross Bun Sign" in Spinocerebellar Ataxia Types 2 and 7-Case Reports and Review of Literature. Mov Disord Clin Pract 2022; 9:1105-1113. [PMID: 36339304 PMCID: PMC9631856 DOI: 10.1002/mdc3.13550] [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: 02/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 09/19/2023] Open
Abstract
Background The "hot cross bun" sign is a cruciform hyperintensity is seen on T2 weighted imaging within the pons. The sign is considered to be pathognomic for Multiple system atrophy type C. The clinical and radiological features of Multiple system atrophy type C overlap with the autosomal dominant inherited ataxias. We present a case series of 3 African patients with genetically proven Spinocerebellar Ataxia presenting with the Hot cross bun sign and a scoping review of similar studies. Cases We described the phenotypic and radiological presentation of genetically confirmed SCA-2 in two, and SCA-7 in one patient, with the "hot cross bun" sign. Literature Review We performed a scoping review on the Hot Cross Bun Sign.A total of 66 articles were retrieved. We describe the diverse aetiologies of the sign and associated phenotypic and radiological features. We review the Spinocerebellar Ataxias described with a Hot cross bun sign and make comparisons to Multiple System Atrophy Type C [Ref. 1,2]. Conclusions To our knowledge this is the first description of an African cohort presenting with the Hot Cross Bun Sign. We expand the differential diagnosis of the Hot Cross Bun Sign.
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Affiliation(s)
- Ansuya Kasavelu Naidoo
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
| | - Cait‐Lynn Deanne Wells
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
| | | | - Neil Naidoo
- Greys Academic HospitalPietermaritzburgSouth Africa
- School of Clinical Medicine, Division NeurologyUniversity of KwaZulu NatalDurbanSouth Africa
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5
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Thieme A, Timmann D. [Diagnosis and Treatment of Ataxias: An Up-To-Date Overview]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:233-251. [PMID: 35584690 DOI: 10.1055/a-1772-8897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ataxias are a heterogeneous group of diseases. They can occur at any age and have various causes. Most ataxias are rare diseases and many are genetic disorders. A large and steadily increasing number of underlying gene defects are known. The path to the correct diagnosis is often challenging. This overview summarizes the typical findings for the most important acquired, hereditary and non-hereditary degenerative ataxias. The focus is on ataxias with adult onset.
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Identification of the Prodromal Symptoms and Pre-Ataxic Stage in Cerebellar Disorders: The Next Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910057. [PMID: 34639359 PMCID: PMC8507858 DOI: 10.3390/ijerph181910057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 02/02/2023]
Abstract
Cerebellar ataxias (CAs) manifest with a combination of motor incoordination, cognitive, affective and recently identified social symptoms. Novel therapies aim to stop the progression of the subgroup of the degenerative ataxias, or even to cure the disease with a functional and anatomical restoration of the cerebellar circuitry in the near future. The goal of stopping the progression of the disease is particularly relevant if applied at a very early stage of the disease, when the cerebellar reserve is only slightly impaired. Therefore, the search of the prodromal phase or pre-ataxic stage of CAs represents a very important challenge for the scientific community. The identification of pre-manifest individuals and the recruitment of individuals at risk has become a key-challenge to address neuroprotective therapies. The feasibility is high due to the recent progress in the biological and morphological biomarkers of CAs.
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7
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Louis ED, Faust PL. Essential Tremor Within the Broader Context of Other Forms of Cerebellar Degeneration. THE CEREBELLUM 2021; 19:879-896. [PMID: 32666285 DOI: 10.1007/s12311-020-01160-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Essential tremor (ET) has recently been reconceptualized by many as a degenerative disease of the cerebellum. Until now, though, there has been no attempt to frame it within the context of these diseases. Here, we compare the clinical and postmortem features of ET with other cerebellar degenerations, thereby placing it within the broader context of these diseases. Action tremor is the hallmark feature of ET. Although often underreported in the spinocerebellar ataxias (SCAs), action tremors occur, and it is noteworthy that in SCA12 and 15, they are highly prevalent, often severe, and can be the earliest disease manifestation, resulting in an initial diagnosis of ET in many cases. Intention tremor, sometimes referred to as "cerebellar tremor," is a common feature of ET and many SCAs. Other features of cerebellar dysfunction, gait ataxia and eye motion abnormalities, are seen to a mild degree in ET and more markedly in SCAs. Several SCAs (e.g., SCA5, 6, 14, and 15), like ET, follow a milder and more protracted disease course. In ET, numerous postmortem changes have been localized to the cerebellum and are largely confined to the cerebellar cortex, preserving the cerebellar nuclei. Purkinje cell loss is modest. Similarly, in SCA3, 12, and 15, Purkinje cell loss is limited, and in SCA12 and 15, there is preservation of cerebellar nuclei and relative sparing of other central nervous system regions. Both clinically and pathologically, there are numerous similarities and intersection points between ET and other disorders of cerebellar degeneration.
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Affiliation(s)
- Elan D Louis
- Department of Neurology and Therapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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8
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Trentin S, Fraiman de Oliveira BS, Ferreira Felloni Borges Y, de Mello Rieder CR. Systematic review and meta-analysis of Sniffin Sticks Test performance in Parkinson's disease patients in different countries. Eur Arch Otorhinolaryngol 2021; 279:1123-1145. [PMID: 34319482 DOI: 10.1007/s00405-021-06970-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Olfaction impairment occurs in about 90% of patients with Parkinson's disease. The Sniffin Sticks Test is a widely used instrument to measure olfactory performance and is divided into three subtests that assess olfactory threshold, discrimination and identification. However, cultural and socioeconomic differences can influence test performance. OBJECTIVES We performed a systematic review and meta-analysis of the existent data about Sniffin Sticks Test performance of Parkinson's disease patients and healthy controls in different countries and investigated if there are other cofactors which could influence the olfactory test results. A subgroup analysis by country was performed as well as a meta-regression using age, gender and air pollution as covariates. RESULTS Four hundred and thirty studies were found and 66 articles were included in the meta-analysis. Parkinson's disease patients showed significantly lower scores on the Sniffin Sticks Test and all its subtests than healthy controls. Overall, the heterogeneity among studies was moderate to high as well as the intra-country heterogeneity. The subgroup analysis, stratifying by country, maintained a high residual heterogeneity. CONCLUSION The meta-regression showed a significant correlation with age and air pollution in a few subtests. A high heterogeneity was found among studies which was not significantly decreased after subgroup analysis by country. This fact signalizes that maybe cultural influence has a small impact on the Sniffin Sticks Test results. Age and air pollution have influence in a few olfactory subtests.
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Affiliation(s)
- Sheila Trentin
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, 6690, Ipiranga Avenue, Jardim Botânico, Porto Alegre, 90619-900, Brazil.
| | - Bruno Samuel Fraiman de Oliveira
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, 6690, Ipiranga Avenue, Jardim Botânico, Porto Alegre, 90619-900, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Yuri Ferreira Felloni Borges
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, 6690, Ipiranga Avenue, Jardim Botânico, Porto Alegre, 90619-900, Brazil
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9
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Hommersom MP, Buijsen RAM, van Roon-Mom WMC, van de Warrenburg BPC, van Bokhoven H. Human Induced Pluripotent Stem Cell-Based Modelling of Spinocerebellar Ataxias. Stem Cell Rev Rep 2021; 18:441-456. [PMID: 34031815 PMCID: PMC8930896 DOI: 10.1007/s12015-021-10184-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
Abstract Dominant spinocerebellar ataxias (SCAs) constitute a large group of phenotypically and genetically heterogeneous disorders that mainly present with dysfunction of the cerebellum as their main hallmark. Although animal and cell models have been highly instrumental for our current insight into the underlying disease mechanisms of these neurodegenerative disorders, they do not offer the full human genetic and physiological context. The advent of human induced pluripotent stem cells (hiPSCs) and protocols to differentiate these into essentially every cell type allows us to closely model SCAs in a human context. In this review, we systematically summarize recent findings from studies using hiPSC-based modelling of SCAs, and discuss what knowledge has been gained from these studies. We conclude that hiPSC-based models are a powerful tool for modelling SCAs as they contributed to new mechanistic insights and have the potential to serve the development of genetic therapies. However, the use of standardized methods and multiple clones of isogenic lines are essential to increase validity and reproducibility of the insights gained. Graphical Abstract ![]()
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Affiliation(s)
- Marina P Hommersom
- Department of Human Genetics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Ronald A M Buijsen
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Willeke M C van Roon-Mom
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands.
| | - Hans van Bokhoven
- Department of Human Genetics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands. .,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, Netherlands.
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10
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Brooker SM, Edamakanti CR, Akasha SM, Kuo SH, Opal P. Spinocerebellar ataxia clinical trials: opportunities and challenges. Ann Clin Transl Neurol 2021; 8:1543-1556. [PMID: 34019331 PMCID: PMC8283160 DOI: 10.1002/acn3.51370] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
The spinocerebellar ataxias (SCAs) are a group of dominantly inherited diseases that share the defining feature of progressive cerebellar ataxia. The disease process, however, is not confined to the cerebellum; other areas of the brain, in particular, the brainstem, are also affected, resulting in a high burden of morbidity and mortality. Currently, there are no disease‐modifying treatments for the SCAs, but preclinical research has led to the development of therapeutic agents ripe for testing in patients. Unfortunately, due to the rarity of these diseases and their slow and variable progression, there are substantial hurdles to overcome in conducting clinical trials. While the epidemiological features of the SCAs are immutable, the feasibility of conducting clinical trials is being addressed through a combination of strategies. These include improvements in clinical outcome measures, the identification of imaging and fluid biomarkers, and innovations in clinical trial design. In this review, we highlight current challenges in initiating clinical trials for the SCAs and also discuss pathways for researchers and clinicians to mitigate these challenges and harness opportunities for clinical trial development.
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Affiliation(s)
- Sarah M Brooker
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sara M Akasha
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Cocozza S, Pontillo G, De Michele G, Di Stasi M, Guerriero E, Perillo T, Pane C, De Rosa A, Ugga L, Brunetti A. Conventional MRI findings in hereditary degenerative ataxias: a pictorial review. Neuroradiology 2021; 63:983-999. [PMID: 33733696 PMCID: PMC8213578 DOI: 10.1007/s00234-021-02682-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Purpose Cerebellar ataxias are a large and heterogeneous group of disorders. The evaluation of brain parenchyma via MRI plays a central role in the diagnostic assessment of these conditions, being mandatory to exclude the presence of other underlying causes in determining the clinical phenotype. Once these possible causes are ruled out, the diagnosis is usually researched in the wide range of hereditary or sporadic ataxias. Methods We here propose a review of the main clinical and conventional imaging findings of the most common hereditary degenerative ataxias, to help neuroradiologists in the evaluation of these patients. Results Hereditary degenerative ataxias are all usually characterized from a neuroimaging standpoint by the presence, in almost all cases, of cerebellar atrophy. Nevertheless, a proper assessment of imaging data, extending beyond the mere evaluation of cerebellar atrophy, evaluating also the pattern of volume loss as well as concomitant MRI signs, is crucial to achieve a proper diagnosis. Conclusion The integration of typical neuroradiological characteristics, along with patient’s clinical history and laboratory data, could allow the neuroradiologist to identify some conditions and exclude others, addressing the neurologist to the more appropriate genetic testing.
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Affiliation(s)
- Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
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12
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Phang MWL, Lew SY, Chung I, Lim WKS, Lim LW, Wong KH. Therapeutic roles of natural remedies in combating hereditary ataxia: A systematic review. Chin Med 2021; 16:15. [PMID: 33509239 PMCID: PMC7841890 DOI: 10.1186/s13020-020-00414-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/17/2020] [Accepted: 12/11/2020] [Indexed: 12/30/2022] Open
Abstract
Background Hereditary ataxia (HA) represents a group of genetically heterogeneous neurodegenerative diseases caused by dysfunction of the cerebellum or disruption of the connection between the cerebellum and other areas of the central nervous system. Phenotypic manifestation of HA includes unsteadiness of stance and gait, dysarthria, nystagmus, dysmetria and complaints of clumsiness. There are no specific treatments for HA. Management strategies provide supportive treatment to reduce symptoms. Objectives This systematic review aimed to identify, evaluate and summarise the published literature on the therapeutic roles of natural remedies in the treatment of HA to provide evidence for clinical practice. Methods A systematic literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, PubMed and Science Direct Scopus were thoroughly searched for relevant published articles from June 2007 to July 2020. Results Ten pre-clinical and two clinical studies were eligible for inclusion in this systematic review. We identified the therapeutic roles of medicinal plants Brassica napus, Gardenia jasminoides, Gastrodia elata, Ginkgo biloba, Glycyrrhiza inflata, Paeonia lactiflora, Pueraria lobata and Rehmannia glutinosa; herbal formulations Shaoyao Gancao Tang and Zhengan Xifeng Tang; and medicinal mushroom Hericium erinaceus in the treatment of HA. In this review, we evaluated the mode of actions contributing to their therapeutic effects, including activation of the ubiquitin–proteasome system, activation of antioxidant pathways, maintenance of intracellular calcium homeostasis and regulation of chaperones. We also briefly highlighted the integral cellular signalling pathways responsible for orchestrating the mode of actions. Conclusion We reviewed the therapeutic roles of natural remedies in improving or halting the progression of HA, which warrant further study for applications into clinical practice.
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Affiliation(s)
- Michael Weng Lok Phang
- Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Sze Yuen Lew
- Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Ivy Chung
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - William Kiong-Seng Lim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kuching, Sarawak, 94300, Malaysia
| | - Lee Wei Lim
- Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China.
| | - Kah Hui Wong
- Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
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13
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Louis ED, Faust PL. Essential tremor: the most common form of cerebellar degeneration? CEREBELLUM & ATAXIAS 2020; 7:12. [PMID: 32922824 PMCID: PMC7427947 DOI: 10.1186/s40673-020-00121-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
Background The degenerative cerebellar ataxias comprise a large and heterogeneous group of neurological diseases whose hallmark clinical feature is ataxia, and which are accompanied, to variable degrees, by other features that are attributable to cerebellar dysfunction. Essential tremor (ET) is an exceptionally common neurological disease whose primary motor feature is action tremor, although patients often manifest intention tremor, mild gait ataxia and several other features of cerebellar dysfunction. Main Body In this paper, we review the abundant evidence derived from clinical, neuroimaging and postmortem studies, linking ET to cerebellar dysfunction. Furthermore, we review the combination of clinical, natural history and postmortem features suggesting that ET is neurodegenerative. We then compare the prevalence of ET (400 – 900 cases per 100,000) to that of the other cerebellar degenerations (ranging from <0.5 – 9 cases per 100,000, and in composite likely to be on the order of 20 cases per 100,000) and conclude that ET is 20 to 45 times more prevalent than all other forms of cerebellar degeneration combined. Conclusion Given the data we present, it is logical to conclude that ET is, by far, the most common form of cerebellar degeneration.
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Affiliation(s)
- Elan D Louis
- Department of Neurology and Therapeutics, University of Texas Southwestern, Dallas, TX USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY USA
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