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de-la-Hoz-López D, Cuadrado ML, López-Valdés E, García-Ramos R, Alonso-Frech F, Fernández-Revuelta A, Fernández-de-las-Peñas C, Gómez-Mayordomo V. Sensitization-Associated Symptoms and Neuropathic-like Features in Patients with Cervical Dystonia and Pain. J Clin Med 2024; 13:2134. [PMID: 38610899 PMCID: PMC11012442 DOI: 10.3390/jcm13072134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This exploratory study evaluated the presence of sensitization-associated and neuropathic-like symptoms and identified their association with pressure sensitivity, pain, and disability in patients with cervical dystonia (CD). Methods: Thirty-one patients with CD (74.2% women, age: 61.2 years, SD 10.1) participated. Data collected included clinical variables, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the Central Sensitization Inventory (CSI), the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), as well as widespread pressure pain thresholds (PPTs). Results: Patients with CD with pain (n = 20, 64.5%) showed higher scores on the TWSTRS disability subscale and the CSI (p < 0.001), and lower PPTs (p < 0.05). Fifteen patients (15/31, 48%) showed sensitization-associated symptoms (CSI ≥ 40), whereas five of the patients with pain (5/20, 25%) exhibited neuropathic-like symptoms (S-LANSS ≥ 12). The CSI and S-LANSS were positively associated with the TWSTRS, HADS-A and HADS-D, and negatively associated with PPTs. HADS-D and S-LANSS explained 72.5% of the variance of the CSI (r2: 0.725), whereas CSI explained 42.3% of the variance of the S-LANSS (r2: 0.423). Conclusions: Pain is an important source of disability in CD, and may be a consequence of different mechanisms, including sensitization.
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Affiliation(s)
- Diego de-la-Hoz-López
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - María L. Cuadrado
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Eva López-Valdés
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Rocío García-Ramos
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Alonso-Frech
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Ana Fernández-Revuelta
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain (M.L.C.); (E.L.-V.); (R.G.-R.); (F.A.-F.); (A.F.-R.)
- Department of Neurology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Víctor Gómez-Mayordomo
- Synaptia Institute of Neurosciencies, Hospital Universitario Vithas Madrid La Milagrosa, 28010 Madrid, Spain;
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Gómez-Mayordomo V, Kojović M, López-Valdés E, Alonso-Frech F, Horga A, Fernández-Rodríguez R, Pareés I. Functional neurological symptoms as initial presentation of Creutzfeldt-Jakob disease: case series. J Neurol 2023; 270:1141-1146. [PMID: 36175672 DOI: 10.1007/s00415-022-11376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional Neurological Disorders (FND) are common in clinical practice. It is recognized that FND may present at onset or during the course of other neurological diseases (functional comorbidity). CASES We report a clinical series of three patients who initially presented positive signs of a functional movement disorder (FMD) and were later diagnosed with a Creutzfeldt-Jakob disease (CJD). All patients presented with unilateral functional tremor, two patients also had functional limb weakness. All patients progressed to an asymmetric corticobasal syndrome, fulfilling clinical criteria of CJD. They had a rapid progression and died within 2-3 months. CONCLUSIONS FND may be the initial clinical presentation of neurodegenerative diseases reflecting a dysfunction across brain circuits that are involved in the pathophysiology of FND. A positive diagnosis of FND is essential as it is an adequate examination and a close follow-up of these patients in neurology clinics.
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Affiliation(s)
- Víctor Gómez-Mayordomo
- Neurology Department, Hospital Universitario Infanta Elena. Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD). Universidad Complutense de Madrid, Madrid, Spain.
| | - Maja Kojović
- Neurology Department, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Eva López-Valdés
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Alejandro Horga
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isabel Pareés
- Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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3
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Gómez-Garre P, Jesús S, Periñán MT, Adarmes A, Alonso-Canovas A, Blanco-Ollero A, Buiza-Rueda D, Carrillo F, Catalán-Alonso MJ, Del Val J, Escamilla-Sevilla F, Espinosa-Rosso R, Fernández-Moreno MC, García-Moreno JM, García-Ruiz PJ, Giacometti-Silveira S, Gutiérrez-García J, López-Valdés E, Macías-García D, Martínez-Castrillo JC, Martínez-Torres I, Medialdea-Natera MP, Mínguez-Castellanos A, Moya MÁ, Ochoa-Sepulveda JJ, Ojea T, Rodríguez N, Sillero-Sánchez M, Tejera-Parrado C, Mir P. Mutational spectrum of GNAL, THAP1 and TOR1A genes in isolated dystonia: study in a population from Spain and systematic literature review. Eur J Neurol 2020; 28:1188-1197. [PMID: 33175450 DOI: 10.1111/ene.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/25/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to investigate the prevalence of TOR1A, GNAL and THAP1 variants as the cause of dystonia in a cohort of Spanish patients with isolated dystonia and in the literature. METHODS A population of 2028 subjects (including 1053 patients with different subtypes of isolated dystonia and 975 healthy controls) from southern and central Spain was included. The genes TOR1A, THAP1 and GNAL were screened using a combination of high-resolution melting analysis and direct DNA resequencing. In addition, an extensive literature search to identify original articles (published before 10 August 2020) reporting mutations in TOR1A, THAP1 or GNAL associated to dystonia was performed. RESULTS Pathogenic or likely pathogenic variants in TOR1A, THAP1 and GNAL were identified in 0.48%, 0.57% and 0.29% of our patients, respectively. Five patients carried the variation p.Glu303del in TOR1A. A very rare variant in GNAL (p.Ser238Asn) was found as a putative risk factor for dystonia. In the literature, variations in TOR1A, THAP1 and GNAL accounted for about 6%, 1.8% and 1.1% of published dystonia patients, respectively. CONCLUSIONS There is a different genetic contribution to dystonia of these three genes in our patients (about 1.3% of patients) and in the literature (about 3.6% of patients), probably due the high proportion of adult-onset cases in our cohort. As regards age at onset, site of dystonia onset, and final distribution, in our population there is a clear differentiation between DYT-TOR1A and DYT-GNAL, with DYT-THAP1 likely to be an intermediate phenotype.
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Affiliation(s)
- Pilar Gómez-Garre
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | - Silvia Jesús
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | - María Teresa Periñán
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | - Astrid Adarmes
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | - Araceli Alonso-Canovas
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | | | - Dolores Buiza-Rueda
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | - Fátima Carrillo
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | | | - Javier Del Val
- Movement Disorders Unit, Neurology Department, San Carlos Clinical Hospital, Madrid, Spain
| | | | | | | | | | - Pedro José García-Ruiz
- Movement Disorders Unit, Neurology Department, San Carlos Clinical Hospital, Madrid, Spain
| | | | | | - Eva López-Valdés
- Movement Disorders Unit, Neurology Department, La Fe Hospital, Valencia, Spain
| | - Daniel Macías-García
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
| | | | | | | | | | - Miguel Ángel Moya
- Neurology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Tomás Ojea
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Nuria Rodríguez
- Neurology Department, Puerto Real University Hospital, Cádiz, Spain
| | | | - Cristina Tejera-Parrado
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Pablo Mir
- Movement Disorders Unit, Clinical Neurology and Neurophysiology Department, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED, Madrid, Spain
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4
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Ortega-Suero G, Fernández-Matarrubia M, López-Valdés E, Arpa J. A Novel Missense OPA1 Mutation in a Patient with Dominant Optic Atrophy and Cervical Dystonia. Mov Disord Clin Pract 2019; 6:171-173. [PMID: 30838318 DOI: 10.1002/mdc3.12699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gloria Ortega-Suero
- Neurogenetics Unit, Department of Neurology Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
| | - Marta Fernández-Matarrubia
- Neurogenetics Unit, Department of Neurology Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
| | - Eva López-Valdés
- Movement Disorders Unit, Department of Neurology Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
| | - Javier Arpa
- Neurogenetics Unit, Department of Neurology Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
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5
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Gómez-Garre P, Huertas-Fernández I, Cáceres-Redondo MT, Alonso-Canovas A, Bernal-Bernal I, Blanco-Ollero A, Bonilla-Toribio M, Burguera JA, Carballo M, Carrillo F, José Catalán-Alonso M, Escamilla-Sevilla F, Espinosa-Rosso R, Carmen Fernández-Moreno M, García-Caldentey J, García-Moreno JM, Giacometti-Silveira S, Gutiérrez-García J, Jesús-Maestre S, López-Valdés E, Martínez-Castrillo JC, Medialdea-Natera MP, Méndez-Lucena C, Mínguez-Castellanos A, Angel Moya M, Ochoa-Sepulveda JJ, Ojea T, Rodríguez N, Rubio-Agusti I, Sillero-Sánchez M, del Val J, Vargas-González L, Mir P. Lack of validation of variants associated with cervical dystonia risk: A GWAS replication study. Mov Disord 2014; 29:1825-8. [DOI: 10.1002/mds.26044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/12/2014] [Accepted: 09/01/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Pilar Gómez-Garre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Spain
| | - Ismael Huertas-Fernández
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - María Teresa Cáceres-Redondo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - Araceli Alonso-Canovas
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ramón y Cajal, IRYCIS; Madrid Spain
| | - Inmaculada Bernal-Bernal
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | | | - Marta Bonilla-Toribio
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - Juan Andrés Burguera
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital La Fe; Valencia Spain
| | - Manuel Carballo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - Fatima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - M. José Catalán-Alonso
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos; Madrid Spain
| | - Francisco Escamilla-Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves; Granada Spain
| | | | | | - Juan García-Caldentey
- Unidad de Trastornos del Movimiento; Servicio de Neurología, Fundación Jiménez Díaz; Madrid Spain
| | | | | | | | - Silvia Jesús-Maestre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
- Servicio de Neurología; Centro Hospitalario de Jaén; Jaén Spain
| | - Eva López-Valdés
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Clínico San Carlos; Madrid Spain
| | | | - María Pilar Medialdea-Natera
- Unidad de Trastornos del Movimiento, Servicio de Neurología; Hospital Universitario Virgen de la Victoria; Málaga Spain
| | | | - Adolfo Mínguez-Castellanos
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Miguel Angel Moya
- Servicio de Neurología; Hospital Universitario Puerta del Mar; Cádiz Spain
| | | | - Tomas Ojea
- Servicio de Neurología; Hospital Carlos Haya; Málaga Spain
| | - Nuria Rodríguez
- Servicio de Neurología; Hospital Universitario Puerto Real; Cádiz Spain
| | - Ignacio Rubio-Agusti
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital La Fe; Valencia Spain
| | | | - Javier del Val
- Unidad de Trastornos del Movimiento; Servicio de Neurología, Fundación Jiménez Díaz; Madrid Spain
| | - Laura Vargas-González
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Sevilla Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Spain
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Sánchez-Ferro Á, Rábano A, Catalán MJ, Rodríguez-Valcárcel FC, Fernández Díez S, Herreros-Rodríguez J, García-Cobos E, Álvarez-Santullano MM, López-Manzanares L, Mosqueira AJ, Vela Desojo L, López-Lozano JJ, López-Valdés E, Sánchez-Sánchez R, Molina-Arjona JA. In vivo gastric detection of α-synuclein inclusions in Parkinson's disease. Mov Disord 2014; 30:517-24. [PMID: 25113060 DOI: 10.1002/mds.25988] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/09/2013] [Accepted: 07/13/2014] [Indexed: 12/18/2022] Open
Abstract
α-Synuclein inclusions have been identified in the brain and some parts of the enteric nervous system in Parkinson's disease cases. We aimed to assess these inclusions in gastric mucosa samples from patients with symptomatic Parkinson's disease. Random biopsies were performed by gastroscopy in 28 patients with Parkinson's disease and in 29 age- and sex-matched controls. Gastroscopy was performed to start enteral levodopa (L-dopa) therapy in cases and for diagnostic purposes in controls (gastroesophageal reflux, anemia, and abdominal pain were the main indications). The clinical definition of cases and controls was made a priori. Six controls had data suggestive of "mild presymptomatic parkinsonism". Biopsy specimens were immunostained for α-synuclein. The neuropathological diagnosis was established post hoc. No differences were found in the baseline characteristics of the groups. Positive fibers for the α-synuclein protein were observed in 17 of 28 (60.7%) Parkinson's disease patients, 1 of 23 controls (4.3%), and 1 of 6 (16.7%) cases of incident "mild presymptomatic parkinsonism." Neuropathological diagnosis based on α-synuclein immunostaining showed a sensitivity of 85% (95% confidence interval [CI] 62.1-96.8), specificity of 95% (95% CI 76.2-99.9) and area under the receiver operating characteristics curve (AUC) of 0.90 (95% CI 0.80-1.00). No adverse events occurred. Detection of α-synuclein inclusions in the gastric mucosa is a useful and safe tool providing in vivo evidence of the underlying neurodegenerative peripheral involvement linked to Parkinson's disease. Further studies are warranted to determine its pathophysiological implications.
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Affiliation(s)
- Álvaro Sánchez-Ferro
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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7
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Gómez-Garre P, Huertas-Fernández I, Cáceres-Redondo MT, Alonso-Canovas A, Bernal-Bernal I, Blanco-Ollero A, Bonilla-Toribio M, Burguera JA, Carballo M, Carrillo F, Catalán-Alonso MJ, Escamilla-Sevilla F, Espinosa-Rosso R, Fernández-Moreno MC, García-Caldentey J, García-Moreno JM, García-Ruiz PJ, Giacometti-Silveira S, Gutiérrez-García J, Jesús S, López-Valdés E, Martínez-Castrillo JC, Martínez-Torres I, Medialdea-Natera MP, Méndez-Lucena C, Mínguez-Castellanos A, Moya M, Ochoa-Sepulveda JJ, Ojea T, Rodríguez N, Sillero-Sánchez M, Vargas-González L, Mir P. BDNF Val66Met polymorphism in primary adult-onset dystonia: a case-control study and meta-analysis. Mov Disord 2014; 29:1083-6. [PMID: 24925604 DOI: 10.1002/mds.25938] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/27/2014] [Accepted: 05/08/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A polymorphism in brain-derived neurotrophic factor (BDNF) (Val66Met) has been reported as a risk factor in primary dystonia. However, overall the results have been inconclusive. Our aim was to clarify the association of Val66Met with primary dystonia, and with the most prevalent clinical subtypes, cervical dystonia and blepharospasm. METHODS We conducted a Spanish multicenter case-control study (including 680 primary dystonia patients and 788 healthy controls) and performed a meta-analysis integrating our study and six previously published studies (including a total of 1,936 primary dystonia patients and 2,519 healthy controls). RESULTS We found no allelic or genotypic association with primary dystonia, cervical dystonia, or blepharospasm risks, for the allele A (Met) from a BDNF Val66Met polymorphism in our case-control study. This was confirmed by results from our meta-analysis in white and mixed ethnic populations in any genetic model. CONCLUSION We did not find any evidence supporting the association of the BDNF Val66Met polymorphism with primary dystonia.
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Affiliation(s)
- Pilar Gómez-Garre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
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8
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Catalán MJ, de Pablo-Fernández E, Villanueva C, Fernández-Diez S, Lapeña-Montero T, García-Ramos R, López-Valdés E. Levodopa infusion improves impulsivity and dopamine dysregulation syndrome in Parkinson's disease. Mov Disord 2013; 28:2007-10. [PMID: 24123193 DOI: 10.1002/mds.25636] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 06/22/2013] [Accepted: 07/14/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Impulsivity and dopamine dysregulation syndrome are frequent complications of treatment in Parkinson's disease (PD). METHODS We assessed the effect of jejunal levodopa infusion (JLI) on behavioral symptoms in 8 PD patients with motor complications and severe impulsivity and dopamine dysregulation syndrome (DDS), which had not be controlled before by adjusting oral medications. The infusion was delivered during 15 hours (daily dose 1007.2 ± 302.5 mg) and stopped at night time. Patients were reassessed after 25 ± 9 weeks of treatment with a stable dose of jejunal l-dopa. RESULTS Off periods and dyskinesias decreased by 27% and 20,7% respectively, compared to baseline. DDS and all types of impulse control disorders (ICDs) improved in all patients, with nearly complete symptom resolution. Punding improved in all 5 patients but disappeared completely in only 1. CONCLUSIONS Our experience suggests that l-dopa infusion has a positive effect on both motor complications and behavioral disorders. This treatment approach deserves further controlled studies.
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Affiliation(s)
- María José Catalán
- Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Ampuero I, Alegre-Abarrategui J, Rodal I, España A, Ros R, Sendón JLL, Galloway EG, Cervelló A, Caminero AB, Zabala A, Erro E, Jarauta F, Morlán L, López-Valdés E, Aladro Y, Seijo M, Rivas GG, Muñoz DG, de Yébenes JG. On the diagnosis of CADASIL. J Alzheimers Dis 2010; 17:787-94. [PMID: 19542611 DOI: 10.3233/jad-2009-1112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a genetic arteriopathy related to Notch3 mutations, is difficult to diagnosis. The goal of this study was to determine the value of clinical, immunohistochemical, and molecular techniques for the diagnosis of CADASIL. Clinical features and the immunohistochemical and molecular findings in 200 subjects with suspected CADASIL in whom 93 biopsies and 190 molecular studies are reported. Eighteen pathogenic mutations of the Notch3 gene, six of them previously unreported, were detected in 67 patients. The clinical features did not permit differentiation between CADASIL and CADASIL-like syndromes. The sensitivity and specificity of the skin biopsies was 97.7% and 56.5%, respectively, but increased to 100% and 81.5%, respectively, in cases with proven family history. In conclusion, a clinical diagnosis of CADASIL is difficult to determine and confirmatory techniques should be used judiciously.
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Affiliation(s)
- Israel Ampuero
- Banco de Tejidos para Investigaciones Neurológicas (BTIN), Facultad de Medicina, Universidad Commplutense de Madrid, Madrid, Spain.
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10
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de Toledo M, López-Valdés E, Ferreiro M, Cervera JL, Ramos A, Cabello A, Hernández-Laín A, Montes-Montes S, Lagares A, Alvarez-Linera Prado J. [Lymphomatosis cerebri as the cause of leukoencephalopathy]. Rev Neurol 2008; 46:667-670. [PMID: 18509825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Lymphomatosis cerebri (LC) is an infrequent type of primary lymphoma of the central nervous system that is characterised by diffuse, infiltrating involvement of the white matter of the brain without the formation of a mass. AIM To report the case of a patient with LC in order to draw attention to this disease, which is rarely diagnosed, and to its initial presentation in magnetic resonance imaging (MRI) as leukoencephalopathy. CASE REPORT Our patient was a 56-year-old female who had clinical signs and symptoms of sub-acute dementia. Computerised axial tomography and MRI of the head revealed extensive, diffuse and bilateral involvement of the white matter, basal nuclei, mesencephalon and pons, with no mass effect or contrast enhancement. A stereotactic biopsy of the white matter (which was not conclusive) showed a perivascular mixed mononuclear-cell inflammatory infiltrate of B and T cells. No cytologic atypia was observed. Treatment was established with corticoids, which produced a clinical and radiological improvement in the first two months. During the next month the patient underwent rapid clinical deterioration with sleepiness and a worsening of the ability to walk. In an MRI scan the lesion had a more heterogeneous appearance with mass effect on adjacent structures and patchy contrast enhancement. A wedge biopsy of brain tissue led to a diagnosis of high-grade B-cell lymphoma. CONCLUSIONS The imaging and histological appearance of LC may not be the one typically found in primary lymphomas of the central nervous system, and its clinical presentation may be similar to that of other diffuse processes involving compromise of the white matter (cerebral gliomatosis, inflammatory diseases of the white matter, such as Behçet's disease, Sjögren's disease or systemic lupus erythematosus).
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Affiliation(s)
- M de Toledo
- Servicio de Neurología, Hospital Severo Ochoa, 28911 Leganés, Espana.
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11
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Paraíso V, Francos M, Rodríguez-Berzosa F, Felipe C, López-Valdés E, Martín R, Blázquez J, Chacón C, Fidalgo A, Martín J. Portosystemic Encephalopathy in a Patient Treated With Peritoneal Dialysis. Am J Kidney Dis 2007; 49:854-8. [PMID: 17533029 DOI: 10.1053/j.ajkd.2007.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 03/02/2007] [Indexed: 11/11/2022]
Abstract
We present a case of a 75-year-old man with end-stage renal disease caused by immunoglobulin A nephropathy who developed hepatic encephalopathy 15 months after starting continuous ambulatory peritoneal dialysis therapy. Liver test results were normal except for hyperammonemia (ammonia, 317 microg/dL [186 micromol/L]) and mildly increased alkaline phosphatase and gamma-glutamyl transpeptidase levels. Abdominal ultrasonography showed normal liver architecture, and color Doppler ultrasonography showed a normal splenic-portal axis with hepatopetal blood flow. Histological examination of a laparoscopic liver biopsy specimen showed moderate fibrosis limited to portal tracts without necrosis or inflammation. Magnetic resonance angiography and percutaneous transhepatic portal angiography showed a large shunt between the left gastric and azygous veins, with blood flowing from the portal vein to the superior vena cava. The patient was transferred to hemodialysis treatment, and although his condition improved slightly, episodes of encephalopathy did not disappear. Surgical ligation of the left gastric vein was performed. In the 8 months after surgery, he has experienced no further episodes of hepatic encephalopathy or hyperammonemia. We speculate that increased intra-abdominal pressure and vasodilation caused by peritoneal dialysis solutions in a patient with a spontaneous portosystemic shunt resulted in ammonia-rich blood flow from the portal vein to the superior vena cava and encephalopathy. In addition, it is possible that chronic hepatic hypoxia caused by hypoperfusion from portosystemic shunting contributed to the development of liver fibrosis. To our knowledge, this is the first report of spontaneous portosystemic shunt encephalopathy in a patient with a noncirrhotic liver undergoing peritoneal dialysis.
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Affiliation(s)
- Vicente Paraíso
- Service of Nephrology, Hospital Ntra Sra de Sonsoles, Avila, Spain.
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12
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Posada IJ, Ferreiro-Sieiro A, López-Valdés E, Cabello A, Bermejo-Pareja F. [Whipple's disease confined to the brain. A clinical case with pathological confirmation at necropsy]. Rev Neurol 2004; 38:196-8. [PMID: 14752723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- I J Posada
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
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13
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Posada IJ, López-Valdés E, Vallejo AR, Portera A. Extrapyramidal side effects and serotonin syndrome with fluoxetine and biperiden. Neurologia 1998; 13:405. [PMID: 9859675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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14
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López-Valdés E, Posada IJ, Muñoz A, Bermejo F. Acute hemichorea caused by a cavernous angioma in the caudate. Neurologia 1998; 13:205-6. [PMID: 9608762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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15
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Díaz-Guzmán J, López-Valdés E, Varela JM, Ramos A, Benito-León J, Garcia-Saiz A, Rodríguez-Vallejo A. [HTLV-I myelopathy: presentation of a new case]. Rev Neurol 1997; 25:557-9. [PMID: 9172919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION HTLV-I is a human retrovirus which has been implicated in the genesis of tropical spastic paraparesis (HTLV-I-associated myelopathy). So far five cases of this illness have been detected in Spain, five of them in immigrants. We present a new case in Spain, with a characteristic chronic clinical picture. CASE REPORT A 36-year-old black woman native of Ecuatorial Guinea, developed along 10 years a progressive paraparesis of asymmetric onset with important back pain, that arrives to paraplegic spastic phase at the present time. She presents distal amyotrophies, ulcers of decubitus and loss of control of sphincters, with normal mental status. Laboratory tests: blood, biochemistry and microbiologic studies: normal, or negative. She presented positive Western Blot serology for HTLV-I, confirmed by means of PCR technique. Cranial MRI: small and hyperintense subcortical lesions on T2 weighted images; spinal MRI: local atrophy at high thoracic level. A lumbar puncture was performed, with no cells, and with presence of oligoclonal bands, and a high IgG index. Urodynamic study: neurogenic spastic bladder. EMG: mild axonal polyneuropathy with prevalence in legs. CONCLUSIONS In the differential diagnosis of progressive paraperesis, and mainly with epidemic antecedents, it is necessary to include a determination of HTLV-I between the diagnostic tests.
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Affiliation(s)
- J Díaz-Guzmán
- Servicio de Neurología, Hospital Doce de Octubre, Madrid, España
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López-Valdés E, Hernández-Laín A, Simón R, Porta J, Mateos F. [Treatment of refractory infantile epilepsy with vigabatrin in a series of 55 patients]. Rev Neurol 1996; 24:1255-7. [PMID: 8983724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present the results of treatment with vigabatrin in the polytherapy of resistant infantile epilepsy. A retrospective review of 55 children with resistant epilepsy aged between 2 months and 15 years was carried out between January 1992 and January 1995. Semiologically, the crises treated were simple partial crises (CPS), complex partial crises (CPC), West's syndrome, the Lennox-Gastaut syndrome and polymorphic crises. The efficacy of the drug (defined as a 50% or more reduction in crises), secondary effects and the reduction in the number of drugs necessary were evaluated. 60% of the children studied improved. 20% became completely free of crises. 34% remained unchanged and 3% became worse. In West's syndrome 100% responded satisfactorily, as did 80% of the cases of partial crises, but only 40% of those with Lennox's syndrome responded. Generalized tonic-clonic crises did not respond, and myoclonic crises became worse. Aetiologically, there was greater improvement in the symptomic cases than in the essential cases, the improvement being 70% while 5 patients with tuberose sclerosis responded particularly well. Medication was stopped in one case because of side-effects, due to a psychiatric disturbance, and in another case vigabatrin caused transitory side-effects. In 10% of the subjects the initial efficacy wore off around 6 months later. We have shown the usefulness of vigabatrin in the polytherapy of infantile epilepsy, which is resistant to conventional epileptic drugs, mainly in simple and complex partial crises and in West's syndrome. Its minimal side-effects and the favourable response in over 50% of cases make it an extremely useful drug.
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Affiliation(s)
- E López-Valdés
- Servicio de Neuropediatria Hospital Doce de Octubre, Madrid, España
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