1
|
Thomsen M, Marth K, Loens S, Everding J, Junker J, Borngräber F, Ott F, Jesús S, Gelderblom M, Odorfer T, Kuhlenbäumer G, Kim HJ, Schaeffer E, Becktepe J, Kasten M, Brüggemann N, Pfister R, Kollewe K, Krauss JK, Lohmann E, Hinrichs F, Berg D, Jeon B, Busch H, Altenmüller E, Mir P, Kamm C, Volkmann J, Zittel S, Ferbert A, Zeuner KE, Rolfs A, Bauer P, Kühn AA, Bäumer T, Klein C, Lohmann K. Large-Scale Screening: Phenotypic and Mutational Spectrum in Isolated and Combined Dystonia Genes. Mov Disord 2024; 39:526-538. [PMID: 38214203 DOI: 10.1002/mds.29693] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pathogenic variants in several genes have been linked to genetic forms of isolated or combined dystonia. The phenotypic and genetic spectrum and the frequency of pathogenic variants in these genes have not yet been fully elucidated, neither in patients with dystonia nor with other, sometimes co-occurring movement disorders such as Parkinson's disease (PD). OBJECTIVES To screen >2000 patients with dystonia or PD for rare variants in known dystonia-causing genes. METHODS We screened 1207 dystonia patients from Germany (DysTract consortium), Spain, and South Korea, and 1036 PD patients from Germany for pathogenic variants using a next-generation sequencing gene panel. The impact on DNA methylation of KMT2B variants was evaluated by analyzing the gene's characteristic episignature. RESULTS We identified 171 carriers (109 with dystonia [9.0%]; 62 with PD [6.0%]) of 131 rare variants (minor allele frequency <0.005). A total of 52 patients (48 dystonia [4.0%]; four PD [0.4%, all with GCH1 variants]) carried 33 different (likely) pathogenic variants, of which 17 were not previously reported. Pathogenic biallelic variants in PRKRA were not found. Episignature analysis of 48 KMT2B variants revealed that only two of these should be considered (likely) pathogenic. CONCLUSION This study confirms pathogenic variants in GCH1, GNAL, KMT2B, SGCE, THAP1, and TOR1A as relevant causes in dystonia and expands the mutational spectrum. Of note, likely pathogenic variants only in GCH1 were also found among PD patients. For DYT-KMT2B, the recently described episignature served as a reliable readout to determine the functional effect of newly identified variants. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Mirja Thomsen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katrin Marth
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Judith Everding
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanna Junker
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Fabian Ott
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Silvia Jesús
- 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
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ebba Lohmann
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Frauke Hinrichs
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hauke Busch
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - 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, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arndt Rolfs
- Medical Faculty, University of Rostock, Rostock, Germany
- Agyany Pharmaceuticals, Jerusalem, Israel
| | | | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Rare Diseases, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| |
Collapse
|
2
|
Schneider I, Schönfeld R, Hanert A, Philippen S, Tödt I, Granert O, Mehdorn M, Becktepe J, Deuschl G, Berg D, Paschen S, Bartsch T. Deep brain stimulation of the subthalamic nucleus restores spatial reversal learning in patients with Parkinson's disease. Brain Commun 2024; 6:fcae068. [PMID: 38560516 PMCID: PMC10979721 DOI: 10.1093/braincomms/fcae068] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Spatial learning and navigation are supported by distinct memory systems in the human brain such as the hippocampus-based navigational system and the striatum-cortex-based system involved in motor sequence, habit and reversal learning. Here, we studied the role of subthalamic circuits in hippocampus-associated spatial memory and striatal-associated spatial reversal learning formation in patients with Parkinson's disease, who underwent a deep brain stimulation of the subthalamic nucleus. Deep brain stimulation patients (Parkinson's disease-subthalamic nucleus: n = 26) and healthy subjects (n = 15) were tested in a novel experimental spatial memory task based on the Morris water maze that assesses both hippocampal place memory as well as spatial reversal learning. All subjects were trained to navigate to a distinct spatial location hidden within the virtual environment during 16 learning trials in a subthalamic nucleus Stim-On condition. Patients were then randomized into two groups with either a deep brain stimulation On or Off condition. Four hours later, subjects were retested in a delayed recall and reversal learning condition. The reversal learning was realized with a new hidden location that should be memorized during six consecutive trials. The performance was measured by means of an index indicating the improvement during the reversal learning. In the delayed recall condition, neither patients, healthy subjects nor the deep brain stimulation On- versus Off groups showed a difference in place memory performance of the former trained location. In the reversal learning condition, healthy subjects (reversal index 2.0) and patients in the deep brain stimulation On condition (reversal index 1.6) showed a significant improvement. However, patients in the deep brain stimulation Off condition (reversal index 1.1) performed significantly worse and did not improve. There were no differences between all groups in a final visual guided navigation task with a visible target. These results suggest that deep brain stimulation of subthalamic nucleus restores spatial reversal learning in a virtual navigation task in patients with Parkinson's disease and gives insight into the neuromodulation effects on cognition of subthalamic circuits in Parkinson's disease.
Collapse
Affiliation(s)
- Isabel Schneider
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Robby Schönfeld
- Institute of Psychology, Martin-Luther-University Halle-Wittenberg, Halle 06108, Germany
| | - Annika Hanert
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Sarah Philippen
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Inken Tödt
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Oliver Granert
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Maximilian Mehdorn
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Jos Becktepe
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Günther Deuschl
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Daniela Berg
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Steffen Paschen
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Thorsten Bartsch
- Memory Disorders and Plasticity Group, Department of Neurology, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| |
Collapse
|
3
|
Loens S, Hamami F, Lohmann K, Odorfer T, Ip CW, Zittel S, Zeuner KE, Everding J, Becktepe J, Marth K, Borngräber F, Kollewe K, Kamm C, Kühn AA, Gelderblom M, Volkmann J, Klein C, Bäumer T. Tremor is associated with familial clustering of dystonia. Parkinsonism Relat Disord 2023; 110:105400. [PMID: 37086575 DOI: 10.1016/j.parkreldis.2023.105400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Dystonia is a movement disorder of variable etiology and clinical presentation and is accompanied by tremor in about 50% of cases. Monogenic causes in dystonia are rare, but also in the group of non-monogenic dystonias 10-30% of patients report a family history of dystonia. This points to a number of patients currently classified as idiopathic that have at least in part an underlying genetic contribution. The present study aims to identify clinical and demographic features associated with heritability of yet idiopathic dystonia. METHODS Seven hundred thirty-three datasets were obtained from the DysTract dystonia registry, patients with acquired dystonia or monogenic causes were excluded. Affected individuals were assigned to a familial and sporadic group, and clinical features were compared across these groups. Additionally, the history of movement disorders was also counted in family members. RESULTS 18.2% of patients reported a family history of dystonia. Groups differed in age at onset, disease duration and presence of tremor on a descriptive level. Logistic regression analysis revealed that tremor was the only predictor for a positive family history of dystonia (OR 2.49, CI = 1.54-4.11, p < 0.001). Tremor turned out to be the most common movement disorder in available relatives of patients, and presence of tremor in relatives was associated with tremor in index patients (X2(1) = 16.2, p < 0.001). CONCLUSIONS Tremor is associated with an increased risk of familial clustering of dystonia and with a family history of tremor itself. This indicates a hereditable dystonia-tremor syndrome with a clinical spectrum ranging from tremor-predominant diseases to dystonia.
Collapse
Affiliation(s)
- Sebastian Loens
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany.
| | - Feline Hamami
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Judith Everding
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Katrin Marth
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
4
|
Gövert F, Abrante L, Becktepe J, Balint B, Ganos C, Hofstadt-van Oy U, Krogias C, Varley J, Irani SR, Paneva S, Titulaer MJ, de Vries JM, Boon AJW, Schreurs MWJ, Joubert B, Honnorat J, Vogrig A, Ariño H, Sabater L, Dalmau J, Scotton S, Jacob S, Melzer N, Bien CG, Geis C, Lewerenz J, Prüss H, Wandinger KP, Deuschl G, Leypoldt F. Distinct movement disorders in contactin-associated-protein-like-2 antibody-associated autoimmune encephalitis. Brain 2023; 146:657-667. [PMID: 35875984 DOI: 10.1093/brain/awac276] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/28/2021] [Revised: 06/02/2022] [Accepted: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
Autoimmune encephalitis can be classified into antibody-defined subtypes, which can manifest with immunotherapy-responsive movement disorders sometimes mimicking non-inflammatory aetiologies. In the elderly, anti-LGI1 and contactin associated protein like 2 (CASPR2) antibody-associated diseases compose a relevant fraction of autoimmune encephalitis. Patients with LGI1 autoantibodies are known to present with limbic encephalitis and additionally faciobrachial dystonic seizures may occur. However, the clinical spectrum of CASPR2 autoantibody-associated disorders is more diverse including limbic encephalitis, Morvan's syndrome, peripheral nerve hyperexcitability syndrome, ataxia, pain and sleep disorders. Reports on unusual, sometimes isolated and immunotherapy-responsive movement disorders in CASPR2 autoantibody-associated syndromes have caused substantial concern regarding necessity of autoantibody testing in patients with movement disorders. Therefore, we aimed to systematically assess their prevalence and manifestation in patients with CASPR2 autoimmunity. This international, retrospective cohort study included patients with CASPR2 autoimmunity from participating expert centres in Europe. Patients with ataxia and/or movement disorders were analysed in detail using questionnaires and video recordings. We recruited a comparator group with anti-LGI1 encephalitis from the GENERATE network. Characteristics were compared according to serostatus. We identified 164 patients with CASPR2 autoantibodies. Of these, 149 (90.8%) had only CASPR2 and 15 (9.1%) both CASPR2 and LGI1 autoantibodies. Compared to 105 patients with LGI1 encephalitis, patients with CASPR2 autoantibodies more often had movement disorders and/or ataxia (35.6 versus 3.8%; P < 0.001). This was evident in all subgroups: ataxia 22.6 versus 0.0%, myoclonus 14.6 versus 0.0%, tremor 11.0 versus 1.9%, or combinations thereof 9.8 versus 0.0% (all P < 0.001). The small group of patients double-positive for LGI1/CASPR2 autoantibodies (15/164) significantly more frequently had myoclonus, tremor, 'mixed movement disorders', Morvan's syndrome and underlying tumours. We observed distinct movement disorders in CASPR2 autoimmunity (14.6%): episodic ataxia (6.7%), paroxysmal orthostatic segmental myoclonus of the legs (3.7%) and continuous segmental spinal myoclonus (4.3%). These occurred together with further associated symptoms or signs suggestive of CASPR2 autoimmunity. However, 2/164 patients (1.2%) had isolated segmental spinal myoclonus. Movement disorders and ataxia are highly prevalent in CASPR2 autoimmunity. Paroxysmal orthostatic segmental myoclonus of the legs is a novel albeit rare manifestation. Further distinct movement disorders include isolated and combined segmental spinal myoclonus and autoimmune episodic ataxia.
Collapse
Affiliation(s)
- Felix Gövert
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Ligia Abrante
- Neuroimmunology, Institute of Clinical Chemistry, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK.,Department of Neurology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | | | - Christos Krogias
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - James Varley
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Sofija Paneva
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Juna M de Vries
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Agnita J W Boon
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Bastien Joubert
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Jerome Honnorat
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Helena Ariño
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Service of Neurology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
| | - Lidia Sabater
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Service of Neurology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
| | - Josep Dalmau
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Service of Neurology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.,Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
| | - Sangeeta Scotton
- Department of Neurology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, University of Münster, 48149 Münster, Germany.,Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany
| | - Christian Geis
- Department of Neurology, University of Jena, 07747 Jena, Germany
| | - Jan Lewerenz
- Department of Neurology, Ulm University, 89081 Ulm, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin and Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Klaus-Peter Wandinger
- Neuroimmunology, Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 23538 Lübeck, Germany.,Department of Neurology, University of Luebeck and University Medical Center Schleswig-Holstein, 23538 Lübeck, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.,Neuroimmunology, Institute of Clinical Chemistry, Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| |
Collapse
|
5
|
Al-Fatly B, Tödt I, Tischer M, Neimat J, Hedera P, Wong J, Okun M, Nowacki A, Aziz T, Prokop T, Coenen V, Bargiotas P, Lachenmayer L, Helmers AK, Paschen S, Kühn A, Horn A, Fox M, Becktepe J, Deuschl G. Optimal deep brain stimulation connectivity to treat Holmes tremor. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
|
6
|
Becktepe J, Gövert F, Balint B, Schlenstedt C, Bhatia K, Elble R, Deuschl G. Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment. Mov Disord Clin Pract 2021; 8:371-376. [PMID: 33816665 PMCID: PMC8015892 DOI: 10.1002/mdc3.13150] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor. Objectives A new clinical tool for assessing the presence or absence of clinical signs that are important in axis‐1 classification of tremor patients is introduced: the Standardized Tremor Elements Assessment (STEA). Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified. Methods Three tremor‐focussed and one dystonia‐focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated. Results Interrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Greater agreement was found for items characterizing tremor than for signs of dystonia. Conclusions Clinical signs leading to diagnostic disagreement were identified with STEA, and STEA should therefore be useful in future studies of diagnostic disagreement. The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not simply within a pool of tremor specialists.
Collapse
Affiliation(s)
- Jos Becktepe
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Felix Gövert
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London UK.,Department of Neurology University Hospital Heidelberg Heidelberg Germany
| | - Christian Schlenstedt
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London UK
| | - Rodger Elble
- Department of Neurology Southern Illinois University School of Medicine Springfield Illinois USA
| | - Günther Deuschl
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| |
Collapse
|
7
|
Gövert F, Becktepe J, Balint B, Rocchi L, Brugger F, Garrido A, Walter T, Hannah R, Rothwell J, Elble R, Deuschl G, Bhatia K. Temporal discrimination is altered in patients with isolated asymmetric and jerky upper limb tremor. Mov Disord 2019; 35:306-315. [PMID: 31724777 DOI: 10.1002/mds.27880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/16/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Unilateral or very asymmetric upper limb tremors with a jerky appearance are poorly investigated. Their clinical classification is an unsolved problem because their classification as essential tremor versus dystonic tremor is uncertain. To avoid misclassification as essential tremor or premature classification as dystonic tremor, the term indeterminate tremor was suggested. OBJECTIVES The aim of this study was to characterize this tremor subgroup electrophysiologically and evaluate whether diagnostically meaningful electrophysiological differences exist compared to patients with essential tremor and dystonic tremor. METHODS We enrolled 29 healthy subjects and 64 patients with tremor: 26 with dystonic tremor, 23 with essential tremor, and 15 patients with upper limb tremor resembling essential tremor but was unusually asymmetric and jerky (indeterminate tremor). We investigated the somatosensory temporal discrimination threshold, the short-interval intracortical inhibition, and the cortical plasticity by paired associative stimulation. RESULTS Somatosensory temporal discrimination threshold was significantly increased in patients with dystonic tremor and indeterminate tremor, but it was normal in the essential tremor patients and healthy controls. Significant differences in short-interval intracortical inhibition and paired associative stimulation were not found among the three patient groups and controls. CONCLUSION These results indicate that indeterminate tremor, as defined in this study, shares electrophysiological similarities with dystonic tremor rather than essential tremor. Therefore, we propose that indeterminate tremor should be considered as a separate clinical entity from essential tremor and that it might be dystonic in nature. Somatosensory temporal discrimination appears to be a useful tool in tremor classification. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Florian Brugger
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alicia Garrido
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Tim Walter
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Ricci Hannah
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| |
Collapse
|
8
|
Gövert F, Becktepe J, Deuschl G. [The new tremor classification of the International Parkinson and Movement Disorder Society : Update on frequent tremors]. Nervenarzt 2019; 89:376-385. [PMID: 29442146 DOI: 10.1007/s00115-018-0489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tremor is one of the most frequent movement disorders. The recently published new classification of the Movement Disorder Society separates the clinical description of tremor syndromes as so-called axis 1 symptom constellations from the etiologies of tremor (axis 2). The same tremor syndromes can therefore be combined with different causes and vice versa. The terminology used in this classification is precisely defined and thereby also the necessary language for medical communication. Frequent tremor syndromes, such as enhanced physiologic tremor, dystonic and parkinsonian tremor as well as focal tremors and task and position-specific tremors are discussed with respect to the phenomenology, and current therapy.
Collapse
Affiliation(s)
- F Gövert
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland.
| | - J Becktepe
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland
| | - G Deuschl
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland
| |
Collapse
|
9
|
Paschen S, Forstenpointner J, Becktepe J, Heinzel S, Hellriegel H, Witt K, Helmers AK, Deuschl G. Long-term efficacy of deep brain stimulation for essential tremor: An observer-blinded study. Neurology 2019; 92:e1378-e1386. [PMID: 30787161 DOI: 10.1212/wnl.0000000000007134] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial. METHODS Twenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup. RESULTS Tremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = -0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation. CONCLUSION Vim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years.
Collapse
Affiliation(s)
- Steffen Paschen
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Julia Forstenpointner
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Jos Becktepe
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Sebastian Heinzel
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Helge Hellriegel
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Karsten Witt
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Ann-Kristin Helmers
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Günther Deuschl
- From the Departments of Neurology (S.P., J.F., J.B., S.H., H.H., K.W., G.D.) and Neurosurgery (A.-K.H.), Christian-Albrechts-University; Division of Neurological Pain Research and Therapy (J.F.), Department of Neurology, University Hospital Schleswig-Holstein, Kiel; and Department of Neurology (K.W.), School of Medicine and Health Sciences-European Medical School, University Oldenburg and Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany.
| |
Collapse
|
10
|
Becktepe J, Gövert F, Deuschl G. Übergreifende Konzepte der Neurodegeneration. Akt Neurol 2017. [DOI: 10.1055/s-0042-123500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jos Becktepe
- Klinik für Neurologie, Campus Kiel, Universitätsklinikum Schleswig Holstein, Christian Albrechts Universität Kiel
| | - Felix Gövert
- Klinik für Neurologie, Campus Kiel, Universitätsklinikum Schleswig Holstein, Christian Albrechts Universität Kiel
| | - Günther Deuschl
- Klinik für Neurologie, Campus Kiel, Universitätsklinikum Schleswig Holstein, Christian Albrechts Universität Kiel
| |
Collapse
|