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Chiang MK, Lin TC, Lin KH, Chang YC, Hsieh-Li HM, Lai DM. Hyperbaric Oxygen Therapy Attenuated the Motor Coordination and Cognitive Impairment of Polyglutamine Spinocerebellar Ataxia SCA17 Mice. Cerebellum 2024; 23:401-417. [PMID: 36943575 DOI: 10.1007/s12311-023-01548-y] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a large and diverse group of autosomal-dominant neurodegenerative diseases. No drugs have been approved for these relentlessly progressive and fatal SCAs. Our previous studies indicate that oxidative stress, neuroinflammation, and neuronal apoptosis are elevated in the SCA17 mice, which are the main therapeutic targets of hyperbaric oxygen treatment (HBOT). HBOT is considered to be an alternative and less invasive therapy for SCAs. In this study, we evaluated the HBOT (2.2 ATA for 14 days) effect and the persistence for the management of SCA17 mice and their wild-type littermates. We found HBOT attenuated the motor coordination and cognitive impairment of SCA17 mice and which persisted for about 1 month after the treatment. The results of several biochemistry and liver/kidney hematoxylin and eosin staining show the HBOT condition has no obvious toxicity in the mice. Immunostaining analyses show that the neuroprotective effect of HBOT could be through the promotion of BDNF production and the amelioration of neuroinflammation. Surprisingly, HBOT executes different effects on the male and female SCA17 mice, including the reduction of neuroinflammation and activation of CaMKII and ERK. This study suggests HBOT is a potential alternative therapeutic treatment for SCA17. Accumulated findings have revealed the similarity in disease pathomechanisms and possible therapeutic strategies in polyQ diseases; therefore, HBOT could be an optional treatment as well as the other polyQ diseases.
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Affiliation(s)
- Meng-Ke Chiang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Ta-Chun Lin
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | | | - Ya-Chin Chang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Hsiu Mei Hsieh-Li
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Moraes DBV, Coradine TLC, Silva EVL, Sobreira-Neto MA, Marques W, Gitaí LLG, Tumas V. Genetic Epidemiology and Clinical Characteristics of Patients with Spinocerebellar Ataxias in an Unexplored Brazilian State, Using Strategies for Resource-Limited Settings. Cerebellum 2024; 23:609-619. [PMID: 37454040 DOI: 10.1007/s12311-023-01581-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
Spinocerebellar ataxias (SCAs) have a worldwide average prevalence of 2.7 cases per 100,000 individuals, with significant geographic variability. This study aimed to develop resource-limited strategies to detect and characterize the frequency and genetic-clinical profile of SCAs in an unexplored population from Alagoas State, a low Human Development Index state in northeastern Brazil. Active search strategies were employed to identify individuals with a diagnosis or clinical suspicion of SCAs, and a protocol for clinical and molecular evaluation was applied in collaboration with a reference center in Neurogenetics. A total of 73 individuals with SCAs were identified, with a minimum estimated prevalence of 2.17 cases per 100,000 inhabitants. SCA3 was the most common type (75.3%), followed by SCA7 (15.1%), SCA1 (6.8%), and SCA2 (2.7%). Patients with SCA3 subphenotype 2 were the most predominant. Detailed analysis of patients with SCA3 and SCA7 revealed age at onset and clinical features congruent with other studies, with gait disturbance and reduced visual capacity in SCA7 as the main initial manifestations. The study also identified many asymptomatic individuals at risk of developing SCAs. These findings demonstrate that simple and collaborative strategies can enhance the detection capacity of rare diseases such as SCAs in resource-limited settings and that Alagoas State has a minimum estimated prevalence of SCAs similar to the world average.
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Affiliation(s)
- Débora Beserra Vilar Moraes
- Postgraduate Program, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário - Rua Bernardino de Campos, 1000 - Centro, Ribeirão Preto, SP, 65470-000, Brazil
| | - Tácio Luis Cavalcante Coradine
- Graduation Course, Faculty of Medicine, Federal University of Alagoas, Campus Universitário, Avenida Lourival Melo Mota S/N, Tabuleiro dos Martins, CEP 57.072-900, Maceió, Alagoas, Brazil
| | - Everton Vieira Lopes Silva
- Graduation Course, Faculty of Medicine, Federal University of Alagoas, Campus Universitário, Avenida Lourival Melo Mota S/N, Tabuleiro dos Martins, CEP 57.072-900, Maceió, Alagoas, Brazil
| | - Manoel Alves Sobreira-Neto
- Division of Neurology, Faculty of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes, 1408 - 4°, Andar, CEP: 60.430-140, Fortaleza, Brazil
| | - Wilson Marques
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário - Rua Bernardino de Campos, 1000 - Centro, Ribeirão Preto, SP, 65470-000, Brazil
| | - Lívia Leite Góes Gitaí
- Division of Neurology, Faculty of Medicine, Federal University of Alagoas, Campus Universitário, Avenida Lourival Melo Mota S/N, Tabuleiro dos Martins, CEP 57.072-900, Maceió, Alagoas, Brazil.
- , Maceió, Brazil.
| | - Vitor Tumas
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário - Rua Bernardino de Campos, 1000 - Centro, Ribeirão Preto, SP, 65470-000, Brazil.
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Grassini A, Cermelli A, Roveta F, Zotta M, Lesca A, Marcinnò A, Ferrandes F, Piella E, Boschi S, Lombardo C, Brusco A, Gallone S, Rubino E, Bruni A, Rainero I. Cognitive dysfunction, social behavior disorder, cerebellar ataxia, and atypical brain FDG-PET presentation in spinocerebellar ataxia 17: a case report. Neurol Sci 2024:10.1007/s10072-024-07453-4. [PMID: 38494459 DOI: 10.1007/s10072-024-07453-4] [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: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Spinocerebellar ataxia 17 (SCA17) is a rare autosomal dominant form of inherited ataxia, caused by heterozygous trinucleotide repeat expansions encoding glutamine in the TATA box-binding protein (TBP) gene. CASE DESCRIPTION We describe the clinical history, neuropsychological, and neuroimaging findings of a 42-year-old patient who presented for medical attention showing prevalent behavioral and cognitive problems along with progressively worsening gait disturbances. The patient's family history indicated the presence of SCA17 in the maternal lineage. Genetic analysis confirmed a heterozygous 52-CAG pathological expansion repeat in TBP (normal interval, 25-40 CAG. Brain 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed bilateral hypometabolism in the sensorimotor cortex, with a slight predominance on the right, as well as in the striatal nuclei and thalamic hypermetabolism, a finding similar to what is observed in Huntington's disease. The patient also underwent neuropsychological evaluation, which revealed mild cognitive impairment and difficulties in social interaction and understanding other's emotions (Faux Pas Test and Reading the Mind in the Eyes Test). CONCLUSION Our report emphasizes the importance of considering SCA17 as a possible diagnosis in patients with a prevalent progressive cognitive and behavioral disorders, even with a pattern of FDG-PET hypometabolism not primarily indicative of this disease.
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Affiliation(s)
- Alberto Grassini
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy.
| | - Aurora Cermelli
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Fausto Roveta
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Michela Zotta
- Nuclear Medicine, Città Della Salute E Della Scienza University Hospital, Turin, Italy
| | - Adriana Lesca
- Nuclear Medicine, Città Della Salute E Della Scienza University Hospital, Turin, Italy
| | - Andrea Marcinnò
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Fabio Ferrandes
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Elisa Piella
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Silvia Boschi
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Chiara Lombardo
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
| | - Alfredo Brusco
- Department of Neuroscience and Mental Health, Città Della Salute E Della Scienza University Hospital, Turin, Italy
- Medical Genetics Unit, Città Della Salute E Della Scienza University Hospital, Turin, Italy
| | - Salvatore Gallone
- Department of Neuroscience and Mental Health, Città Della Salute E Della Scienza University Hospital, Turin, Italy
| | - Elisa Rubino
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
- Department of Neuroscience and Mental Health, Città Della Salute E Della Scienza University Hospital, Turin, Italy
| | - Amalia Bruni
- Regional Neurogenetic Centre, Department of Primary Care, ASP Catanzaro, Lamezia Terme, Italy
| | - Innocenzo Rainero
- Aging Brain and Memory Clinic, Department of Neuroscience, "Rita Levi Montalcini", Memory Clinic, University of Torino, Via Cherasco 15, 10126, Turin, Italy
- Department of Neuroscience and Mental Health, Città Della Salute E Della Scienza University Hospital, Turin, Italy
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You H, Cai Q, Ouyang Z, Li X, Wu C. Patient-Reported Outcome Measure of Ataxia Correlates with Canonical Clinical Assessments in Chinese Spinocerebellar Ataxias. Cerebellum 2023:10.1007/s12311-023-01630-5. [PMID: 37943429 DOI: 10.1007/s12311-023-01630-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
Spinocerebellar ataxia (SCA) patients' reports of their own experiences are essential to the outcome evaluation in clinical trials. To better understand the health condition and well-being of ataxia population, Patient-Reported Outcome Measure of Ataxia (PROM-Ataxia) was developed. The aim of our study was to culturally adapt the PROM-Ataxia into Chinese version and assess its correlation with canonical clinical assessments. We translated the PROM-Ataxia into Chinese following the ISPOR TCA Task Force guidelines and evaluated its correlation with measures of motor ataxia, non-ataxia signs, quality of life, and mental health in 92 Chinese SCA participants. Nearly all the participants found this questionnaire complete and intelligible but some items were found repetitive or ambiguous. The total score of PROM-Ataxia from stage 0 to stage 3 was 23.24 ± 18.53, 79.11 ± 40.45, 144.30 ± 41.30, and 176.20 ± 31.74, respectively (p < 0.0001). It was strongly correlated with the Scale for the Assessment and Rating of Ataxia (SARA) (r = 0.832, p < 0.0001). Physical and activities domain of PROM-Ataxia were correlated with measures of motor ataxia, quality of life, and psychological health while mental health domain was correlated with all the clinical assessments including inventory of non-ataxia signs and cognitive assessment. We translated the PROM-Ataxia into Chinese for the first time, which allows transnational comparability in future studies. Our study validated the responsiveness of PROM-Ataxia to established clinical measures in Chinese SCA patients and implied its potential to evaluate the therapeutic effect and optimize the sensitivity of changes in clinical outcome assessments.
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Affiliation(s)
- Huajing You
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qiong Cai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Ziyue Ouyang
- China Spinocerebellar Ataxia Association, Beijing, China
| | - Xunhua Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Chao Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
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Milne SC, Roberts M, Ross HL, Robinson A, Grove K, Modderman G, Williams S, Chua J, Grootendorst AC, Massey L, Szmulewicz DJ, Delatycki MB, Corben LA. Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia. Arch Phys Med Rehabil 2023; 104:1646-1651. [PMID: 37268274 DOI: 10.1016/j.apmr.2023.05.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). DESIGN Participants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. SETTING Assessments were administered at 3 clinical locations in separate states in Australia. PARTICIPANTS Twenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). MAIN OUTCOME MEASURES Total and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. RESULTS Intraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. CONCLUSIONS The m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.
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Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Physiotherapy Department, Monash Health, Cheltenham, Australia; School of Primary and Allied Health Care, Monash University, Frankston, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia.
| | - Melissa Roberts
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Physiotherapy Department, Monash Health, Cheltenham, Australia
| | - Hannah L Ross
- Physiotherapy Department, Monash Health, Cheltenham, Australia
| | | | - Kristen Grove
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Gabrielle Modderman
- Rehabilitation Services, Royal Darwin and Palmerston Regional Hospital, Darwin, Australia
| | - Shannon Williams
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | | | | | - Libby Massey
- MJD Foundation, Darwin, Australia; College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - David J Szmulewicz
- Balance Disorders & Ataxia Service, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Monash Medical Centre, Monash Health, Clayton, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia; Victorian Clinical Genetics Services, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
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De Mattei F, Ferrandes F, Gallone S, Canosa A, Calvo A, Chiò A, Vasta R. Epidemiology of Spinocerebellar Ataxias in Europe. Cerebellum 2023:10.1007/s12311-023-01600-x. [PMID: 37698771 DOI: 10.1007/s12311-023-01600-x] [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] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a heterogenous group of rare neurodegenerative conditions sharing an autosomal dominant pattern of inheritance. More than 40 SCAs have been genetically determined. However, a systematic review of SCA epidemiology in Europe is still missing. Here we performed a narrative review of the literature on the epidemiology of the most common SCAs in Europe. PubMed, Embase, and MEDLINE were searched from inception until 1 April 2023. All English peer-reviewed articles published were considered and then filtered by abstract examination and subsequently by full text reading. A total of 917 original articles were retrieved. According to the inclusion criteria and after reviewing references for useful papers, a total of 35 articles were included in the review. Overall, SCA3 is the most frequent spinocerebellar ataxia in Europe. Its frequency is strikingly higher in Portugal, followed by Germany, France, and Netherlands. None or few cases were described in Italy, Russia, Poland, Serbia, Finland, and Norway. SCA1 and SCA2 globally displayed similar frequencies, and are more prevalent in Italy, United Kingdom, Poland, Serbia, and France.
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Affiliation(s)
- Filippo De Mattei
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Fabio Ferrandes
- Aging Brain and Memory Clinic, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Salvatore Gallone
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Antonio Canosa
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Andrea Calvo
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Adriano Chiò
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 1, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Rosario Vasta
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Zhao J, Zeng W, Huang X, Hu M, Yuan K, Wu C, Qiu H, Chu J. Analysis and hierarchical clustering of infratentorial morphological MRI identifies SCAs phenogroups. J Neurol 2023; 270:4466-4477. [PMID: 37291395 DOI: 10.1007/s00415-023-11792-1] [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: 02/21/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical decision-making in spinocerebellar ataxia spectrum diseases (SCAs) has mainly been based on genetic tests, not considering the SCAs' imaging and clinical heterogenicity. OBJECTIVE To identify SCAs phenogroups by analysis and hierarchical clustering of infratentorial morphological MRI for unveiling pathophysiological differences among common SCA subtypes. METHODS We prospectively enrolled 119 (62 women; mean age 37 years) genetically diagnosed SCAs (SCA1 n = 21, SCA2 n = 10, symptomatic SCA3 n = 59, presymptomatic SCA3 n = 22, SCA6 n = 7) and 35 healthy controls (HCs). All patients underwent MRI and detailed neurological and neuropsychology examinations. The width of each cerebellar peduncle (CP) and anteroposterior diameter of the spinal cord and pontine were measured. Twenty-five SCAs patients (15 women; mean age 35 years) were followed for at least a year (17 (15, 24) months), whose MRI and the Scale for the Assessment and Rating of Ataxia (SARA) were collected. RESULTS Infratentorial morphological MRI measurements could significantly discriminate SCAs from HCs, even among SCA subtypes. Two mutually exclusive and clinically distinct phenogroups were identified. Despite similar (CAG)n, phenogroup 1 (n = 66, 55.5%) presented more atrophied infratentorial brain structures and more severe clinical symptoms with older age and earlier age of onset when compared with phenogroup 2. More importantly, all SCA2, most of SCA1 (76%), and symptomatic SCA3 (68%) were classified into phenogroup 1, whereas all SCA6 and all presymptomatic SCA3 were in phenogroup 2. The right middle CP had the highest diagnostic value in predicting phenogroup 2 (AUC = 0.99; P < 0.01) with high specificity (95%). Consistent with the significantly increased SARA (7.5 vs 10, P = 0.021), the bilateral inferior CP, spinal cord, and pontine tegmentum were more atrophy during the follow-up (P < 0.05). CONCLUSION SCAs were with significant infratentorial brain atrophy than HCs. We identified two different SCAs phenogroups associated with substantial differences in infratentorial brain atrophy, clinical presentation, and may reflect the underlying molecular profiles to some extent, paving the way for a more personalized diagnostic and treatment approach.
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Affiliation(s)
- Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Wenting Zeng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Xiaolong Huang
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, Fujian, China
| | - Manshi Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Kang Yuan
- Sun Yat-Sen University, Guangzhou, 518000, Guangdong, China
| | - Chao Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 518000, China.
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China.
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
| | - Haishan Qiu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China.
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China.
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8
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Guo R, Cui M, Li X, Wu M, Xu F, Zhang Y, Wang C, Feng P, Wang J, Huo S, Luo Z, Xing R, Gu J, Shi X, Liu Y, Wang L. Design, synthesis and biological evaluation of pyrrolopyrimidine derivatives as novel and selective positive modulator of the small conductance Ca 2+-activated K + channels. Eur J Med Chem 2023; 254:115353. [PMID: 37068385 DOI: 10.1016/j.ejmech.2023.115353] [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: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
The type 2 small conductance Ca2+-activated K+ channels (SK2) have been considered as one of the most promising therapeutic targets for spinocerebellar ataxias type 2 (SCA2) by playing a critical role in the control of normal purkinje cells (PCs) pacemaking. Herein, a novel series of pyrrolopyrimidine derivatives were designed and synthesized from the lead compound NS13001 as subtype-selective modulators of SK channels. Among them, the halogen-substituted compound 12b (EC50 = 0.34 ± 0.044 μM) was identified with a ∼5.4-fold higher potency on potentiating SK2-a channels at submicromolar concentrations as compared to NS13001 (EC50 = 1.83 ± 0.50 μM). Furthermore, compound 12b exhibited selectivity on SK2-a/SK3 subtype by displaying 93.33 ± 3.26% efficacies on SK2-a channels, and 84.54% ± 7.49% on SK3 channels. In addition, compound 12b demonstrated the potential to cross the blood-brain barrier (BBB) with suitable pharmacokinetic properties and low cytotoxicity. Molecular docking study also unveiled the binding interactions of compound 12b with SK2-CaM protein complex. Overall, the novel pyrrolopyrimidines provide an insightful guidance for future structural optimization of SK channel agonists.
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Affiliation(s)
- Ran Guo
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Miao Cui
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Xiaojing Li
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Mengqi Wu
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Fei Xu
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Yining Zhang
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Chun Wang
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Penglei Feng
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Jianchao Wang
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Sijia Huo
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Zijun Luo
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Ruijuan Xing
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Jianmin Gu
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Xiaowei Shi
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China.
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, PR China; Hebei Province Key Laboratory of Environment and Human Health, Shijiazhuang, 050017, PR China.
| | - Lei Wang
- Department of Medicinal Chemistry, School of Pharmacy, Hebei Medical University, Shijiazhuang, 050017, PR China; Hebei Province Key Laboratory of Innovative Drug Research and Evaluation, Shijiazhuang, 050017, PR China.
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9
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Galvão AF, Lemos T, Martins CP, Horsczaruk CHR, Oliveira LAS, Ferreira ADS. Body sway and movement strategies for control of postural stability in people with spinocerebellar ataxia type 3: A cross-sectional study. Clin Biomech (Bristol, Avon) 2022; 97:105711. [PMID: 35779462 DOI: 10.1016/j.clinbiomech.2022.105711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postural instability with an excessive body sway is a disabling manifestation in spinocerebellar ataxia type 3. Whether the larger body sway reflects distinct movement strategies for postural control remains uncertain. This study compared the control of postural stability of people with spinocerebellar ataxia type 3 with healthy subjects using body sway and movement strategy analyses derived from bi- and three-dimensional posturography. METHODS Twenty-three patients (7 men, 16 women, 47 ± 11 years) and 102 healthy participants (34 men, 68 women; 44 ± 22 years) underwent posturography while standing with eyes open/closed tasks. Postural stability was assessed using elliptical area and average velocity of body sway. Spatial patterns (single-, double-, or multi-centered) were derived from the number of high-density regions in the three-dimensional statokinesigram. FINDINGS Repeated measures two-way analysis-of-variance showed a vision-by-group interaction effect for area (F1,122 = 28.831, P < 0.001, η2 = 0.037) and velocity (F1,123 = 59.367, P < 0.001, η2 = 0.073); sway area and velocity were higher in spinocerebellar ataxia type 3 and increased under eyes-closed condition, with a higher increase in the spinocerebellar ataxia type 3. A main effect for group (F1,123 = 11.702, P < 0.001, η2 = 0.061) but not vision (F1,123 = 2.257, P = 0.136, η2 = 0.005) was found for the number of high-density regions. Spatial patterns were different between groups under trials with eyes closed (χ22,125 = 7.46, P = 0.023) but not open (χ22,125 = 2.026, P = 0.363), with a shift from single- to double- or multi-centered spatial patterns. INTERPRETATION Compared to healthy subjects, a larger body displacement and velocity in spinocerebellar ataxia type 3, mainly under visual constraints, are not related to the predominance of either ankle or hip movement strategies.
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Affiliation(s)
- Ana Fernanda Galvão
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Thiago Lemos
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Camilla Polonini Martins
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | | | - Laura Alice Santos Oliveira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
| | - Arthur de Sá Ferreira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - UNISUAM, Rio de Janeiro, Brazil.
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10
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Winser S, Chan AYY, Chung R, Whitney S, Kannan P. Validity of balance measures in cerebellar ataxia: A prospective study with 12-month follow-up. PM R 2022. [PMID: 35474301 DOI: 10.1002/pmrj.12826] [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: 10/04/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Balance deficits are common in cerebellar ataxia. Determining which balance outcome measures are psychometrically strong for this population remains an unmet need. OBJECTIVE Evaluate the validity and responsiveness of two clinic-based balance measures [Berg Balance Scale (BBS) and balance sub-component of the Scale for the Assessment and Rating of Ataxia (SARA-bal)] and two laboratory-based balance measures [Sensory Organization Test (SOT) and Limits of Stability (LOS)] in cerebellar ataxia. DESIGN Prospective cohort study. SETTING Institutional study assessing 40 participants with cerebellar ataxia at baseline, 6, and 12 months. MAIN OUTCOME MEASURES Balance was assessed using the BBS, SARA-bal, SOT, and LOS; disease severity was assessed using the SARA; and Patients' Global Impression of Change (PGIC) was used to estimate responsiveness to disease progress at 6 and 12 months. RESULTS BBS and SARA-bal (Spearman's correlation coefficient, ρS = -0.89, p < 0.01) demonstrated strong criterion validity. Convergent validity was moderate to high (ρS range:-0.75 to 0.92) and external validity was low (ρS range:-0.75 to 0.11). Composite SOT scores (SOT-COM; ρS=0.29, p<0.01) and maximal excursion (MXE-LOS) in the forward (F) and right (R) directions of the LOS (ρS = 0.18, p < 0.01) demonstrated moderate to low criterion and convergent validity. The area under the receiver operating characteristic curve (AUCROC ) and its effect size (standard response mean [SRM]) for categorizing 'stable' and 'worsened' patients at 6 and 12 months were satisfactory for the BBS (AUCROC :0.75; SRM-Stable:1.06; SRM-Worsened:1.16), SARA-bal (AUCROC :0.76; SRM-Stable:0.86; SRM-Worsened:0.85), and MXE-LOS(R) (AUCROC :0.29; SRM-Stable:0.41; SRM-Worsened:1.39). CONCLUSION BBS and SARA-bal have moderate to strong criterion and convergent validity and adequate responsiveness to balance changes. Both laboratory-based measures (SOT and LOS) demonstrated a high floor effect. The SOT-COM and MXE-LOS(R) demonstrated moderate to low criterion validity, with only the MXE-LOS(R) displaying adequate responsiveness to balance changes after 6 and 12 months. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stanley Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Anne Y Y Chan
- Division of Neurology, Prince of Wales Hospital and Dept. of Medicine and Therapeutics, Chinese University of Hong Kong
| | - Raymond Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Susan Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, USA.,Rehabilitation Research Chair at King Saud University, Saudi Arabia
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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11
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Abstract
Polyglutamine diseases are a collection of nine CAG trinucleotide expansion disorders, presenting with a spectrum of neurological and clinical phenotypes. Recent human, mouse and cell studies of Huntington's disease have highlighted the role of DNA repair genes in somatic expansion of the CAG repeat region, modifying disease pathogenesis. Incomplete splicing of the HTT gene has also been shown to occur in humans, with the resulting exon 1 fragment most probably contributing to the Huntington's disease phenotype. In the spinocerebellar ataxias, studies have converged on transcriptional dysregulation of ion channels as a key disease modifier. In addition, advances have been made in understanding how increased levels of toxic, polyglutamine-expanded proteins can arise in the spinocerebellar ataxias through post-transcriptional and -translational modifications and autophagic mechanisms. Recent studies in spinal and bulbar muscular atrophy implicate similar pathogenic pathways to the more common polyglutamine diseases, highlighting autophagy stimulation as a potential therapeutic target. Finally, the therapeutic use of antisense oligonucleotides in several polyglutamine diseases has shown preclinical benefits and serves as potential future therapies in humans.
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Affiliation(s)
- Emma L Bunting
- UCL Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Joseph Hamilton
- UCL Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sarah J Tabrizi
- UCL Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK; UK Dementia Research Institute, University College London, London, WC1N 3BG, UK.
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12
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van Prooije T, Ibrahim NM, Azmin S, van de Warrenburg B. Spinocerebellar ataxias in Asia: Prevalence, phenotypes and management. Parkinsonism Relat Disord 2021; 92:112-118. [PMID: 34711523 DOI: 10.1016/j.parkreldis.2021.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
This paper reviews and summarizes three main aspects of spinocerebellar ataxias (SCA) in the Asian population. First, epidemiological studies were comprehensively reviewed. Overall, the most common subtypes include SCA1, SCA2, SCA3, and SCA6, but there are large differences in the relative prevalence of these and other SCA subtypes between Asian countries. Some subtypes such as SCA12 and SCA31 are rather specific to certain Asian populations. Second, we summarized distinctive phenotypic manifestations of SCA patients of Asian origin, for example a frequent co-occurrence of parkinsonism in some SCA subtypes. Lastly, we have conducted an exploratory survey study to map SCA-specific expertise, resources, and management in various Asian countries. This showed large differences in accessibility, genetic testing facilities, and treatment options between lower and higher income Asian countries. Currently, many Asian SCA patients remain without a final genetic diagnosis. Lack of prevalence data on SCA, lack of patient registries, and insufficient access to genetic testing facilities hamper a wider understanding of these diseases in several (particularly lower income) Asian countries.
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Affiliation(s)
- Teije van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
| | - Norlinah Mohamed Ibrahim
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shahrul Azmin
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
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13
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Abstract
The term SCA refers to a phenotypically and genetically heterogeneous group of autosomal dominant spinocerebellar ataxias. Phenotypically they present as gait ataxia frequently in combination with dysarthria and oculomotor problems. Additional signs and symptoms are common and can include various pyramidal and extrapyramidal signs and intellectual impairment. Genetic causes of SCAs are either repeat expansions within disease genes or common mutations (point mutations, deletions, insertions etc.). Frequently the two types of mutations cause indistinguishable phenotypes (locus heterogeneity). This article focuses on SCAs caused by common mutations. It describes phenotype and genotype of the presently 27 types known and discusses the molecular pathogenesis in those 21 types where the disease gene has been identified. Apart from the dominant types, the article also summarizes findings in a variant caused by mutations in a mitochondrial gene. Possible common disease mechanisms are considered based on findings in the various SCAs described.
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Affiliation(s)
- Ulrich Müller
- Institute of Human Genetics, JLU-Gießen, Schlangenzahl 14, 35392, Giessen, Germany.
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14
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Cendelin J, Cvetanovic M, Gandelman M, Hirai H, Orr HT, Pulst SM, Strupp M, Tichanek F, Tuma J, Manto M. Consensus Paper: Strengths and Weaknesses of Animal Models of Spinocerebellar Ataxias and Their Clinical Implications. Cerebellum 2021; 21:452-481. [PMID: 34378174 DOI: 10.1007/s12311-021-01311-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/02/2023]
Abstract
Spinocerebellar ataxias (SCAs) represent a large group of hereditary degenerative diseases of the nervous system, in particular the cerebellum, and other systems that manifest with a variety of progressive motor, cognitive, and behavioral deficits with the leading symptom of cerebellar ataxia. SCAs often lead to severe impairments of the patient's functioning, quality of life, and life expectancy. For SCAs, there are no proven effective pharmacotherapies that improve the symptoms or substantially delay disease progress, i.e., disease-modifying therapies. To study SCA pathogenesis and potential therapies, animal models have been widely used and are an essential part of pre-clinical research. They mainly include mice, but also other vertebrates and invertebrates. Each animal model has its strengths and weaknesses arising from model animal species, type of genetic manipulation, and similarity to human diseases. The types of murine and non-murine models of SCAs, their contribution to the investigation of SCA pathogenesis, pathological phenotype, and therapeutic approaches including their advantages and disadvantages are reviewed in this paper. There is a consensus among the panel of experts that (1) animal models represent valuable tools to improve our understanding of SCAs and discover and assess novel therapies for this group of neurological disorders characterized by diverse mechanisms and differential degenerative progressions, (2) thorough phenotypic assessment of individual animal models is required for studies addressing therapeutic approaches, (3) comparative studies are needed to bring pre-clinical research closer to clinical trials, and (4) mouse models complement cellular and invertebrate models which remain limited in terms of clinical translation for complex neurological disorders such as SCAs.
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Affiliation(s)
- Jan Cendelin
- Department of Pathophysiology, Faculty of Medicine in Pilsen, Charles University, alej Svobody 75, 323 00, Plzen, Czech Republic. .,Laboratory of Neurodegenerative Disorders, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 75, 323 00, Plzen, Czech Republic.
| | - Marija Cvetanovic
- Department of Neuroscience, Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Mandi Gandelman
- Department of Neurology, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Hirokazu Hirai
- Department of Neurophysiology and Neural Repair, Gunma University Graduate School of Medicine, 3-39-22, Gunma, 371-8511, Japan.,Viral Vector Core, Gunma University Initiative for Advanced Research (GIAR), Gunma, 371-8511, Japan
| | - Harry T Orr
- Department of Laboratory Medicine and Pathology, Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig-Maximilians University, Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Filip Tichanek
- Department of Pathophysiology, Faculty of Medicine in Pilsen, Charles University, alej Svobody 75, 323 00, Plzen, Czech Republic.,Laboratory of Neurodegenerative Disorders, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 75, 323 00, Plzen, Czech Republic
| | - Jan Tuma
- Department of Pathophysiology, Faculty of Medicine in Pilsen, Charles University, alej Svobody 75, 323 00, Plzen, Czech Republic.,The Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX, 78229, USA
| | - Mario Manto
- Unité des Ataxies Cérébelleuses, Service de Neurologie, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, Université de Mons, UMons, Mons, Belgium
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15
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Arruda WO, Meira AT, Ono SE, de Carvalho Neto A, Betting LEGG, Raskin S, Camargo CHF, Teive HAG. Volumetric MRI Changes in Spinocerebellar Ataxia (SCA3 and SCA10) Patients. Cerebellum 2020; 19:536-43. [PMID: 32367276 DOI: 10.1007/s12311-020-01137-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spinocerebellar ataxias type 3 (SCA3) and type 10 (SCA10) are the most prevalent in southern Brazil. To analyze the relationships between volumetric MRI changes and clinical and genetic findings in SCA3 and SCA10 patients. All patients in the study had a confirmed genetic diagnosis. Demographic data, ataxia severity (SARA score), and the size of the expanded alleles were evaluated. Nineteen SCA3 and 18 SCA10 patients were selected and compared with a similar number of healthy controls. Patient and control groups underwent the same MRI protocol. The standard FreeSurfer pipeline was used for the morphometric data. Our results show more affected brain structures (volume reductions) in SCA3 patients than in SCA10 patients (15 vs. 5 structures). Volume reductions in brain structures were also greater in the former. The main areas with significant volumetric reductions in the former were the cerebellum, basal ganglia, brain stem, and diencephalon, whereas in the latter, significant volume reductions were observed in the cerebellum and pallidum. While SARA scores and disease duration were more correlated with volume reduction in SCA10, in SCA3, the expansion length (CAGn) correlated positively with cerebellar WM, thalamus, brain stem, and total GM volumes. There was no correlation between expansion length (ATTCTn) and neuroimaging findings in SCA10. Neuroimaging results differed significantly between SCA3 and SCA10 patients and were compatible with the differences in clinical presentation, disease progression, and molecular findings.
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16
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Rentiya Z, Hutnik R, Mekkam YQ, Bae J. The Pathophysiology and Clinical Manifestations of Spinocerebellar Ataxia Type 6. Cerebellum 2020; 19:459-64. [PMID: 32125675 DOI: 10.1007/s12311-020-01120-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Spinocerebellar ataxias (SCA) constitute of a group of degenerative and progressive disorders that can be identified on a molecular and cellular basis. Along with histological changes, the clinical presentation of SCA differs between subtypes. In addition to basic cerebellar dysfunction symptoms, patients with SCA develop gait ataxia, dysphagia, dysarthria, oculomotor disturbances, pyramidal and extrapyramidal disease signs, rigidity, bradycardia, sensory deficits, and mild cognitive and executive function decline. MRI scans have confirmed reduction in mass of frontal, temporal, and parietal portions of the brain along with the cerebellar peduncles, brainstem, and cranial nerve III. Clinically, these damages manifest as decline in cognition and problems with speech, contemplation, and vision. This review article compares the most prevalent subtypes of SCA based on genetic background, pathogenesis, neurological manifestations, other presenting symptoms, and diagnostic workup. Further goals of research in this field should be directed towards a cure for SCA, which currently does not exist.
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17
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Coarelli G, Darios F, Petit E, Dorgham K, Adanyeguh I, Petit E, Brice A, Mochel F, Durr A. Plasma neurofilament light chain predicts cerebellar atrophy and clinical progression in spinocerebellar ataxia. Neurobiol Dis 2021; 153:105311. [PMID: 33636389 DOI: 10.1016/j.nbd.2021.105311] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 11/13/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Neurofilament light chain (NfL) is a marker of brain atrophy and predictor of disease progression in rare diseases such as Huntington Disease, but also in more common neurological disorders such as Alzheimer's disease. The aim of this study was to measure NfL longitudinally in autosomal dominant spinocerebellar ataxias (SCAs) and establish correlation with clinical and imaging parameters. We enrolled 62 pathological expansions carriers (17 SCA1, 13 SCA2, 19 SCA3, and 13 SCA7) and 19 age-matched controls in a prospective biomarker study between 2011 and 2015 and followed for 24 months at the Paris Brain Institute. We performed neurological examination, brain 3 T MRI and plasma NfL measurements using an ultrasensitive single-molecule array at baseline and at the two-year follow-up visit. We evaluated NfL correlations with ages, CAG repeat sizes, clinical scores and volumetric brain MRIs. NfL levels were significantly higher in SCAs than controls at both time points (p < 0.001). Age-adjusted NfL levels were significantly correlated at baseline with clinical scores (p < 0.01). We identified optimal NfL cut-off concentrations to differentiate controls from carriers for each genotype (SCA1 16.87 pg/mL, SCA2, 19.1 pg/mL, SCA3 16.04 pg/mL, SCA7 16.67 pg/mL). For all SCAs, NfL concentration was stable over two years (p = 0.95) despite a clinical progression (p < 0.0001). Clinical progression between baseline and follow-up was associated with higher NfL concentrations at baseline (p = 0.04). Of note, all premanifest carriers with NfL levels close to cut off concentrations had signs of the disease at follow-up. For all SCAs, the higher the observed NfL, the lower the pons volume at baseline (p < 0.01) and follow-up (p = 0.02). Higher NfL levels at baseline in all SCAs predicted a decrease in cerebellar volume (p = 0.03). This result remained significant for SCA2 only among all genotypes (p = 0.02). Overall, plasma NfL levels at baseline in SCA expansion carriers predict cerebellar volume change and clinical score progression. NfL levels might help refine inclusion criteria for clinical trials in carriers with very subtle signs.
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Affiliation(s)
- Giulia Coarelli
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Frederic Darios
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Emilien Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), F-75013 Paris, France
| | - Isaac Adanyeguh
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Elodie Petit
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexis Brice
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France
| | - Fanny Mochel
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexandra Durr
- Sorbonne Université, ICM (Paris Brain Institute), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; APHP Department of Genetics, Pitié-Salpêtrière University Hospital, Paris, France.
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18
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Wu F, Wang X, Li X, Teng H, Tian T, Bai J. Spinocerebellar ataxia type 23 (SCA23): a review. J Neurol 2020. [PMID: 33175256 DOI: 10.1007/s00415-020-10297-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023]
Abstract
Spinocerebellar ataxias (SCAs), formerly known as autosomal dominant cerebellar ataxias (ADCAs), are a group of hereditary heterogeneous neurodegenerative diseases. Gait, progressive ataxia, dysarthria, and eye movement disorder are common symptoms of spinocerebellar ataxias. Other symptoms include peripheral neuropathy, cognitive impairment, psychosis, and seizures. Patients may lose their lives due to out of coordinated respiration and/or swallowing. Neurological signs cover pyramidal or extrapyramidal signs, spasm, ophthalmoplegia, hyperactive deep tendon reflexes, and so on. Different subtypes of SCAs present various clinical features. Spinocerebellar ataxia type 23 (SCA23), one subtype of the SCA family, is characterized by mutant prodynorphin (PDYN) gene. Based on literatures, this review details a series of SCA23, to improve a whole understanding of clinicians and point out the potential research direction of this dysfunction, including a history, pathophysiological mechanism, diagnosis and differential diagnosis, epigenetics, penetrance and prevalence, genetic counseling, treatment and prognosis.
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19
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Manini A, Bocci T, Migazzi A, Monfrini E, Ronchi D, Franco G, De Rosa A, Sartucci F, Priori A, Corti S, Comi GP, Bresolin N, Basso M, Di Fonzo A. A case report of late-onset cerebellar ataxia associated with a rare p.R342W TGM6 (SCA35) mutation. BMC Neurol 2020; 20:408. [PMID: 33160304 PMCID: PMC7648302 DOI: 10.1186/s12883-020-01964-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022] Open
Abstract
Background Mutations in TGM6 gene, encoding for transglutaminase 6 (TG6), have been implicated in the pathogenesis of spinocerebellar ataxia type 35 (SCA35), a rare autosomal dominant disease marked by cerebellar degeneration and characterized by postural instability, incoordination of gait, features of cerebellar dysfunction and pyramidal signs. Case presentation Here we report the case of an Italian patient with late-onset, slowly progressive cerebellar features, including gait ataxia, scanning speech and ocular dysmetria and pyramidal tract signs. Whole exome sequencing revealed the rare heterozygous c.1024C > T (p.R342W) variant of TGM6, located at a highly evolutionary conserved position and predicted as pathogenic by in silico tools. Expression of TG6-R342W mutant in HEK293T cells led to a significant reduction of transamidase activity compared to wild-type TG6. Conclusion This finding extends SCA35 genetic landscape, highlighting the importance of TGM6 screening in undiagnosed late-onset and slowly progressive cerebellar ataxias. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01964-1.
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Affiliation(s)
- Arianna Manini
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.,"Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Alice Migazzi
- Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | - Edoardo Monfrini
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Dario Ronchi
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giulia Franco
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Anna De Rosa
- Department of Clinical and Experimental Medicine, Unit of Neurology, Pisa University Medical School, Pisa, Italy
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Unit of Neurology, Pisa University Medical School, Pisa, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefania Corti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Nereo Bresolin
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Manuela Basso
- Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
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20
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Kondo Y, Bando K, Ariake Y, Katsuta W, Todoroki K, Nishida D, Mizuno K, Takahashi Y. Test-retest reliability and minimal detectable change of the Balance Evaluation Systems Test and its two abbreviated versions in persons with mild to moderate spinocerebellar ataxia: A pilot study. NeuroRehabilitation 2020; 47:479-486. [PMID: 33136076 PMCID: PMC7836065 DOI: 10.3233/nre-203154] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND: The reliability of the evaluation of the Balance Evaluation Systems Test (BESTest) and its two abbreviated versions are confirmed for balance characteristics and reliability. However, they are not utilized in cases of spinocerebellar ataxia (SCA). OBJECTIVE: We aimed to examine the test-retest reliability and minimal detectable change (MDC) of the BESTest and its abbreviated versions in persons with mild to moderate spinocerebellar ataxia. METHODS: The BESTest was performed in 20 persons with SCA at baseline and one month later. The scores of the abbreviated version of the BESTest were determined from the BESTest scores. The interclass correlation coefficient (1,1) was used as a measure of relative reliability. Furthermore, we calculated the MDC in the BESTest and its abbreviated versions. RESULTS: The intraclass correlation coefficients (1,1) and MDC at 95% confidence intervals were 0.92, 8.7(8.1%), 0.91, 4.1(14.5%), and 0.81, 5.2(21.6%) for the Balance, Mini-Balance, and Brief-Balance Evaluation Systems Tests, respectively. CONCLUSIONS: The BESTest and its abbreviated versions had high test-retest reliability. The MDC values of the BESTest could enable clinicians and researchers to interpret changes in the balance of patients with SCA more precisely.
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Affiliation(s)
- Yuki Kondo
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kyota Bando
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yosuke Ariake
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Wakana Katsuta
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kyoko Todoroki
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daisuke Nishida
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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21
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Gitaí LLG, Éckeli AL, Sobreira-Neto MA, Diniz PRB, Santos AC, Júnior WM, Fernandes RMF. Which Factors in Spinocerebellar Ataxia Type 3 Patients Are Associated with Restless Legs Syndrome/Willis-Ekbom Disease? Cerebellum 2021; 20:21-30. [PMID: 32946033 DOI: 10.1007/s12311-020-01170-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There is evidence of a higher prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) in individuals with spinocerebellar ataxia type 3 (SCA3), although the factors underlying this association remain unknown. The present study aimed to determine the prevalence of RLS/WED in SCA3 patients and to investigate which factors of SCA3 patients are associated with presence of RLS/WED. From February to August of 2006, we carried out clinical interviews in 40 controls and 40 SCA3 patients, diagnosed and followed up at Faculty of Medicine of Ribeirão Preto, University of São Paulo. Twenty-seven SCA3 patients were submitted to a detailed clinical protocol, electroneuromyography, blood work up, polysomnography (PSG), suggested immobilization test (SIT), and magnetic resonance image (MRI). RLS/WED was found in 27.5% of SCA3 patients and 2.5% of normal controls (p = 0.003). The factors related to RLS/WED in SCA3 patients were female gender, age at start of the symptoms of ataxia after 30 years, presence of peripheral neuropathy, and documented iron deficiency. Among SCA3 patients, those with RLS showed higher values of maximal discomfort level and discomfort level sum compared to non-RLS individuals on SIT. There is a relation between RLS/WED and SCA3, which seems to be resultant of different factors whose identification could improve the quality of assistance to those patients as well as to promote a better comprehension of the pathophysiology of both RLS/WED and SCA3.
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22
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Scott SSDO, Pedroso JL, Barsottini OGP, França-Junior MC, Braga-Neto P. Natural history and epidemiology of the spinocerebellar ataxias: Insights from the first description to nowadays. J Neurol Sci 2020; 417:117082. [PMID: 32791425 DOI: 10.1016/j.jns.2020.117082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/24/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/03/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a heterogeneous group of autosomal dominant inherited diseases that share the degeneration of the cerebellum and its connections as their main feature. We performed a detailed description of the natural history of the main SCAs, focusing on epidemiology, progression, haplotype analysis and its correlation with founder effect, and perspective of future treatments. References for this review were identified by an in-depth literature search on PubMed and selected on the basis of relevance to the topic and on the authors' judgment. More than 40 SCAs have been described so far. SCA3 is the most common subtype worldwide, followed by SCA2 and 6. To evaluate the natural history and to estimate the progression of the main SCAs, consortiums were created all over the globe. Clinical rating scales have been developed to provide an accurate estimation of cerebellar clinical deficits, evaluating cerebellar and non-cerebellar signs. Natural history studies revealed that SCA1 patients' functional status worsened significantly faster than in other SCA subtypes, followed by SCA3, SCA2, SCA6, and SCA10. Number of CAG repeats, age of onset, and ataxia severity at baseline are strong contributors to the risk of death in most SCAs. Understanding the natural history of SCAs is extremely important. Although these are rare diseases, the impact they have on the affected individual are enormous. The advances in the field of genetics are helping understand neuronal functions and dysfunctions and allowing the study and development of possible therapies.
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Affiliation(s)
| | - José Luiz Pedroso
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, R. Sena Madureira1500, São Paulo/SP, Brazil
| | | | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, R. Alexandre Baraúna 949, Fortaleza/CE, Brazil; Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Manguba 1700, Fortaleza/CE, Brazil.
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23
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Ihl T, Kadas EM, Oberwahrenbrock T, Endres M, Klockgether T, Schroeter J, Brandt AU, Paul F, Minnerop M, Doss S, Schmitz-Hübsch T, Zimmermann HG. Investigation of Visual System Involvement in Spinocerebellar Ataxia Type 14. Cerebellum 2020; 19:469-482. [PMID: 32338350 PMCID: PMC7351844 DOI: 10.1007/s12311-020-01130-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxia type 14 (SCA-PRKCG, formerly SCA14) is a rare, slowly progressive disorder caused by conventional mutations in protein kinase Cγ (PKCγ). The disease usually manifests with ataxia, but previous reports suggested PRKCG variants in retinal pathology. To systematically investigate for the first time visual function and retinal morphology in patients with SCA-PRKCG. Seventeen patients with PRKCG variants and 17 healthy controls were prospectively recruited, of which 12 genetically confirmed SCA-PRKCG patients and 14 matched controls were analyzed. We enquired a structured history for visual symptoms. Vision-related quality of life was obtained with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) including the Neuro-Ophthalmic Supplement (NOS). Participants underwent testing of visual acuity, contrast sensitivity, visual fields, and retinal morphology with optical coherence tomography (OCT). Measurements of the SCA-PRKCG group were analyzed for their association with clinical parameters (ataxia rating and disease duration). SCA-PRKCG patients rate their vision-related quality of life in NEI-VFQ significantly worse than controls. Furthermore, binocular visual acuity and contrast sensitivity were worse in SCA-PRKCG patients compared with controls. Despite this, none of the OCT measurements differed between groups. NEI-VFQ and NOS composite scores were related to ataxia severity. Additionally, we describe one patient with a genetic variant of uncertain significance in the catalytic domain of PKCγ who, unlike all confirmed SCA-PRKCG, presented with a clinically silent epitheliopathy. SCA-PRKCG patients had reduced binocular vision and vision-related quality of life. Since no structural retinal damage was found, the pathomechanism of these findings remains unclear.
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Affiliation(s)
- Thomas Ihl
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ella M Kadas
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Timm Oberwahrenbrock
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias Endres
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site, Berlin, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jan Schroeter
- University Tissue Bank, Cornea Bank Berlin, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, University of California, Irvine, CA, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Sarah Doss
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Neurological Sciences, Movement Disorders Section, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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24
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Gonzales-Sáenz C, Cruz-Rodriguez C, Espinoza-Huertas K, Véliz-Otani D, Marca V, Ortega O, Milla-Neyra K, Alvarez-Tejada J, Mazzetti P, Cornejo-Olivas M. Distribution of the CAG Triplet Repeat in ATXN1, ATXN3, and CACNA1A Loci in Peruvian Population. Cerebellum 2020; 19:527-35. [PMID: 32285347 DOI: 10.1007/s12311-020-01129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Spinocerebellar ataxia subtypes 1, 3, and 6 (SCA1, MJD/SCA3, and SCA6) are among the most prevalent autosomal dominant cerebellar ataxias worldwide, but their relative frequencies in Peru are low. Frequency of large normal (LN) alleles at spinocerebellar ataxia-causative genes has been proposed to be associated with disease prevalence. To investigate the allelic distribution of the CAG repeat in ATXN1, ATXN3, and CACNA1A genes in a Peruvian mestizo population and examine their association with the relative frequency of SCA1, MJD/SCA3, and SCA6 across populations. We genotyped 213 healthy mestizo individuals from Northern Lima, Peru, for ATXN1, ATXN3, and CACNA1A using polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE). We compared the frequency of LN alleles and relative disease frequency between populations. We also tested 40 samples for CAT repeat interruptions within the CAG tract of ATXN1. We found no association between disease frequency and population frequency of LN alleles at ATXN1 and ATXN3. All 40 ATXN1 samples tested for CAT interruptions were positive. Frequency of LN alleles at CACNA1A correlates with SCA6 frequency across several populations, but this effect was largely driven by data from a single population. Low frequency of SCA1 and MJD/SCA3 in Peru is not explained by frequency of LN alleles at ATXN1 and ATXN3, respectively. The observed correlation between CACNA1A LN alleles and SCA6 frequency requires further assessment.
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25
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Teive HAG, Camargo CHF, Munhoz RP. Reply to Comment on: "The Geographic Diversity of Spinocerebellar Ataxias (SCAs) in the Americas: A Systematic Review". Mov Disord Clin Pract 2020; 7:239. [PMID: 32071950 PMCID: PMC7011827 DOI: 10.1002/mdc3.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hélio A. G. Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, and Internal Medicine Post‐Graduation Program, Hospital de ClínicasFederal University of ParanáCuritibaParanáBrazil
| | - Carlos Henrique F. Camargo
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, and Internal Medicine Post‐Graduation Program, Hospital de ClínicasFederal University of ParanáCuritibaParanáBrazil
| | - Renato P. Munhoz
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Torotno Western Hospital, Division of NeuroogyUniversity of TorontoOntarioTorontoCanada
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26
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Leite CDMBA, Schieferdecker MEM, Frehner C, Munhoz RP, Ashizawa T, Teive HAG. Body composition in Spinocerebellar ataxia type 3 and 10 patients: Comparative study with control group. Nutr Neurosci 2020; 23:49-54. [PMID: 29734917 PMCID: PMC6996146 DOI: 10.1080/1028415x.2018.1469282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative genetic diseases characterized by movement disorders that can affect nutritional status and body composition. This study sought to assess body composition in SCA3 and SCA10 patients. Methods: Anthropometric assessments and bioelectric impedance analysis were performed in 46 SCA3 and SCA10 patients and 76 controls of both genders. Results: Of the patients, 69.6% had SCA3 and 58.7% were women. SCA3 patients had significantly lower percentages of body fat (%BF) than controls (15.0 ± 6.1 vs. 20.6 ± 7.1; p=0.014) and (22.4 ± 6.9 vs. 30.1 ± 6.0; p<0.001), respectively. Among the women, there was a statistically significant difference in %BF between SCA3 and SCA10 patients (22.4 ± 6.9 vs. 32.4 ± 4.9; p<0.001). Male and female SCA3 patients had significantly lower fat-free mass (FFM) than controls [50.6 kg (46.9-54.7) vs. 58.6 kg (52.6-63.9); p=0.001] and [38.2 kg (35.1-42.6) vs. 42.8 kg (39.7-46.1); p=0.004], respectively. Male SCA10 patients also had lower FFM than controls [51.2 kg (47.1-55.4) vs. (52.6-63.9); p=0.008]. Female SCA10 patients had significantly higher FFM than controls and SCA3 patients [45.0 kg (43.3-45.6) vs. 42.8 kg (39.7-46.1); p=0.004] and [45.0 kg (43.3-45.6) vs. 38.2 kg (35.1-42.6); p=0.004], respectively. There was moderate correlation (-0.42) between disease duration and muscle mass (MM), and weak (-0.38) between SARA (Scale for the Assessment and Rating of Ataxia) and MM in SCA3. In SCA10, there was no significant correlation between these variables. Conclusion: Female SCA3 patients had more body composition changes than female SCA10 patients, mainly in relation to FFM. SCA3 and SCA10 patients need nutritional follow-up to minimize body compartment changes.
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Affiliation(s)
| | | | - Caroline Frehner
- Multi-professional residence Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Renato P. Munhoz
- Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network, Toronto, Canada
| | - Tetsuo Ashizawa
- Neuroscience Research Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Hélio A. G. Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil
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27
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Bolton C, Lacy M. Comparison of cognitive profiles in spinocerebellar ataxia subtypes: a case series. Cerebellum Ataxias 2019; 6:13. [PMID: 31548897 PMCID: PMC6749672 DOI: 10.1186/s40673-019-0107-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The spinocerebellar ataxias (SCA) are a heterogeneous group of progressive neurodegenerative disorders that are associated with diffuse cerebellar atrophy. While the physical symptoms of this condition have long been studied, more attention has been given to cognitive changes in recent years. We describe a case series of four adults with various genetically-confirmed subtypes of SCA. CASE PRESENTATION Patients with SCA types 2, 3, and 6 presented with impaired cognitive profiles consistent with the existing literature while the reported patient with SCA-14 showed notable impairment inconsistent with the only published case controlled study. CONCLUSIONS Comparisons were made between the four patients with a common pattern of slowed processing speed, poor memory retrieval, and reduced mental flexibility. Confrontation naming and consolidation-based memory were intact across all patients. These findings are discussed in light of the relevant literature on cerebellar cognitive affective syndrome.
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Affiliation(s)
- Corey Bolton
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Maureen Lacy
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637 USA
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Egorova PA, Gavrilova AV, Bezprozvanny IB. In Vivo Analysis of the Climbing Fiber-Purkinje Cell Circuit in SCA2-58Q Transgenic Mouse Model. Cerebellum 2018; 17:590-600. [PMID: 29876801 DOI: 10.1007/s12311-018-0951-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebellar Purkinje cells (PCs) and cerebellar pathways are primarily affected in many autosomal dominant cerebellar ataxias. PCs generate complex spikes (CS) in vivo when activated by climbing fiber (CF) which rise from the inferior olive. In this study, we investigated the functional state of the CF-PC circuitry in the transgenic mouse model of spinocerebellar ataxia type 2 (SCA2), a polyglutamine neurodegenerative genetic disease. In our experiments, we used an extracellular single-unit recording method to compare the PC activity pattern and the CS shape in age-matched wild-type mice and SCA2-58Q transgenic mice. We discovered no alterations in the CS properties of PCs in aging SCA2 mice. To examine the integrity of the olivocerebellar pathway, we applied harmaline, an alkaloid that acts directly on the inferior olive neurons. The pharmacological stimulation of olivocerebellar circuit by harmaline uncovered disturbances in SCA2-58Q PC activity pattern and in the complex spike shape when compared with age-matched wild-type cells. The abnormalities in the CF-PC circuitry were aggravated with age. We propose that alterations in CF-PC circuitry represent one of potential causes of ataxic symptoms in SCA2 and in other SCAs.
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29
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Ashizawa AT, Holt J, Faust K, Liu W, Tiwari A, Zhang N, Ashizawa T. Intravenously Administered Novel Liposomes, DCL64, Deliver Oligonucleotides to Cerebellar Purkinje Cells. Cerebellum 2019; 18:99-108. [PMID: 29987489 DOI: 10.1007/s12311-018-0961-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cerebellar Purkinje cells (PCs) show conspicuous damages in many ataxic disorders. Targeted delivery of short nucleic acids, such as antisense oligonucleotides, to PCs may be a potential treatment for ataxic disorders, especially spinocerebellar ataxias (SCAs), which are mostly caused by a gain of toxic function of the mutant RNA or protein. However, oligonucleotides do not cross the blood-brain barrier (BBB), necessitating direct delivery into the central nervous system (CNS) through intra-thecal, intra-cisternal, intra-cerebral ventricular, or stereotactic parenchymal administration. We have developed a novel liposome (100 to 200 nm in diameter) formulation, DCL64, composed of dipalmitoyl-phosphatidylcholine, cholesterol, and poloxamer L64, which incorporates oligonucleotides efficiently (≥ 70%). Confocal microscopy showed that DCL64 was selectively taken up by brain microvascular endothelial cells by interacting with low-density lipoprotein receptor (LDLr) family members on cell surface, but not with other types of lipid receptors such as caveolin or scavenger receptor class B type 1. LDLr family members are implicated in brain microvascular endothelial cell endocytosis/transcytosis, and are abundantly localized on cerebellar PCs. Intravenous administration of DCL64 in normal mice showed distribution of oligonucleotides to the brain, preferentially in PCs. Mice that received DCL64 showed no adverse effect on hematological, hepatic, and renal functions in blood tests, and no histopathological abnormalities in major organs. These studies suggest that DCL64 delivers oligonucleotides to PCs across the BBB via intravenous injection with no detectable adverse effects. This property potentially makes DCL64 particularly attractive as a delivery vehicle in treatments of SCAs.
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Affiliation(s)
- Ana Tari Ashizawa
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Neuroscience, University of Florida, Gainesville, FL, USA.,Bio-Path Holdings, Inc., Bellaire, TX, USA
| | - Jenny Holt
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Kelsey Faust
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Weier Liu
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Anjana Tiwari
- Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, 6670 Bertner Avenue, R11-117, Houston, TX, 77030, USA
| | - Nan Zhang
- Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, 6670 Bertner Avenue, R11-117, Houston, TX, 77030, USA
| | - Tetsuo Ashizawa
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA. .,Department of Neurology, University of Florida, Gainesville, FL, USA. .,Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, 6670 Bertner Avenue, R11-117, Houston, TX, 77030, USA.
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30
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Shimobayashi E, Kapfhammer JP. Calcium Signaling, PKC Gamma, IP3R1 and CAR8 Link Spinocerebellar Ataxias and Purkinje Cell Dendritic Development. Curr Neuropharmacol 2018; 16:151-159. [PMID: 28554312 PMCID: PMC5883377 DOI: 10.2174/1570159x15666170529104000] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 01/05/2023] Open
Abstract
Background Spinocerebellar ataxias (SCAs) are a group of cerebellar diseases characterized by progressive ataxia and cerebellar atrophy. Several forms of SCAs are caused by missense mutations or deletions in genes related to calcium signaling in Purkinje cells. Among them, spinocerebellar ataxia type 14 (SCA14) is caused by missense mutations in PRKCG gene which encodes protein kinase C gamma (PKCγ). It is remarkable that in several cases in which SCA is caused by point mutations in an individual gene, the affected genes are involved in the PKCγ signaling pathway and calcium signaling which is not only crucial for proper Purkinje cell function but is also involved in the control of Purkinje cell dendritic development. In this review, we will focus on the PKCγ signaling related genes and calcium signaling related genes then discuss their role for both Purkinje cell dendritic development and cerebellar ataxia. Methods Research related to SCAs and Purkinje cell dendritic development is reviewed. Results PKCγ dysregulation causes abnormal Purkinje cell dendritic development and SCA14. Carbonic anhydrase related protein 8 (Car8) encoding CAR8 and Itpr1 encoding IP3R1were identified as upregulated genes in one of SCA14 mouse model. IP3R1, CAR8 and PKCγ proteins are strongly and specifically expressed in Purkinje cells. The common function among them is that they are involved in the regulation of calcium homeostasis in Purkinje cells and their dysfunction causes ataxia in mouse and human. Furthermore, disruption of intracellular calcium homeostasis caused by mutations in some calcium channels in Purkinje cells links to abnormal Purkinje cell dendritic development and the pathogenesis of several SCAs. Conclusion Once PKCγ signaling related genes and calcium signaling related genes are disturbed, the normal dendritic development of Purkinje cells is impaired as well as the integration of signals from other neurons, resulting in abnormal development, cerebellar dysfunction and eventually Purkinje cell loss.
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Affiliation(s)
- Etsuko Shimobayashi
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH-4056 Basel, Switzerland
| | - Josef P Kapfhammer
- Anatomical Institute, Department of Biomedicine Basel, University of Basel, Pestalozzistrasse 20, CH-4056 Basel, Switzerland
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Rodríguez-Labrada R, Velázquez-Pérez L, Ziemann U. Transcranial magnetic stimulation in hereditary ataxias: Diagnostic utility, pathophysiological insight and treatment. Clin Neurophysiol 2018; 129:1688-1698. [PMID: 29940480 DOI: 10.1016/j.clinph.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 12/28/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a valuable technique to assess and modulate human brain function in normal and pathological conditions. This critical review surveys the contributions of TMS to the diagnosis, insight into pathophysiology and treatment of genetically confirmed hereditary ataxias, a heterogeneous group of neurodegenerative disorders that can affect motor cortex and the corticospinal tract. Most studies were conducted on small sample sizes and focused on diagnostic approaches. The available data demonstrate early involvement of the corticospinal tract and motor cortex circuitry, and support the possible efficacy of cerebellar repetitive TMS (rTMS) as therapeutic approach. Further TMS-based studies are warranted, to establish biomarkers for early diagnosis and disease monitoring, explore the involvement of the cerebello-dentato-thalamo-cortical projection, study the effects of rTMS-induced plasticity, and utilize rTMS for treatment.
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Affiliation(s)
- Roberto Rodríguez-Labrada
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba; School of Physical Culture and Sport, University of Holguin, Holguin, Cuba
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba; School of Physical Culture and Sport, University of Holguin, Holguin, Cuba; Cuban Academy of Science, Havana, Cuba.
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany.
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Catai LMP, Camargo CHF, Moro A, Ribas G, Raskin S, Teive HAG. Dystonia in Patients with Spinocerebellar Ataxia 3 - Machado-Joseph disease: An Underestimated Diagnosis? Open Neurol J 2018; 12:41-49. [PMID: 30008965 PMCID: PMC6008980 DOI: 10.2174/1874205x01812010041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 02/08/2023] Open
Abstract
Background Spinocerebellar Ataxia type 3 (SCA3) or Machado-Joseph Disease (MJD) is characterized by cerebellar, central and peripheral symptoms, including movement disorders. Dystonia can be classified as hereditary and neurodegenerative when present in SCA3. Objective The objective of this study was to evaluate the dystonia characteristics in patients with MJD. Method We identified all SCA3 patients with dystonia from the SCA3 HC-UFPR database, between December 2015 and December 2016.Their medical records were reviewed to verify the diagnosis of dystonia and obtain demographic and clinical data. Standardized evaluation was carried out through the classification of Movement Disorders Society of 2013 and Burke Fahn-Marsden scale (BFM). Results Amongst the presenting some common characteristics, 381 patients with SCA3, 14 (3.7%) subjects presented dystonia: 5 blepharospasm, 1 cervical dystonia, 3 oromandibular, 3 multifocal and 2 generalized dystonia. Regarding dystonia's subtypes, 71.4% had SCA3 subtype I and 28.6% SCA3 subtype II. The average age of the disease onset was 40±10.7 years; the SCA3 disease duration was 11.86± 6.13 years; the CAG repeat lengths ranged from 75 to 78, and the BFM scores ranged from 1.0 to 40. There was no correlation between the dystonia severity and CAG repeat lengths or the SCA3 clinical evolution. Conclusion Dystonia in SCA3 is frequent and displays highly variable clinical profiles and severity grades. Dystonia is therefore a present symptom in SCA3, which may precede the SCA3 classic symptoms. Dystonia diagnosis is yet to be properly recognized within SCA3 patient.
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Affiliation(s)
- Ligia Maria Perrucci Catai
- Botulinum Toxin Unit, Hospital Universitário, State University of Ponta Grossa, Ponta Grossa, Brazil.,Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Adriana Moro
- Paraná Association for Parkinson's Disease, Curitiba, Brazil
| | - Gustavo Ribas
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Salmo Raskin
- Group for Advanced Molecular Investigation, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Genetika-Centro de Aconselhamento e Laboratório de Genética, Curitiba, Brazil
| | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Silva GV, Bonilha P, Moro A, Munhoz R, Raskin S, Ashizawa T, Nascimento FA, Teive HAG. Spinocerebellar ataxias type 3 and 10: Onset and progression of ataxia during pregnancy and puerperium. Parkinsonism Relat Disord 2018; 52:119-20. [PMID: 29609848 DOI: 10.1016/j.parkreldis.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/17/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
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Luo L, Wang J, Lo RY, Figueroa KP, Pulst SM, Kuo PH, Perlman S, Wilmot G, Gomez CM, Schmahmann J, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind M, Xia G, Subramony SH, Ashizawa T, Kuo SH. The Initial Symptom and Motor Progression in Spinocerebellar Ataxias. Cerebellum 2018; 16:615-622. [PMID: 27848087 DOI: 10.1007/s12311-016-0836-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The aim of this study is to determine whether the initial symptom associates with motor progression in spinocerebellar ataxias (SCAs). SCAs are clinically heterogeneous and the initial presentation may represent different subtypes of SCA with different motor progression. We studied 317 participants with SCAs1, 2, 3, and 6 from the Clinical Research Consortium for SCAs (CRC-SCA) and repeatedly measured the severity of ataxia for 2 years. SCA patients were divided into gait-onset and non-gait-onset (speech, vision, and hand dexterity) groups based on the initial presentation. In addition to demographic comparison, we employed regression models to study ataxia progression in these two groups after adjusting for age, sex, and pathological CAG repeats. The majority of SCA patients had gait abnormality as an initial presentation. The pathological CAG repeat expansions were similar between the gait-onset and non-gait-onset groups. In SCA1, gait-onset group progressed slower than non-gait-onset group, while gait-onset SCA6 group progressed faster than their counterpart. In addition, the disease presented 9 years later for SCA2 gait-onset group than non-gait-onset group. Initial symptoms of SCA3 did not influence age of onset or disease progression. The initial symptom in each SCA has a different influence on age of onset and motor progression. Therefore, gait and non-gait-onset groups of SCAs might represent different subtypes of the diseases.
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Affiliation(s)
- Lan Luo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jie Wang
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Raymond Y Lo
- Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Pei-Hsin Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Susan Perlman
- Department of Neurology, University of California Los Angeles, California, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | | | - Jeremy Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah H Ying
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Geschwind
- Department of Neurology, University of California San Francisco, California, USA
| | - Guangbin Xia
- Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, USA
| | - S H Subramony
- Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Braga-Neto P, Pedroso JL, Furtado GV, Gheno TC, Saraiva-Pereira ML, Jardim LB, Barsottini OGP; Rede Neurogenetica. Dentatorubro-Pallidoluysian Atrophy (DRPLA) among 700 Families with Ataxia in Brazil. Cerebellum 2017; 16:812-6. [PMID: 28432641 DOI: 10.1007/s12311-017-0862-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Dentatorubro-pallidoluysian atrophy (DRPLA) is a spinocerebellar ataxia (SCA) very rare in non-Asian populations. To date, DRPLA was undetected in the general Brazilian population. Adult-onset ataxic patients have been recruited from several Brazilian neurology and neurogenetics centers. CAG lengths at SCA1, SCA2, SCA3/MJD, SCA6, SCA7, SCA12, SCA17 and DRPLA associated genes, and ATTCT expansions at SCA10 gene were studied. A single DRPLA case detected is reported. Proband was a 69-year-old Brazilian woman of mixed ancestry, with a late-onset pure ataxia: her alleles at the associated gene, ATN1, presented 14/52 CAG repeats. History of gait ataxia and dementia was observed in two out of six siblings but was absent in her parents. This was the single DRPLA diagnosis obtained from 700 Brazilian unrelated cases with adult-onset ataxia, 487 of them with clear autosomal dominant inheritance. DRPLA accounted for 0.14% of all adult-onset ataxia cases and for 0.2% of families with autosomal dominant inheritance. Normal CAG repeats at ATN1 had a median (range) of 14 (5-20) repeats in other 410 Brazilian chromosomes. DRPLA is quite rare in Brazilian SCA families, which is consistent with the lack of large normal alleles in our population.
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Atadzhanov M, Smith DC, Mwaba MH, Siddiqi OK, Bryer A, Greenberg LJ. Clinical and genetic analysis of spinocerebellar ataxia type 7 (SCA7) in Zambian families. Cerebellum Ataxias 2017; 4:17. [PMID: 29214039 PMCID: PMC5706398 DOI: 10.1186/s40673-017-0075-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND To date, 43 types of Spinocerebellar Ataxias (SCAs) have been identified. A subset of the SCAs are caused by the pathogenic expansion of a CAG repeat tract within the corresponding gene. Ethnic and geographic differences are evident in the prevalence of the autosomal dominant SCAs. Few descriptions of the clinical phenotype and molecular genetics of the SCAs are available from the African continent. Established studies mostly concern the South African populations, where there is a high frequency of SCA1, SCA2 and SCA7. The SCA7 mutation in South Africa (SA) has been found almost exclusively in families of indigenous Black African ethnic origin. OBJECTIVE To present the results of the first clinical description of seven Zambian families presenting with autosomal dominant SCA, as well as the downstream molecular genetic analysis of a subset of these families. METHODS The study was undertaken at the University Teaching Hospital in Lusaka, Zambia. Ataxia was quantified with the Brief Ataxia Rating Scale derived from the modified international ataxia rating scale. Molecular genetic testing for 5 types of SCA (SCA1, SCA2, SCA3, SCA6 and SCA7) was performed at the National Health Laboratory Service at Groote Schuur Hospital and the Division of Human Genetics, University of Cape Town, SA. The clinical and radiological features were evaluated in seven families with autosomal dominant cerebellar ataxia. Molecular genetic analysis was completed on individuals representing three of the seven families. RESULTS All affected families were ethnic Zambians from various tribes, originating from three different regions of the country (Eastern, Western and Central province). Thirty-four individuals from four families had phenotypic features of SCA7. SCA7 was confirmed by molecular testing in 10 individuals from 3 of these families. The age of onset of the disease varied from 12 to 59 years. The most prominent phenotypic features in these families were gait and limb ataxia, dysarthria, visual loss, ptosis, ophthalmoparesis/ophthalmoplegia, pyramidal tract signs, and dementia. Affected members of the SCA7 families had progressive macular degeneration and cerebellar atrophy. All families displayed marked anticipation of age at onset and rate of symptom progression. The pathogenic SCA7 CAG repeat ranges varied from 47 to 56 repeats. Three additional families were found to have clinical phenotypes associated with autosomal dominant SCA, however, DNA was not available for molecular confirmation. The age of onset of the disease in these families varied from 19 to 53 years. The most common clinical picture in these families included a combination of cerebellar symptoms with slow saccadic eye movements, peripheral neuropathy, dementia and tremor. CONCLUSION SCA is prevalent in ethnic Zambian families. The SCA7 families in this report had similar clinical presentations to families described in other African countries. In all families, the disease had an autosomal dominant pattern of inheritance across multiple generations. All families displayed anticipation of both age of onset and the rate of disease progression. Further clinical and molecular investigations of the inherited ataxias in a larger cohort of patients is important to understand the natural history and origin of SCAs in the Zambian population.
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Affiliation(s)
- Masharip Atadzhanov
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Danielle C. Smith
- Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Neurology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mwila H. Mwaba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Omar K. Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Global Neurology Program, Division of Neuro-Immunology, Center for Virology and Vaccine Research, Department of Neurology, Beth Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Alan Bryer
- Division of Neurology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - L. Jacquie Greenberg
- Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Gan SR, Wang J, Figueroa KP, Pulst SM, Tomishon D, Lee D, Perlman S, Wilmot G, Gomez CM, Schmahmann J, Paulson H, Shakkottai VG, Ying SH, Zesiewicz T, Bushara K, Geschwind MD, Xia G, Subramony SH, Ashizawa T, Kuo SH. Postural Tremor and Ataxia Progression in Spinocerebellar Ataxias. Tremor Other Hyperkinet Mov (N Y) 2017; 7:492. [PMID: 29057148 PMCID: PMC5647398 DOI: 10.7916/d8gm8krh] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postural tremor can sometimes occur in spinocerebellar ataxias (SCAs). However, the prevalence and clinical characteristics of postural tremor in SCAs are poorly understood, and whether SCA patients with postural tremor have different ataxia progression is not known. METHODS We studied postural tremor in 315 patients with SCA1, 2, 3, and 6 recruited from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA), which consists of 12 participating centers in the United States, and we evaluated ataxia progression in these patients from January 2010 to August 2012. RESULTS Among 315 SCA patients, postural tremor was most common in SCA2 patients (SCA1, 5.8%; SCA2, 27.5%; SCA3, 12.4%; SCA6, 16.9%; p = 0.007). SCA3 patients with postural tremor had longer CAG repeat expansions than SCA3 patients without postural tremor (73.67 ± 3.12 vs. 70.42 ± 3.96, p = 0.003). Interestingly, SCA1 and SCA6 patients with postural tremor had a slower rate of ataxia progression (SCA1, β = -0.91, p < 0.001; SCA6, β = -1.28, p = 0.025), while SCA2 patients with postural tremor had a faster rate of ataxia progression (β = 1.54, p = 0.034). We also found that the presence of postural tremor in SCA2 patients could be influenced by repeat expansions of ATXN1 (β = -1.53, p = 0.037) and ATXN3 (β = 0.57, p = 0.018), whereas postural tremor in SCA3 was associated with repeat lengths in TBP (β = 0.63, p = 0.041) and PPP2R2B (β = -0.40, p = 0.032). DISCUSSION Postural tremor could be a clinical feature of SCAs, and the presence of postural tremor could be associated with different rates of ataxia progression. Genetic interactions between ataxia genes might influence the brain circuitry and thus affect the clinical presentation of postural tremor.
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Affiliation(s)
- Shi-Rui Gan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Karla P. Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M. Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Darya Tomishon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Danielle Lee
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, GA, USA
| | | | - Jeremy Schmahmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah H. Ying
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Khalaf Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Guangbin Xia
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - S. H. Subramony
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Bezerra MLE, Pedroso JL, Braga-Neto P, Abrahao A, de Albuquerque MVC, Borges FRP, Saraiva-Pereira ML, Jardim LB, de Oliveira Braga NI, Manzano GM, Barsottini OGP. Pattern of Peripheral Nerve Involvement in Spinocerebellar Ataxia Type 2: a Neurophysiological Assessment. Cerebellum 2017; 15:767-773. [PMID: 26708559 DOI: 10.1007/s12311-015-0753-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathy is frequent in spinocerebellar ataxia type 2 (SCA2), but the pattern and characteristics of nerve involvement are still an unsettled issue. This study aimed to evaluate the prevalence, extent, and distribution of nerve involvement in SCA2 patients through neurophysiological studies. Thirty-one SCA2 patients and 20 control subjects were enrolled in this study. All subjects were prospectively evaluated through electromyography, including nerve conduction, needle electromyography in proximal and distal muscles of the upper and lower limbs, and sural radial amplitude ratio (SRAR). We aimed to differentiate distal axonopathy from diffuse nerve commitment, characterizing neuronopathy. Nerve involvement was observed in 83.6 % (26 individuals) of SCA2 patients. Among these, 19 had diffuse sensory abnormalities on nerve conduction predominantly on the upper limbs, with diffuse chronic denervation on needle electromyography and elevated SRAR values. Four individuals had only diffuse sensory involvement, and 2 had only motor involvement on needle evaluation and normal nerve conduction. These were interpreted as neuronopathy due to the diffuse distribution of the involvement. One individual had distal sensory axonopathy, with lower limb predominance. In this study, we found neuronopathy as the main pattern of nerve involvement in SCA2 patients and that motor involvement is a frequent feature. This information brings new insights into the understanding of the pathophysiology of nerve involvement in SCA2 and sets some key points about the phenotype, which is relevant to guide the genetic/molecular diagnosis.
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Affiliation(s)
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Agessandro Abrahao
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
- Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Velázquez-Pérez L, Tünnerhoff J, Rodríguez-Labrada R, Torres-Vega R, Belardinelli P, Medrano-Montero J, Peña-Acosta A, Canales-Ochoa N, Vázquez-Mojena Y, González-Zaldivar Y, Auburger G, Ziemann U. Corticomuscular Coherence: a Novel Tool to Assess the Pyramidal Tract Dysfunction in Spinocerebellar Ataxia Type 2. Cerebellum 2017; 16:602-606. [PMID: 27730516 DOI: 10.1007/s12311-016-0827-4] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Clinical signs of corticospinal tract dysfunction are a common feature of spinocerebellar ataxia type 2 (SCA2) patients. The objective of this study is to assess dysfunction of the corticospinal tract in SCA2 using corticomuscular coherence. Testing corticomuscular coherence and rating of ataxia severity and non-ataxia symptoms were performed in 19 SCA2 patients and 24 age-matched controls. Central motor conduction times (CMCT) to upper and lower right limbs were obtained for the SCA2 group using Transcraneal magnetic stimulation (TMS). SCA2 patients exhibited a significant reduction of corticomuscular coherence for lower limbs, but not for upper limbs. This difference remained significant, even when excluding those individuals with clinical signs of corticospinal tract dysfunction. Corticomuscular coherence for lower limbs correlated inversely with CMCT to tibialis anterior muscle. Corticomuscular coherence could be a valuable electrophysiological tool to assess the corticospinal tract involvement in SCA2, even in the absence of clinical signs of corticospinal tract dysfunction.
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Affiliation(s)
- Luis Velázquez-Pérez
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100.
| | - Johannes Tünnerhoff
- Department Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Roberto Rodríguez-Labrada
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100
| | - Reidenis Torres-Vega
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100
| | - Paolo Belardinelli
- Department Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jacqueline Medrano-Montero
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100
| | - Arnoy Peña-Acosta
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100
| | - Nalia Canales-Ochoa
- Department Clinical Neurophysiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Calle Libertad 26, Holguín, Cuba, 80100
| | - Yaimeé Vázquez-Mojena
- Department Molecular Neurobiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba
| | - Yanetza González-Zaldivar
- Department Molecular Neurobiology, Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba
| | - Georg Auburger
- Exp. Neurology, Building 89, Goethe University Medical School, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Ulf Ziemann
- Department Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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Yang ZH, Shi MM, Liu YT, Wang YL, Luo HY, Wang ZL, Shi CH, Xu YM. TGM6 gene mutations in undiagnosed cerebellar ataxia patients. Parkinsonism Relat Disord 2017; 46:84-86. [PMID: 28927799 DOI: 10.1016/j.parkreldis.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Zhi-Hua Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Meng-Meng Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yu-Tao Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yan-Lin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Hai-Yang Luo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Zhi-Lei Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China.
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, Henan, China.
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Zhang XY, Wang JJ, Zhu JN. Cerebellar fastigial nucleus: from anatomic construction to physiological functions. Cerebellum Ataxias 2016; 3:9. [PMID: 27144010 PMCID: PMC4853849 DOI: 10.1186/s40673-016-0047-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
Fastigial nucleus (FN) is the phylogenetically oldest nucleus in the cerebellum, a classical subcortical motor coordinator. As one of the ultimate integration stations and outputs of the spinocerebellum, the FN holds a key position in the axial, proximal and ocular motor control by projecting to the medial descending systems and eye movement related nuclei. Furthermore, through topographic connections with extensive nonmotor systems, including visceral related nuclei in the brainstem, hypothalamus, as well as the limbic system, FN has also been implicated in regulation of various nonsomatic functions, such as feeding, cardiovascular and respiratory, defecation and micturition, immune, as well as emotional activities. In clinic, FN lesion or dysfunction results in motor deficits including spinocerebellar ataxias, and nonmotor symptoms. In this review, we summarize the cytoarchitecture, anatomic afferent and efferent connections, as well as the motor and nonmotor functions of the FN and the related diseases and disorders. We suggest that by bridging the motor and nonmotor systems, the cerebellar FN may help to integrate somatic motor and nonsomatic functions and consequently contribute to generate a coordinated response to internal and external environments.
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Affiliation(s)
- Xiao-Yang Zhang
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Biological Science and Technology, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023 China
| | - Jian-Jun Wang
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Biological Science and Technology, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023 China
| | - Jing-Ning Zhu
- State Key Laboratory of Pharmaceutical Biotechnology and Department of Biological Science and Technology, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023 China
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Lo RY, Figueroa KP, Pulst SM, Perlman S, Wilmot G, Gomez C, Schmahmann J, Paulson H, Shakkottai VG, Ying S, Zesiewicz T, Bushara K, Geschwind M, Xia G, Yu JT, Lee LE, Ashizawa T, Subramony SH, Kuo SH. Depression and clinical progression in spinocerebellar ataxias. Parkinsonism Relat Disord 2016; 22:87-92. [PMID: 26644294 DOI: 10.1016/j.parkreldis.2015.11.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Depression is a common comorbidity in spinocerebellar ataxias (SCAs) but its association with ataxia progression is not well understood. OBJECTIVES To study the prevalence and influence of depressive symptoms in SCAs. METHODS We studied 300 participants with SCA 1, 2, 3 and 6 from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA) and repeatedly measured depressive symptoms by the 9-item Patient Health Questionnaire (PHQ-9) along with other clinical features including ataxia, functional status, and quality of life every 6 months for 2 years. We employed regression models to study the effects of depressive symptoms on clinical progression indexed by Scale for Assessment and Rating of Ataxia (SARA), Unified Huntington's Disease Rating Scale Part IV (UHDRS-IV) and EQ5D after adjusting for age, sex and pathological CAG repeats. RESULTS Comorbid depression is common in SCAs (26%). Although the baseline prevalence of depression was similar among different SCA types, suicidal ideation was more frequently reported in SCA3 (65%). Depressive symptoms were associated with SARA scores but did not significantly progress over time within 2 years or deteriorate by increased numbers of pathological CAG repeats. The effects of depression on ataxia progression varied across different SCA types. Nevertheless, depression had consistently negative and significant impact on functional status and quality of life in all SCAs, even after accounting for ataxia progression. CONCLUSIONS Depressive symptoms are not simply the consequence of motor disability in SCAs. Comorbid depression per se contributes to different health outcomes and deserves more attention when caring patients with SCAs.
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Abstract
While the onset of a dominantly inherited ataxia is typically taken to be the onset of gait ataxia, a wide range of other symptoms related to central and/or peripheral nervous system impairment, or even to non-neurological involvement, can be the presenting feature. Knowledge of these is fairly robust for the commonest spinocerebellar ataxias (SCAs 1, 2, 3 and 6) and for those where a striking non-ataxic presentation is the norm (SCAs 7 and 12), but the literature is potentially misleading in the rarer dominant ataxias. This review summarises what is currently known of these non-ataxic presentations and outlines and explains the difficulties associated with determining non-ataxic presentations of dominant ataxias. The relevant literature was surveyed, including systematic reviews (where available) and case reports. Non-ataxic presentations of dominant ataxias are classified by symptom.
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Affiliation(s)
- Elsdon Storey
- Department of Medicine (Neuroscience), Monash University, Alfred Hospital Campus, Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Neuroscience, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia.
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Saute JAM, Rieder CRM, Castilhos RM, Monte TL, Schumacher-Schuh AF, Donis KC, D'Ávila R, Souza GN, Russo AD, Furtado GV, Gheno TC, Souza DOG, Saraiva-Pereira ML, Portela LVC, Camey S, Torman VBL, Jardim LB. Planning future clinical trials in Machado Joseph disease: Lessons from a phase 2 trial. J Neurol Sci 2015; 358:72-6. [PMID: 26297649 DOI: 10.1016/j.jns.2015.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 06/23/2015] [Revised: 07/24/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND In a recent phase 2 clinical trial in spinocerebellar ataxia type 3/Machado Joseph disease (SCA3/MJD), a neurogenetic disorder without specific therapy, benefits of lithium carbonate were found only on secondary efficacy outcomes, all related to ataxic features. In order to help designing future studies, we further analyzed the trial data searching for treatment response modifiers and metric properties of spinocerebellar ataxia (SCA) scales. METHODS Efficacy analysis was performed with the Neurological Examination Score for the Assessment of Spinocerebellar Ataxia (NESSCA) and the Scale for the Assessment and Rating of Ataxia (SARA) subscores and with the subgroup of patients with independent gait according to the 8-meter walking-time (8MW). Interactions of clinical/molecular findings with treatment response, minimally important differences (MIDs), and sample size estimations for NESSCA, SARA, Spinocerebellar Ataxia Functional Index (SCAFI) and Composite Cerebellar Functional Score (CCFS) were evaluated. RESULTS 62 SCA3/MJD patients had been randomly assigned (1:1) for the double-blind, placebo-controlled trial. While cerebellar NESSCA (range: 0-7 points) differed between groups 0.64 points (95% CI 0.23 to 1.05, p<0.001) over the whole 48weeks of study, favoring lithium, no effect was found on non-ataxia subscores. Among patients able to perform the 8MW on baseline, NESSCA (p=0.010) and SCAFI (p=0.015) differed between groups favoring lithium. Finally, estimated sample sizes for the scales were provided. CONCLUSION Lithium efficacy on cerebellar NESSCA, and on SCAFI and CCFS in the primary analysis, together with the lack of effect on non-ataxia features suggests that lithium should be tested in phase 3 trials in SCA3/MJD and that ataxia scales should be preferred to multisystem neurological instruments as the primary outcome. The inclusion of early stage patients is advisable in future clinical trials in SCA3/MJD. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01096082.
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Affiliation(s)
- Jonas Alex Morales Saute
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Carlos R M Rieder
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Raphael Machado Castilhos
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Instituto Nacional de Genética Médica Populacional (INAGEMP), Brazil
| | - Thais Lampert Monte
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | - Karina Carvalho Donis
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Rui D'Ávila
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Gabriele Nunes Souza
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Aline Dutra Russo
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Gabriel Vasata Furtado
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tailise Conte Gheno
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Diogo Onofre Gomes Souza
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia em Excitotoxicidade e Neuroproteção (INCTEN), Brazil
| | - Maria Luiza Saraiva-Pereira
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Luis Valmor Cruz Portela
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia em Excitotoxicidade e Neuroproteção (INCTEN), Brazil
| | - Suzi Camey
- Post-Graduation Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vanessa Bielefeld Leotti Torman
- Post-Graduation Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Genética Médica Populacional (INAGEMP), Brazil.
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Zeigelboim BS, de Carvalho HAS, Teive HAG, Liberalesso PBN, Jurkiewicz AL, da Silva Abdulmassih EM, Marques JM, Cordeiro ML. Central auditory processing in patients with spinocerebellar ataxia. Hear Res 2015; 327:235-44. [PMID: 26183435 DOI: 10.1016/j.heares.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autosomal dominant spinocerebellar ataxias (SCAs) are a group of rare and heterogeneous neurodegenerative diseases characterized by the presence of progressive cerebellar ataxia. Although the symptomatology of SCAs is well known, information regarding central auditory functioning in these patients is lacking. Therefore, we assessed the central auditory processing disorders (CAPD) in patients with different subtypes of SCA. METHODS In a retrospective cross-sectional study, we subjected 43 patients with SCAs to otorhinolaryngological, audiological, Brainstem Auditory Evoked Potential (BAEP) and acoustic immittance evaluations as well as CAPD tests, namely the Standard Spondaic Word (SSW) and the Random Gap Detection Test (RGDT). RESULTS Most patients (83.7%) reported an imbalance when walking; many reported difficulty speaking (48.8%), dizziness (41.8%), and dysphagia (39.5%). In the audiometric test, 14/43 patients (32.5%) presented alterations, including 4/12 patients with SCA3 (33.3%), 1/8 patients with SCA2 (12.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 3/6 patients with SCA10 (50%), and 3/14 patients with an undetermined type of SCA (21.4%). In the BAEP test, 20/43 patients (46.5%) presented alterations (11.6% na orelha esquerda e 34.9% bilateralmente), including 7/12 patients with SCA3 (58.3%), 5/8 patients with SCA2 (62.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 4/6 patients with SCA10 (66.7%), and 2/14 patients with an undetermined type of SCA (14.2%). In the SSW, 22/40 patients (55%) presented alterations (2.5% in the right ear, 15% in the left ear, and 37.5% bilaterally), including 6/10 patients (60%) with SCA3, 3/8 (37.5%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 8/14 (57.1%) with an undetermined type SCA. For the RGDT, 30/40 patients (75%) presented alterations, including 8/10 (80%) with SCA3, 6/8 (75%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 9/14 (64.3%) with an undetermined type of SCA. In immittance testing, 19/43 patients (44.1%) presented alterations, including 6/12 (50%) with SCA3, 4/8 (50%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 2/6 (33.3%) with SCA10, and 4/14 (28.6%) with an undetermined type of SCA. CONCLUSIONS A majority of patients exhibited SSW test deficits, with a predominance of bilateralism, and three-fourths had impaired RGDT performance, pointing to difficulties with binaural integration and temporal resolution. Assessment of CAPD is important for therapeutic follow ups in patients with SCA.
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Affiliation(s)
| | | | - Hélio Afonso Ghizoni Teive
- Neurology Service, Department of Clinical Medical, Clinical Hospital, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | - Mara Lúcia Cordeiro
- Neurosciences Research Group, Pelé Little Prince Research Institute, Curitiba, Brazil; Faculdades Little Prince, Curitiba, Brazil; Department of Psychiatry and Biobehavioral Sciences of the David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
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Abstract
Hereditary ataxia is a heterogeneous disorder characterized by progressive ataxia combined with/without peripheral neuropathy, extrapyramidal symptoms, pyramidal symptoms, seizure, and multiple systematic involvements. More than 35 autosomal dominant cerebellar ataxias have been designated as spinocerebellar ataxia, and there are 55 recessive ataxias that have not been named systematically. Conducting genetic sequencing to confirm a diagnosis is difficult due to the large amount of subtypes with phenotypic overlap. The prevalence of hereditary ataxia can vary among countries, and estimations of prevalence and subtype frequencies are necessary for planning a diagnostic strategy in a specific population. This review covers the various hereditary ataxias reported in the Korean population with a focus on the prevalence and subtype frequencies as the clinical characteristics of the various subtypes.
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Affiliation(s)
- Ji Sun Kim
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea ; Neuroscience Center, Samsung Medical Center, Seoul, Korea
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Chen HC, Lirng JF, Soong BW, Guo WY, Wu HM, Chen CCC, Chang CY. The merit of proton magnetic resonance spectroscopy in the longitudinal assessment of spinocerebellar ataxias and multiple system atrophy-cerebellar type. Cerebellum Ataxias 2014; 1:17. [PMID: 26331041 PMCID: PMC4552155 DOI: 10.1186/s40673-014-0017-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Spinocerebellar ataxia (SCA) and multiple system atrophy-cerebellar type (MSA-C) often present with similar clinical manifestations in the beginning. Magnetic resonance spectroscopy (MRS) has been proved to be a useful tool to help differentiate different types of SCA and MSA-C on cross-sectional studies. However, longitudinal changes of the MRS metabolites in these subjects have never been reported. The purpose of this study was to track the longitudinal evolution of the MRS metabolites in these patients and to ascertain the correlation between clinical severity measured by Scale of the Assessment and Rating of Ataxia (SARA) and MRS metabolites. RESULTS Significant reductions of NAA/Cr and NAA/Cho in the cerebellar hemispheres in all patients and lower Cho/Cr in the cerebellar hemispheres in patients with SCA2 or MSA-C were found at all times. At initial assessments, patients with MSA-C or SCA2 tended to have lower NAA/Cr and Cho/Cr in the cerebellar hemispheres than those with SCA3 or SCA6. At follow-ups, patients with SCA2 or MSA-C had a lower NAA/Cr in cerebellar hemispheres than those with SCA3 or SCA6. Patients with MSA-C had a lower NAA/Cr in the vermis and Cho/Cr in the cerebellar hemispheres than those with SCA2 at the start, and had a lower NAA/Cr in cerebellar hemispheres than those with SCA2 at follow-ups. CONCLUSION Characteristic patterns of neurodegenerative evolution were observed in patients with disparate SCAs and MSA-C using MRS and SARA. A continual impairment of neuronal integrity was observed in all groups of patients. The longitudinal changes of MRS metabolites and SARA scores were most striking in patients with SCA2 and MSA-C. Although the changes in the metabolites on MRS may still be used to help understand the pathophysiology of ataxia disorders, they are short of being a good biomarker.
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Affiliation(s)
- Hung-Chieh Chen
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing-Wen Soong
- Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, 155, Sec. 2, Linung St, Taipei, Taiwan ; Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan Yuo Guo
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Yen Chang
- Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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