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Chatterjee S, Ghosh R, Das S, Dubey S. Knowledge gaps in diabetic striatopathy and other movement disorders in diabetes. J Endocrinol Invest 2024; 47:1305-1307. [PMID: 37874460 DOI: 10.1007/s40618-023-02226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
- S Chatterjee
- Department of Endocrinology and Metabolism, Medical College and Hospital, Kolkata, India
| | - R Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Kolkata, India
| | - S Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India
| | - S Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, India.
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2
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Badrfam R, Zandifar A. Status dissociatus and movement disorders in anti N-methyl-d-aspartate receptor (anti NMDAR) encephalitis; diagnostic challenges ahead. Gen Hosp Psychiatry 2024; 88:75-76. [PMID: 38278744 DOI: 10.1016/j.genhosppsych.2024.01.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Rahim Badrfam
- Department of Psychiatry, Imam Hossein Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Atefeh Zandifar
- Department of Psychiatry, Imam Hossein Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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3
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Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Reply to letter to editor "Knowledge gaps in diabetic striatopathy and other movement disorders in diabetes". J Endocrinol Invest 2024; 47:1309-1310. [PMID: 37898590 DOI: 10.1007/s40618-023-02227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023]
Affiliation(s)
- A Arecco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy
| | - S Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties, University of Genova, 16132, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - P Renzetti
- Division of Neuroradiology, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - L Marinelli
- IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132, Genoa, Italy
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4
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Shambetova C, Klein C. Genetic testing for non-parkinsonian movement disorders: Navigating the diagnostic maze. Parkinsonism Relat Disord 2024; 121:106033. [PMID: 38429185 DOI: 10.1016/j.parkreldis.2024.106033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
Genetic testing has become a valuable diagnostic tool for movement disorders due to substantial advancements in understanding their genetic basis. However, the heterogeneity of movement disorders poses a significant challenge, with many genes implicated in different subtypes. This paper aims to provide a neurologist's perspective on approaching patients with hereditary hyperkinetic disorders with a focus on select forms of dystonia, paroxysmal dyskinesia, chorea, and ataxia. Age at onset, initial symptoms, and their severity, as well as the presence of any concurrent neurological and non-neurological features, contribute to the individual clinical profiles of hereditary non-parkinsonian movement disorders, aiding in the selection of appropriate genetic testing strategies. There are also more specific diagnostic clues that may facilitate the decision-making process and may be highly specific for certain conditions, such as diurnal fluctuations and l-dopa response in dopa-responsive dystonia, and triggering factors, duration and frequency of attacks in paroxysmal dyskinesia. While the genetic and mutational spectrum across non-parkinsonian movement disorders is broad, certain groups of diseases tend to be associated with specific types of pathogenic variants, such as repeat expansions in many of the ataxias. Some of these pathogenic variants cannot be detected by standard methods, such as panel or exome sequencing, but require the investigation of intronic regions for repeat expansions, such as Friedreich's or FGF14-linked ataxia. With our advancing knowledge of the genetic underpinnings of movement disorders, the incorporation of precise and personalized diagnostic strategies can enhance patient care, prognosis, and the application and development of targeted therapeutic interventions.
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Affiliation(s)
- Cholpon Shambetova
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Center for Continuing and Distance Learning, I. K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
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5
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Rodriguez-Porcel F, Sarva H, Joutsa J, Falup-Pecurariu C, Shukla AW, Mehanna R, Śmiłowska K, Lanza G, Filipović SR, Shalash A, Ferris M, Jankovic J, Espay AJ, Pandey S. Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members. J Neurol Sci 2024; 458:122925. [PMID: 38340409 DOI: 10.1016/j.jns.2024.122925] [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: 11/16/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Post-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. OBJECTIVES To survey current opinions and practices on the diagnosis and treatment of PSMD. METHODS A survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. RESULTS Parkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. CONCLUSIONS Regionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.
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Affiliation(s)
| | - Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Department of Neurology, Weill Cornell Medicine, NY, New York, USA
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku; Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, TX, USA
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Saša R Filipović
- University of Belgrade, Institute for Medical Research, Human Neuroscience Group, Belgrade, Serbia
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Margaret Ferris
- Department of Neurology Stanford University, Palo Alto, CA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Sanjay Pandey
- Department of Neurology and Stroke Medicine, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad, Delhi National Capital Region, India
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6
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Corazza LA, Dousseau GC, de Freitas JL, Torres IA, Rocha MSG. A Case of NEDMAGA: Neurodevelopmental Disorder with Movement Abnormalities, Abnormal Gait, and Autistic Features. Mov Disord Clin Pract 2024; 11:181-183. [PMID: 38386481 PMCID: PMC10883404 DOI: 10.1002/mdc3.13954] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 02/24/2024] Open
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7
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Aktan D, Depierreux F. How to face the hemifacial spasm: challenges and misconceptions. Acta Neurol Belg 2024; 124:17-23. [PMID: 37498482 DOI: 10.1007/s13760-023-02342-7] [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: 03/19/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
Hemifacial spasm (HFS) is characterised by intermittent, brief or sustained, repetitive contractions of the muscles innervated by one facial nerve. It is one of the most frequent movement disorders affecting the face. However common and allegedly straightforward to diagnose, it might reveal as a challenge for clinicians in various situations. Indeed, it often needs prior exclusion of many other movement disorders affecting the face, with frequent phenomenological overlaps with blepharospasm, post-facial palsy, facial motor tics, etc. The clinical diagnosis shall be supported by modern brain imaging techniques, and sometimes electromyography, as some particular aetiologies may require specific treatment. Primary forms are associated with vascular compression of the ipsilateral seventh cranial nerve, whereas secondary forms can be caused by any injury occurring on the facial nerve course. This article proposes a global and organised approach to the diagnosis, and the ensuing therapeutic options, as many practitioners still use some inefficient medications when they encounter a case of facial spasm.
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Affiliation(s)
- David Aktan
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium.
| | - Frédérique Depierreux
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium
- Movement Disorder Unit, Neurology Department, CHU Liège, Liège, Belgium
- GIGA-CRC in vivo imaging, University of Liège, Liège, Belgium
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8
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Marten L, Depierreux F. [Drug-induced movement disorders : nosology and treatment]. Rev Med Liege 2024; 79:88-93. [PMID: 38356424] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Movements disorders are frequently encountered in general practice and emergency departments and are in many cases of iatrogenic origin. Dopamine D2 receptor blocking agents (DRBA), mainly neuroleptics, are most often incriminated. These drug-induced movement disorders (DIMD) can be classified according to the kinetics of the manifestations (acute DIMD and tardive syndromes), the phenomenology of the abnormal movements observed or depending on the pharmacological agent involved. The diagnosis is based on the time course of the events, clinical examination and meticulous anamnesis of the patient's previous and current treatments. Management is always based on the interruption of the suspected causal treatment when possible. Some cases have a severe prognosis and require immediate treatment.
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9
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Zech M, Winkelmann J. Next-generation sequencing and bioinformatics in rare movement disorders. Nat Rev Neurol 2024; 20:114-126. [PMID: 38172289 DOI: 10.1038/s41582-023-00909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
The ability to sequence entire exomes and genomes has revolutionized molecular testing in rare movement disorders, and genomic sequencing is becoming an integral part of routine diagnostic workflows for these heterogeneous conditions. However, interpretation of the extensive genomic variant information that is being generated presents substantial challenges. In this Perspective, we outline multidimensional strategies for genetic diagnosis in patients with rare movement disorders. We examine bioinformatics tools and computational metrics that have been developed to facilitate accurate prioritization of disease-causing variants. Additionally, we highlight community-driven data-sharing and case-matchmaking platforms, which are designed to foster the discovery of new genotype-phenotype relationships. Finally, we consider how multiomic data integration might optimize diagnostic success by combining genomic, epigenetic, transcriptomic and/or proteomic profiling to enable a more holistic evaluation of variant effects. Together, the approaches that we discuss offer pathways to the improved understanding of the genetic basis of rare movement disorders.
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Affiliation(s)
- Michael Zech
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Juliane Winkelmann
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany.
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.
- Munich Cluster for Systems Neurology, SyNergy, Munich, Germany.
- DZPG, Deutsches Zentrum für Psychische Gesundheit, Munich, Germany.
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10
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Yeow D, Rudaks LI, Siow SF, Davis RL, Kumar KR. Genetic Testing of Movements Disorders: A Review of Clinical Utility. Tremor Other Hyperkinet Mov (N Y) 2024; 14:2. [PMID: 38222898 PMCID: PMC10785957 DOI: 10.5334/tohm.835] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Currently, pathogenic variants in more than 500 different genes are known to cause various movement disorders. The increasing accessibility and reducing cost of genetic testing has resulted in increasing clinical use of genetic testing for the diagnosis of movement disorders. However, the optimal use case(s) for genetic testing at a patient level remain ill-defined. Here, we review the utility of genetic testing in patients with movement disorders and also highlight current challenges and limitations that need to be considered when making decisions about genetic testing in clinical practice. Highlights The utility of genetic testing extends across multiple clinical and non-clinical domains. Here we review different aspects of the utility of genetic testing for movement disorders and the numerous associated challenges and limitations. These factors should be weighed on a case-by-case basis when requesting genetic tests in clinical practice.
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Affiliation(s)
- Dennis Yeow
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Laura I. Rudaks
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sue-Faye Siow
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ryan L. Davis
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Neurogenetics Research Group, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kishore R. Kumar
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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11
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Cardoso F. Difficulties of Access to Diagnostic Methods and Therapies in Movement Disorders: A Call to Action. Mov Disord Clin Pract 2024; 11:7-9. [PMID: 38291850 PMCID: PMC10828618 DOI: 10.1002/mdc3.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine DepartmentThe Federal University of Minas GeraisBelo HorizonteBrazil
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12
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McKeon A, Tracy J. Paraneoplastic movement disorders. Handb Clin Neurol 2024; 200:211-227. [PMID: 38494279 DOI: 10.1016/b978-0-12-823912-4.00004-9] [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] [Indexed: 03/19/2024]
Abstract
Paraneoplastic movement disorders are diverse autoimmune neurological illnesses occurring in the context of systemic cancer, either in isolation or as part of a multifocal neurological disease. Movement phenomena may be ataxic, hypokinetic (parkinsonian), or hyperkinetic (myoclonus, chorea, or other dyskinetic disorders). Some disorders mimic neurodegenerative or hereditary illnesses. The subacute onset and coexisting nonclassic features of paraneoplastic disorders aid distinction. Paraneoplastic autoantibodies provide further information regarding differentiating cancer association, disease course, and treatment responses. A woman with cerebellar ataxia could have metabotropic glutamate receptor 1 autoimmunity, in the setting of Hodgkin lymphoma, a mild neurological phenotype and response to immunotherapy. A different woman, also with cerebellar ataxia, could have Purkinje cytoplasmic antibody type 1 (anti-Yo), accompanying ovarian adenocarcinoma, a rapidly progressive phenotype and persistent disabling deficits despite immune therapy. The list of antibody biomarkers is growing year-on-year, each with its own ideal specimen type for detection (serum or CSF), accompanying neurological manifestations, cancer association, treatment response, and prognosis. Therefore, a profile-based approach to screening both serum and CSF is recommended. Immune therapy trials are generally undertaken, and include one or more of corticosteroids, IVIg, plasma exchange, rituximab, or cyclophosphamide. Symptomatic therapies can also be employed for hyperkinetic disorders.
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Affiliation(s)
- Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Jennifer Tracy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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13
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Foucher JR, Bartsch AJ, Mainberger O, Vercueil L, de Billy CC, Obrecht A, Arcay H, Berna F, Clauss JME, Weibel S, Hanke M, Elowe J, Schorr B, Bregeon E, Braun B, Cetkovich M, Jabs BE, Dorfmeister T, Ungvari GS, Dormegny-Jeanjean LC, Pfuhlmann B. Parakinesia: A Delphi consensus report. Schizophr Res 2024; 263:45-54. [PMID: 36357299 DOI: 10.1016/j.schres.2022.09.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022]
Abstract
Abnormal movements are intrinsic to some forms of endogenous psychoses. Spontaneous dyskinesias are observed in drug-naïve first-episode patients and at-risk subjects. However, recent descriptions of spontaneous dyskinesias may actually represent the rediscovery of a more complex phenomenon, 'parakinesia' which was described and documented in extensive cinematographic recordings and long-term observations by German and French neuropsychiatrists decades before the introduction of antipsychotics. With the emergence of drug induced movement disorders, the description of parakinesia has been refined to emphasize the features enabling differential diagnosis with tardive dyskinesia. Unfortunately, parakinesia was largely neglected by mainstream psychiatry to the point of being almost absent from the English-language literature. With the renewed interest in motor phenomena intrinsic to SSD, it was timely not only to raise awareness of parakinesia, but also to propose a scientifically usable definition for this phenomenon. Therefore, we conducted a Delphi consensus exercise with clinicians familiar with the concept of parakinesia. The original concept was separated into hyperkinetic parakinesia (HPk) as dyskinetic-like expressive movements and parakinetic psychomotricity (PPM), i.e., patient's departing from the patient's normal motion style. HPk prevails on the upper part of the face and body, resembling expressive and reactive gestures that not only occur inappropriately but also appear distorted. Abnormal movements vary in intensity depending on the level of psychomotor arousal and are thus abated by antipsychotics. HPk frequently co-occurs with PPM, in which gestures and mimics lose their naturalness and become awkward, disharmonious, stiff, mannered, and bizarre. Patients are never spontaneously aware of HPk or PPM, and the movements are never experienced as self-dystonic or self-alien. HPk and PPM are highly specific to endogenous psychoses, in which they are acquired and progressive, giving them prognostic value. Their differential diagnoses and correspondences with current international concepts are discussed.
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Affiliation(s)
- Jack R Foucher
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France.
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Olivier Mainberger
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Laurent Vercueil
- Clinical Neurophysiology Unit, Univ. Grenoble Alpes, INSERM U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Clément C de Billy
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Alexandre Obrecht
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Hippolyte Arcay
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France
| | - Fabrice Berna
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Julie M E Clauss
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; SAGE - CNRS UMR 7363, FMTS, University of Strasbourg, France
| | - Sébastien Weibel
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Markus Hanke
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Julien Elowe
- Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Prangins, Switzerland
| | - Benoit Schorr
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | | | - Birgit Braun
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Regensburg, Germany
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Burkhard E Jabs
- Klinik für Psychiatrie & Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
| | - Thomas Dorfmeister
- Abteilung für Psychiatrie und psychotherapeutische Medizin, Landesklinikum Neunkirchen, Austria
| | - Gabor S Ungvari
- Section of Psychiatry, University Notre Dame, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ludovic C Dormegny-Jeanjean
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Bruno Pfuhlmann
- Klinik für Psychiatrie & Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
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14
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Merello M, Bhatia K. Movement Disorders Clinical Practice Third Annual Conference. Mov Disord Clin Pract 2024; 11:6. [PMID: 38435442 PMCID: PMC10828612 DOI: 10.1002/mdc3.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Marcelo Merello
- Servicio de Movimientos Anormales, Departamento de NeurocienciasFleniBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
| | - Kailash Bhatia
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
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Lagrand TJ, Brusse‐Keizer M, Charmley A, Edwards MJ, Tijssen MA, Lehn AC. A Critical Appraisal of the Whack-a-Mole and Swivel Chair Signs in the Diagnosis of Functional Movement Disorders. Mov Disord Clin Pract 2024; 11:63-68. [PMID: 38291841 PMCID: PMC10828619 DOI: 10.1002/mdc3.13895] [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: 06/14/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The demonstration of positive signs during neurological examination is a cornerstone of the diagnosis of functional movement disorders, however, the available data supporting the diagnostic value of some of these signs is limited. OBJECTIVES To determine the diagnostic value (sensitivity and specificity) of the "whack-a-mole" (WAM) and "swivel chair" (SC) tests in patients with functional movement disorders (FMD). METHODS We enrolled patients with functional and organic movements in the WAM test if they exhibited tremor, dystonia, myoclonus, chorea, or tics. For the SC test, patients with a gait disorder as their primary impairment were recruited. Two blinded movement disorder specialists rated the presence of these signs in edited videos. RESULTS Inclusion criteria were met by 42 patients with FMD and 65 patients with organic movement disorders. Both tests demonstrated high specificity (means, 78% and 96%), but their sensitivity was low (means, 52% and 37%). Interobserver agreement for the WAM sign was 0.77 in the FMD group, against 0.28 in patients with organic movement disorders, whereas Movement Disorders Clinical Practice for Review Only for the SC sign was 0.69 in both groups. CONCLUSIONS The present study indicates that physicians must be cautious in the application and interpretation of these clinical signs in the diagnosis of functional movement disorders, and they should be carefully considered and used as necessary.
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Affiliation(s)
- Tjerk J. Lagrand
- Department of NeurologyAlrijne ZiekenhuisLeiderdorpThe Netherlands
| | - Marjolein Brusse‐Keizer
- Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
- Medical School Twente, Medisch Spectrum TwenteEnschedeThe Netherlands
| | - Andrew Charmley
- Department of NeurologyTownsville University HospitalDouglasQueenslandAustralia
| | - Mark J. Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Marina A.J. Tijssen
- Department of NeurologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Expertise Center Movement Disorders GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Alexander C. Lehn
- Department of NeurologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
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16
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Kandadai RM, Yaranagula SD, Kola S, Alugolu R, Prasad V, Borgohain R. Complex Movement Disorder with Prominent Tic like Movements: Expanding the Clinical Spectrum of IgLON 5 Antibody Disease. Mov Disord Clin Pract 2024; 11:94-96. [PMID: 38291846 PMCID: PMC10828616 DOI: 10.1002/mdc3.13929] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
| | - Sai Deepak Yaranagula
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Sruthi Kola
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Rajesh Alugolu
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Vanakuru Prasad
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Rupam Borgohain
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
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17
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Wikeley S, Bacon I, Greer O, Evans M, Hasan R, Pathak S. New-onset movement disorder in the immediate postpartum period. BMJ Case Rep 2023; 16:e254132. [PMID: 38154870 PMCID: PMC10759129 DOI: 10.1136/bcr-2022-254132] [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] [Indexed: 12/30/2023] Open
Abstract
This case report describes a woman who developed involuntary, uncoordinated movements of her face and limbs following a spontaneous vaginal delivery, complicated by postpartum haemorrhage. Using systematic assessment with multidisciplinary team input, a differential diagnosis was proposed and relevant investigations were undertaken. Atypical eclamptic or generalised seizures were excluded clinically and neuroimaging ruled out an intracranial vascular event such as stroke or venous sinus thrombosis. Local anaesthetic systemic toxicity was managed empirically with intravenous lipid emulsion and intravenous fluids. A diagnosis of drug-induced dyskinesia was made, most likely secondary to ondansetron, with which dystonias and myoclonus have been described. This woman's symptoms were transient and resolved within 2 hours.This case presented a complex differential diagnosis, highlighting the paucity of guidance available. We propose a diagnostic algorithm to aid in the identification of acute involuntary movements in pregnancy and the puerperium.
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Affiliation(s)
- Sarah Wikeley
- Rookery Medical Centre, Royal College of General Practitioners, Newmarket, Suffolk, UK
| | - Imogen Bacon
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Orene Greer
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Matthew Evans
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Rizwan Hasan
- Department of Anaesthetics, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
| | - Sangeeta Pathak
- Department of Obstetrics & Gynaecology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
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18
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Kamble N, Pal PK. Electrophysiology in Functional Movement Disorders: An Update. Tremor Other Hyperkinet Mov (N Y) 2023; 13:49. [PMID: 38162980 PMCID: PMC10756160 DOI: 10.5334/tohm.793] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Background Functional movement disorders (FMD) are a diagnostic and therapeutic challenge, both to the neurologist and psychiatrists. The phenomenology is varied and can present as tremors, dystonia, jerks/myoclonus, gait disorder, other abnormal movements or a combination. There has been an increase in the use of electrophysiological studies that are an important tool in the evaluation of FMDs. Methods We searched the database platforms of MEDLINE, Google scholar, Web of Sciences, Scopus using the Medical Subject Heading terms (MeSH) for all the articles from 1st January 1970 till November 2022. A total of 658 articles were obtained by the search mechanism. A total of 79 relevant articles were reviewed thoroughly, of which 26 articles that had electrophysiological data were included in the present review. Results Variability, distractibility and entertainability can be demonstrated in functional tremors by using multichannel surface electromyography. Voluntary ballistic movements tend to decrease the tremor, while loading the tremulous limb with weight causes the tremor amplitude to increase in functional tremor. Presence of Bereitschaftspotential demonstrates the functional nature of palatal tremor and myoclonus. Co-contraction testing may be helpful in differentiating functional from organic dystonia. The R2 blink reflex recovery cycle has been found to be abnormally enhanced in organic blepharospasm, whereas it is normal in presumed functional blepharospasm. Plasticity is found to be abnormally high in organic dystonia and normal in functional dystonia, in addition to enhanced facilitation in patients with organic dystonia. Conclusions Electrophysiological tests supplement clinical examination and helps in differentiating FMD from organic movement disorders.
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Affiliation(s)
- Nitish Kamble
- Departments of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bengaluru-560029, Karnataka, India
| | - Pramod Kumar Pal
- Departments of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bengaluru-560029, Karnataka, India
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19
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Boisclair M, Hadjinicolaou A, Nigam M. Clinical Reasoning: A 3-Year-Old Boy With Abnormal Movements During Sleep. Neurology 2023; 101:1134-1139. [PMID: 37857493 PMCID: PMC10791058 DOI: 10.1212/wnl.0000000000207980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
We report a case of a 3-year-old boy who presented with abnormal movements that initially occurred only during sleep. Three years later, he went on to develop hyperkinetic movements during the daytime while awake. There was a strong family history of various paroxysmal neurologic disorders. In this report, we discuss the clinical approach, differential diagnosis, investigation, and treatment options for nocturnal hyperkinetic movements and paroxysmal movement disorders.
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Affiliation(s)
- Mélissa Boisclair
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Aristides Hadjinicolaou
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Milan Nigam
- From the Centre Hospitalier de l'Université de Montréal (M.B.), Faculty of Medicine, University of Montreal; Department of Neurosciences (M.B., A.H., M.N.), Université de Montréal; Department of Pediatrics (A.H.), Division of Neurology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal; and Centre for Advanced Research in Sleep Medicine (M.N.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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20
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Angelini L, Terranova R, Lazzeri G, van den Berg KRE, Dirkx MF, Paparella G. The role of laboratory investigations in the classification of tremors. Neurol Sci 2023; 44:4183-4192. [PMID: 37814130 PMCID: PMC10641063 DOI: 10.1007/s10072-023-07108-w] [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: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Tremor is the most common movement disorder. Although clinical examination plays a significant role in evaluating patients with tremor, laboratory tests are useful to classify tremors according to the recent two-axis approach proposed by the International Parkinson and Movement Disorders Society. METHODS In the present review, we will discuss the usefulness and applicability of the various diagnostic methods in classifying and diagnosing tremors. We will evaluate a number of techniques, including laboratory and genetic tests, neurophysiology, and neuroimaging. The role of newly introduced innovative tremor assessment methods will also be discussed. RESULTS Neurophysiology plays a crucial role in tremor definition and classification, and it can be useful for the identification of specific tremor syndromes. Laboratory and genetic tests and neuroimaging may be of paramount importance in identifying specific etiologies. Highly promising innovative technologies are being developed for both clinical and research purposes. CONCLUSIONS Overall, laboratory investigations may support clinicians in the diagnostic process of tremor. Also, combining data from different techniques can help improve understanding of the pathophysiological bases underlying tremors and guide therapeutic management.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
| | - Roberta Terranova
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giulia Lazzeri
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Kevin R E van den Berg
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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21
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Eskandar M, Tochen L, Shin MR, Lavenstein B, Meltzer M, Gropman A, Sen K. Limitations of Multigene Next-Generation Sequencing Panel for "Cerebral Palsy" Phenotype and Other Complex Movement Disorders. Pediatr Neurol 2023; 149:15-18. [PMID: 37757660 DOI: 10.1016/j.pediatrneurol.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
In the past couple of decades, literature in pediatric neurology and clinical genetics has identified hundreds of monogenic disorders that can masquerade as infantile cerebral palsy (CP). Accurate and prompt diagnosis in such cases may be challenging due to several reasons. There are commercial multigene CP panels, but their diagnostic yield is often limited compared with exome sequencing because of diverse etiologies that may mimic CP. We report one such case where a patient with spastic hemiplegia underwent a long diagnostic journey before genetic diagnosis was established with exome sequencing and appropriate management was started. TTC19-related mitochondrial complex III deficiency is an ultrarare disorder of energy metabolism that presents with bilateral lesions in the basal ganglia and a degenerative neuropsychiatric phenotype.
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Affiliation(s)
- Marina Eskandar
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Laura Tochen
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Mi Ran Shin
- Rehabilitation Medicine, Children's National Hospital, Washington, District of Columbia
| | - Bennett Lavenstein
- Division of Child Neurology, Children's National Hospital, Washington District of Columbia
| | - Meira Meltzer
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Andrea Gropman
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Kuntal Sen
- Division of Neurogenetics and Neurodevelopmental Pediatrics, Children's National Hospital, Washington, District of Columbia.
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22
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Wolters AF, Snijders AH, Bloem BR. Video case: A new phenotype within the spectrum of functional orofacial movement disorders. J Neurol 2023; 270:6159-6162. [PMID: 37615750 DOI: 10.1007/s00415-023-11949-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Amée F Wolters
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Anke H Snijders
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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23
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Gilmour GS, Langer LK, Lang AE, MacGillivray L, Lidstone SC. Neuropsychiatric phenotypes in functional movement disorder. CNS Spectr 2023; 28:747-755. [PMID: 37424291 DOI: 10.1017/s1092852923002353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Functional movement disorder (FMD), the motor-dominant subtype of functional neurological disorder, is a complex neuropsychiatric condition. Patients with FMD also manifest non-motor symptoms. Given that patients with FMD are diagnosed based on motor phenotype, the contribution of non-motor features to the neuropsychiatric syndrome is not well characterized. The objective of this hypothesis-generating study was to explore potential novel, neuropsychiatric FMD phenotypes by combining movement disorder presentations with non-motor comorbidities including somatic symptoms, psychiatric diagnoses, and psychological traits. METHODS This retrospective chart review evaluated 158 consecutive patients with a diagnosis of FMD who underwent deep phenotyping across neurological and psychiatric domains. Demographic, clinical, and self-report features were analyzed. A data-driven approach using cluster analysis was performed to detect patterns when combining the movement disorder presentation with somatic symptoms, psychiatric diagnoses, and psychological factors. These new neuropsychiatric FMD phenotypes were then tested using logistic regression models. RESULTS Distinct neuropsychiatric FMD phenotypes emerged when stratifying by episodic vs. constant motor symptoms. Episodic FMD was associated with hyperkinetic movements, hyperarousal, anxiety, and history of trauma. In contrast, constant FMD was associated with weakness, gait disorders, fixed dystonia, activity avoidance, and low self-agency. Pain, fatigue, somatic preoccupation, and health anxiety were common across all phenotypes. CONCLUSION This study found patterns spanning the neurological-psychiatric interface that indicate that FMD is part of a broader neuropsychiatric syndrome. Adopting a transdisciplinary view of illness reveals readily identifiable clinical factors that are relevant for the development and maintenance of FMD.
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Affiliation(s)
- Gabriela S Gilmour
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura K Langer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lindsey MacGillivray
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah C Lidstone
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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24
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Mestre TA, Luo S, Stebbins GT, Sampaio C, Goetz CG. Reply to: "The Framework for Diagnostic Criteria in Movement Disorders: The Value of Methodological Tools and Combined Criteria". Mov Disord 2023; 38:1763-1764. [PMID: 37718268 DOI: 10.1002/mds.29588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Tiago A Mestre
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Ottawa, Ottawa, Ontario, Canada
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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25
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Vignatelli L, Calandra-Buonaura G, Stankovic I, Kaufmann H, Cortelli P, Wenning GK. The Framework for Diagnostic Criteria in Movement Disorders: The Value of Methodological Tools and Combined Criteria. Mov Disord 2023; 38:1762-1763. [PMID: 37718267 DOI: 10.1002/mds.29587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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26
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Costa R, Aubert AM, Seppänen AV, Ådén U, Sarrechia I, Zemlin M, Cuttini M, Männamaa M, Pierrat V, van Heijst A, Barros H, Zeitlin J, Johnson S. Prediction of movement difficulties at 5 years from parent report at 2 years in children born extremely preterm. Dev Med Child Neurol 2023; 65:1215-1225. [PMID: 38038478 DOI: 10.1111/dmcn.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023]
Abstract
AIM To assess the predictive validity of parent-reported gross motor impairment (GMI) at age 2 years to detect significant movement difficulties at age 5 years in children born extremely preterm. METHOD Data were from 556 children (270 males, 286 females) born at less than 28 weeks' gestation in 2011 to 2012 in 10 European countries. Parent report of moderate/severe GMI was defined as walking unsteadily or unable to walk unassisted at 2 years corrected age. Examiners assessed significant movement difficulties (score ≤ 5th centile on the Movement Assessment Battery for Children, Second Edition) and diagnoses of cerebral palsy (CP) were collected by parent report at 5 years chronological age. RESULTS At 2 years, 66 (11.9%) children had moderate/severe GMI. At 5 years, 212 (38.1%) had significant movement difficulties. Parent reports of GMI at age 2 years accurately classified CP at age 5 years in 91.0% to 93.2% of children. Classification of moderate/severe GMI at age 2 years had high specificity (96.2%; 95% confidence interval 93.6-98.0) and positive predictive value (80.3%; 68.7-89.1) for significant movement difficulties at age 5 years. However, 74.5% of children with significant movement difficulties at 5 years were not identified with moderate/severe GMI at age 2 years, resulting in low sensitivity (25.1%; 19.4-31.5). INTERPRETATION This questionnaire may be used to identify children born extremely preterm who at age 2 years have a diagnosis of CP or movement difficulties that are likely to have a significant impact on their functional outcomes at age 5 years.
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Affiliation(s)
- Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Anna-Veera Seppänen
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michael Zemlin
- Saarland University Medical Center, Department für General Pediatrics and Neonatology, Homburg, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
- Erasmus MC, Rotterdam, the Netherlands
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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27
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Khan M. Restless Legs Syndrome and Other Common Sleep-Related Movement Disorders. Continuum (Minneap Minn) 2023; 29:1130-1148. [PMID: 37590826 DOI: 10.1212/con.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews common sleep-related movement disorders, including their clinical description, epidemiology, pathophysiology (if known), and evaluation and management strategies. This article will provide the reader with a good foundation for approaching concerns that are suggestive of sleep-related movement disorders to properly evaluate and manage these conditions. LATEST DEVELOPMENTS α2δ Ligands, such as gabapentin enacarbil, can be used for the initial treatment of restless legs syndrome (RLS) or in those who cannot tolerate, or have developed augmentation to, dopamine agonists. Another option is the rotigotine patch, which has a 24-hour treatment window and may be beneficial for those who have developed augmentation with short-acting dopamine agonists. IV iron can improve RLS symptoms even in those whose serum ferritin level is between 75 ng/mL and 100 ng/mL. At serum ferritin levels greater than 75 ng/mL, oral iron will likely have minimal absorption or little effect on the improvement of RLS. Research has found an association between RLS and cardiovascular disease, particularly in people who have periodic limb movements of sleep. ESSENTIAL POINTS RLS is the most common sleep-related movement disorder. Its pathophysiology is likely a combination of central iron deficiency, dopamine overproduction, and possibly cortical excitation. Treatment includes oral or IV iron. Dopaminergic medications can be very effective but often lead to augmentation, which limits their long-term use. Other sleep-related movement disorders to be aware of are sleep-related rhythmic movement disorder, nocturnal muscle cramps, sleep-related propriospinal myoclonus, sleep bruxism, and benign myoclonus of infancy.
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Ream MA, Lam WK, Grosse SD, Ojodu J, Jones E, Prosser LA, Rose AM, Comeau AM, Tanksley S, Powell CM, Kemper AR. Evidence and Recommendation for Guanidinoacetate Methyltransferase Deficiency Newborn Screening. Pediatrics 2023; 152:e2023062100. [PMID: 37465909 PMCID: PMC10527896 DOI: 10.1542/peds.2023-062100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 07/20/2023] Open
Abstract
Guanidinoacetate methyltransferase (GAMT) deficiency is an autosomal recessive disorder of creatine biosynthesis due to pathogenic variants in the GAMT gene that lead to cerebral creatine deficiency and neurotoxic levels of guanidinoacetate. Untreated, GAMT deficiency is associated with hypotonia, significant intellectual disability, limited speech development, recurrent seizures, behavior problems, and involuntary movements. The birth prevalence of GAMT deficiency is likely between 0.5 and 2 per million live births. On the basis of small case series and sibling data, presymptomatic treatment with oral supplements of creatine, ornithine, and sodium benzoate, and a protein-restricted diet to reduce arginine intake, appear to substantially improve health and developmental outcomes. Without newborn screening, diagnosis typically happens after the development of significant impairment, when treatment has limited utility. GAMT deficiency newborn screening can be incorporated into the tandem-mass spectrometry screening that is already routinely used for newborn screening, with about 1 per 100 000 newborns screening positive. After a positive screen, diagnosis is established by finding an elevated guanidinoacetate concentration and low creatine concentration in the blood. Although GAMT deficiency is significantly more rare than other conditions included in newborn screening, the feasibility of screening, the low number of positive results, the relative ease of diagnosis, and the expected benefit of presymptomatic dietary therapy led to a recommendation from the Advisory Committee on Heritable Disorders in Newborns and Children to the Secretary of Health and Human Services that GAMT deficiency be added to the Recommended Uniform Screening Panel. This recommendation was accepted in January 2023.
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Affiliation(s)
- Margie A. Ream
- Division of Child Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Wendy K.K. Lam
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, Maryland
| | - Elizabeth Jones
- Association of Public Health Laboratories, Silver Spring, Maryland
| | - Lisa A. Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Angela M. Rose
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Anne Marie Comeau
- New England Newborn Screening Program, Department of Pediatrics, UMass Chan School of Medicine, Worcester, Massachusetts
| | - Susan Tanksley
- Texas Department of State Health Services, Laboratory Services Section, Austin, Texas
| | - Cynthia M. Powell
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex R. Kemper
- Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
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29
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Erro R, Magrinelli F, Bhatia KP. Paroxysmal movement disorders: Paroxysmal dyskinesia and episodic ataxia. Handb Clin Neurol 2023; 196:347-365. [PMID: 37620078 DOI: 10.1016/b978-0-323-98817-9.00033-8] [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] [Indexed: 08/26/2023]
Abstract
Paroxysmal movement disorders have traditionally been classified into paroxysmal dyskinesia (PxD), which consists in attacks of involuntary movements (mainly dystonia and/or chorea) without loss of consciousness, and episodic ataxia (EA), which features spells of cerebellar dysfunction with or without interictal neurological manifestations. In this chapter, PxD will be discussed first according to the trigger-based classification, thus reviewing clinical, genetic, and molecular features of paroxysmal kinesigenic dyskinesia, paroxysmal nonkinesigenic dyskinesia, and paroxysmal exercise-induced dyskinesia. EA will be presented thereafter according to their designated gene or genetic locus. Clinicogenetic similarities among paroxysmal movement disorders have progressively emerged, which are herein highlighted along with growing evidence that their pathomechanisms overlap those of epilepsy and migraine. Advances in our comprehension of the biological pathways underlying paroxysmal movement disorders, which involve ion channels as well as proteins associated with the vesical synaptic cycle or implicated in neuronal energy metabolism, may represent the cornerstone for defining a shared pathophysiologic framework and developing target-specific therapies.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Salerno, Italy
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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30
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Paton L, Philopena R, Mackewicz P. Movement disorders in children: recognition and management in the emergency department. Pediatr Emerg Med Pract 2022; 19:1-20. [PMID: 36378853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
The differential diagnosis for pediatric patients presenting to the emergency department with movement-based neurological complaints is wide. Clinicians must ensure these children receive an appropriate evaluation to recognize rare diseases. Early recognition of these diagnoses helps facilitate coordination with specialists, guides imaging, and ensures proper management and disposition. This issue reviews 3 less-common movement disorders: acute cerebellar ataxia, anti-N-methyl-D-aspartate receptor encephalitis, and acute disseminated encephalomyelitis. The common presentations, evaluation, and management of these conditions in the emergency department are discussed.
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Affiliation(s)
- Lance Paton
- Pediatric Emergency Medicine, Westchester Medical Center, Valhalla, NY
| | - Rhonda Philopena
- Assistant Clinical Professor, Pediatric Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Phillip Mackewicz
- Clinical Fellow of Pediatric Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
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Youssef P. Childhood Neurologic Conditions: Movement Disorders. FP Essent 2022; 523:20-26. [PMID: 36459665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Most movement disorders in children are hyperkinetic. The most common type is tic disorders, which can involve motor and phonic tics and are classified as simple or complex. Motor or phonic tics that persist for more than 1 year are defined as persistent (chronic) tic disorder. Tourette syndrome can be diagnosed if a child has multiple motor tics and at least one phonic tic for more than 1 year with onset before age 18 years. Children with Tourette syndrome may have symptoms of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, depression, or behavioral disorders. Chorea can be seen as a symptom of rheumatic fever (Sydenham chorea), in children with a history of kernicterus, and in dyskinetic cerebral palsy. Chorea also may be part of an underlying metabolic or genetic condition. Dystonia is characterized by repetitive contortions and posturing of the limbs and body. It can be isolated or part of an underlying neurologic condition. Tremor can occur as a manifestation of essential tremor or can be an enhanced physiologic tremor exacerbated by drugs, illness, or stimulants. Ataxia most often is seen as a postinfectious or postvaccination acute cerebellar ataxia. Progressive ataxias are consistent with an underlying metabolic or genetic condition. Transient and developmental movement disorders include benign neonatal sleep myoclonus, jitteriness in neonates, shuddering, and stereotypies.
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Affiliation(s)
- Paul Youssef
- Mayo Clinic Rochester Department of Neurology, 200 First St SW Floor 8, Rochester, MN 55905
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Balta D, Kuo H, Wang J, Porco IG, Morozova O, Schladen MM, Cereatti A, Lum PS, Della Croce U. Characterization of Infants' General Movements Using a Commercial RGB-Depth Sensor and a Deep Neural Network Tracking Processing Tool: An Exploratory Study. Sensors (Basel) 2022; 22:7426. [PMID: 36236525 PMCID: PMC9572717 DOI: 10.3390/s22197426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Cerebral palsy, the most common childhood neuromotor disorder, is often diagnosed through visual assessment of general movements (GM) in infancy. This skill requires extensive training and is thus difficult to implement on a large scale. Automated analysis of GM performed using low-cost instrumentation in the home may be used to estimate quantitative metrics predictive of movement disorders. This study explored if infants' GM may be successfully evaluated in a familiar environment by processing the 3D trajectories of points of interest (PoI) obtained from recordings of a single commercial RGB-D sensor. The RGB videos were processed using an open-source markerless motion tracking method which allowed the estimation of the 2D trajectories of the selected PoI and a purposely developed method which allowed the reconstruction of their 3D trajectories making use of the data recorded with the depth sensor. Eight infants' GM were recorded in the home at 3, 4, and 5 months of age. Eight GM metrics proposed in the literature in addition to a novel metric were estimated from the PoI trajectories at each timepoint. A pediatric neurologist and physiatrist provided an overall clinical evaluation from infants' video. Subsequently, a comparison between metrics and clinical evaluation was performed. The results demonstrated that GM metrics may be meaningfully estimated and potentially used for early identification of movement disorders.
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Affiliation(s)
- Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - HsinHung Kuo
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | - Jing Wang
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | | | - Olga Morozova
- Children’s National Hospital, Washington, DC 20010, USA
| | - Manon Maitland Schladen
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Peter Stanley Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC 20064, USA
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
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Righetti S, Allcock RJN, Yaplito-Lee J, Adams L, Ellaway C, Jones KJ, Selvanathan A, Fletcher J, Pitt J, van Kuilenburg ABP, Delatycki MB, Laing NG, Kirk EP. The relationship between beta-ureidopropionase deficiency due to UPB1 variants and human phenotypes is uncertain. Mol Genet Metab 2022; 137:62-67. [PMID: 35926322 DOI: 10.1016/j.ymgme.2022.07.011] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Beta-ureidopropionase deficiency, caused by variants in UPB1, has been reported in association with various neurodevelopmental phenotypes including intellectual disability, seizures and autism. AIM We aimed to reassess the relationship between variants in UPB1 and a clinical phenotype. METHODS Literature review, calculation of carrier frequencies from population databases, long-term follow-up of a previously published case and reporting of additional cases. RESULTS Fifty-three published cases were identified, and two additional cases are reported here. Of these, 14 were asymptomatic and four had transient neurological features; clinical features in the remainder were variable and included non-neurological presentations. Several of the variants previously reported as pathogenic are present in population databases at frequencies higher than expected for a rare condition. In particular, the variant most frequently reported as pathogenic, p.Arg326Gln, is very common among East Asians, with a carrier frequency of 1 in 19 and 1 in 907 being homozygous for the variant in gnomAD v2.1.1. CONCLUSION Pending the availability of further evidence, UPB1 should be considered a 'gene of uncertain clinical significance'. Caution should be used in ascribing clinical significance to biochemical features of beta-ureidopropionase deficiency and/or UPB1 variants in patients with neurodevelopmental phenotypes. UPB1 is not currently suitable for inclusion in gene panels for reproductive genetic carrier screening. SYNOPSIS The relationship between beta-ureidopropionase deficiency due to UPB1 variants and clinical phenotypes is uncertain.
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Affiliation(s)
| | | | - Joy Yaplito-Lee
- Department of Metabolic Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Louisa Adams
- Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | | | - Kristi J Jones
- Sydney Children's Hospitals Network, Sydney, NSW, Australia; University of Sydney, NSW, Australia
| | | | | | - James Pitt
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - André B P van Kuilenburg
- Amsterdam UMC location, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Laboratory Genetic Metabolic Diseases, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Martin B Delatycki
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nigel G Laing
- Centre for Medical Research University of Western Australia, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Edwin P Kirk
- University of New South Wales, Sydney, NSW, Australia; Sydney Children's Hospitals Network, Sydney, NSW, Australia; New South Wales Health Pathology, Sydney, NSW, Australia.
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Koens LH, Tuitert I, Blokzijl H, Engelen M, Klouwer FCC, Lange F, Leen WG, Lunsing RJ, Koelman JHTM, Verrips A, de Koning TJ, Tijssen MAJ. Eye movement disorders in inborn errors of metabolism: A quantitative analysis of 37 patients. J Inherit Metab Dis 2022; 45:981-995. [PMID: 35758105 PMCID: PMC9541348 DOI: 10.1002/jimd.12533] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/30/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Inborn errors of metabolism are genetic disorders that need to be recognized as early as possible because treatment may be available. In late-onset forms, core symptoms are movement disorders, psychiatric symptoms, and cognitive impairment. Eye movement disorders are considered to be frequent too, although specific knowledge is lacking. We describe and analyze eye movements in patients with an inborn error of metabolism, and see whether they can serve as an additional clue in the diagnosis of particularly late-onset inborn errors of metabolism. Demographics, disease characteristics, and treatment data were collected. All patients underwent a standardized videotaped neurological examination and a video-oculography. Videos are included. We included 37 patients with 15 different inborn errors of metabolism, including 18 patients with a late-onset form. With the exception of vertical supranuclear gaze palsy in Niemann-Pick type C and external ophthalmolplegia in Kearns-Sayre syndrome, no relation was found between the type of eye movement disorder and the underlying metabolic disorder. Movement disorders were present in 29 patients (78%), psychiatric symptoms in 14 (38%), and cognitive deficits in 26 patients (70%). In 87% of the patients with late-onset disease, eye movement disorders were combined with one or more of these core symptoms. To conclude, eye movement disorders are present in different types of inborn errors of metabolism, but are often not specific to the underlying disorder. However, the combination of eye movement disorders with movement disorders, psychiatric symptoms, or cognitive deficits can serve as a diagnostic clue for an underlying late-onset inborn error of metabolism.
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Affiliation(s)
- Lisette H. Koens
- Department of Neurology and Clinical NeurophysiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Expertise Center Movement Disorders GroningenUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | - Inge Tuitert
- Department of Neurology and Clinical NeurophysiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Expertise Center Movement Disorders GroningenUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and HepatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Marc Engelen
- Department of Neurology and Clinical NeurophysiologyUniversity of Amsterdam, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Femke C. C. Klouwer
- Department of Neurology and Clinical NeurophysiologyUniversity of Amsterdam, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Fiete Lange
- Department of Neurology and Clinical NeurophysiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wilhelmina G. Leen
- Department of Neurology and Clinical NeurophysiologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
| | - Roelineke J. Lunsing
- Department of Neurology and Clinical NeurophysiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Johannes H. T. M. Koelman
- Department of Neurology and Clinical NeurophysiologyUniversity of Amsterdam, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Aad Verrips
- Department of Neurology and Clinical NeurophysiologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
| | - Tom J. de Koning
- Expertise Center Movement Disorders GroningenUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
- Department of GeneticsUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of PediatricsClinical Sciences, Lund UniversityLundSweden
| | - Marina A. J. Tijssen
- Department of Neurology and Clinical NeurophysiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Expertise Center Movement Disorders GroningenUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
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35
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Ghadery CM, Kalia LV, Connolly BS. Movement disorders of the mouth: a review of the common phenomenologies. J Neurol 2022; 269:5812-5830. [PMID: 35904592 DOI: 10.1007/s00415-022-11299-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Movement disorders of the mouth encompass a spectrum of hyperactive movements involving the muscles of the orofacial complex. They are rare conditions and are described in the literature primarily in case reports originating from neurologists, psychiatrists, and the dental community. The focus of this review is to provide a phenomenological description of different oral motor disorders including oromandibular dystonia, orofacial dyskinesia and orolingual tremor, and to offer management strategies for optimal treatment based on the current literature. A literature search of full text studies using PubMed/Medline and Cochrane library combined with a manual search of the reference lists was conducted until June 2021. Results from this search included meta-analyses, systematic reviews, reviews, clinical studies, case series, and case reports published by neurologists, psychiatrists, dentists and oral and maxillofacial surgeons. Data garnered from these sources were used to provide an overview of most commonly encountered movement disorders of the mouth, aiding physicians in recognizing these rare conditions and in initiating appropriate therapy.
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Affiliation(s)
- C M Ghadery
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - L V Kalia
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - B S Connolly
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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Tang W, van Ooijen PMA, Sival DA, Maurits NM. 2D Gait Skeleton Data Normalization for Quantitative Assessment of Movement Disorders from Freehand Single Camera Video Recordings. Sensors (Basel) 2022; 22:4245. [PMID: 35684866 PMCID: PMC9185346 DOI: 10.3390/s22114245] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Overlapping phenotypic features between Early Onset Ataxia (EOA) and Developmental Coordination Disorder (DCD) can complicate the clinical distinction of these disorders. Clinical rating scales are a common way to quantify movement disorders but in children these scales also rely on the observer's assessment and interpretation. Despite the introduction of inertial measurement units for objective and more precise evaluation, special hardware is still required, restricting their widespread application. Gait video recordings of movement disorder patients are frequently captured in routine clinical settings, but there is presently no suitable quantitative analysis method for these recordings. Owing to advancements in computer vision technology, deep learning pose estimation techniques may soon be ready for convenient and low-cost clinical usage. This study presents a framework based on 2D video recording in the coronal plane and pose estimation for the quantitative assessment of gait in movement disorders. To allow the calculation of distance-based features, seven different methods to normalize 2D skeleton keypoint data derived from pose estimation using deep neural networks applied to freehand video recording of gait were evaluated. In our experiments, 15 children (five EOA, five DCD and five healthy controls) were asked to walk naturally while being videotaped by a single camera in 1280 × 720 resolution at 25 frames per second. The high likelihood of the prediction of keypoint locations (mean = 0.889, standard deviation = 0.02) demonstrates the potential for distance-based features derived from routine video recordings to assist in the clinical evaluation of movement in EOA and DCD. By comparison of mean absolute angle error and mean variance of distance, the normalization methods using the Euclidean (2D) distance of left shoulder and right hip, or the average distance from left shoulder to right hip and from right shoulder to left hip were found to better perform for deriving distance-based features and further quantitative assessment of movement disorders.
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Affiliation(s)
- Wei Tang
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Peter M. A. van Ooijen
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Deborah A. Sival
- Department of Pediatric Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands;
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Abstract
Movement disorders are commonly encountered by the general practitioner and can be divided into 2 broad categories: hypokinetic and hyperkinetic. The former involves loss or slowing of movement, whereas the latter is characterized by excessive and involuntary movements. A careful history will guide the examiner to the appropriate category of movement disorders. As no laboratory test or radiologic study is confirmatory for these disorders, diagnosis must be made clinically and the neurologic examination is indispensable. In this article, we discuss physical examination techniques that will help diagnose common movement disorders.
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Affiliation(s)
- Daniel Winkel
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive Northeast, Suite 290, Atlanta, GA 30329, USA.
| | - Lisa Bernstein
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
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Tomiyama M. [Functional Movement Disorders That Do Not Improve after Explaining the Diagnosis: The Role of Neurologists]. Brain Nerve 2022; 74:559-564. [PMID: 35589647 DOI: 10.11477/mf.1416202080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In recent years, the term "functional" is starting to replace "psychogenic" when referring to a specific group of movement disorders, with an increasing emphasis being placed on the role of neurologists in the management of these disorders. These conditions are common and disabling, and sometimes difficult to diagnose. History taking and physical examination may highlight positive signs suggestive of diagnosis, which should not be based on exclusion. During examination, the distraction sign may be observed. When functional myoclonus is present, the patient's movements may vary over time. The role of a neurologist is not only to diagnose functional movement disorders, but also explain to the patient that the patient has a distinct neurological disorder and provide clinical evidence that supports the diagnosis. It is useful to share the positive signs with patients when explaining the diagnosis. In this article, I describe a patient with functional abdominal jerks to demonstrate how a diagnosis is made and how one can explain the diagnosis to the patient. Once a patient accepts and understands the diagnosis, treatment can be initiated. Collaboration with psychiatrists and physiotherapists is essential. It has been shown that cognitive behavioral therapy and physiotherapy are beneficial in ameliorating functional movements.
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Affiliation(s)
- Masahiko Tomiyama
- Department of Neurology, Hirosaki University Graduate School of Medicine
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39
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Wojcik M, Morrissey M, Borden K, Teta B, Sicko R, Showers A, Sunny S, Caggana M. Method modification to reduce false positives for newborn screening of guanidinoacetate methyltransferase deficiency. Mol Genet Metab 2022; 135:186-192. [PMID: 35120844 DOI: 10.1016/j.ymgme.2022.01.101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
Guanidinoacetate methyltransferase (GAMT) deficiency is an autosomal recessive disorder that results in reduced activity of guanidinoacetate methyltransferase, an accumulation of guanidinoacetate (GUAC), and a lack of cerebral creatine (CRE). Lack of CRE in the brain can cause intellectual disability, autistic-like behavior, seizures, and movement disorders. Identification at birth and immediate therapy can prevent intellectual disability and seizures. If started early in life, treatment with creatine supplements is highly effective. Because there are reliable biomarkers for GAMT deficiency, GUAC and CRE, and because the disorder is readily treatable with a significant improvement in outcomes, GAMT deficiency is an excellent candidate for newborn screening. Several programs have conducted pilot programs or started screening. An isobaric interferant of the GUAC marker has been reported which may cause false positive results. To reduce the number of false positives, a second-tier HPLC test to separate GUAC from unknown, isobaric interferants may be incorporated into the screening algorithm. New York State began screening for GAMT deficiency in October 2018 using a three-tiered screening approach. Quantification of GUAC and CRE were incorporated into routine screening for amino acids and acylcarnitines. In the first year of screening a total of 263,739 samples were tested for GAMT deficiency. Of these, 3382 required second tier testing. After second tier testing, 210 repeat specimens were requested for borderline results and 10 referrals were made to specialty care centers for confirmatory testing. In the first year of screening there were no confirmed cases of GAMT deficiency detected. To reduce the number of samples needing second tier testing and the number false positives we explored the use of a second MS transition to confirm the identity of the GUAC marker. GUAC and its internal standard are detected as butylated esters after sample preparation and derivatization. The original method used transition of the GUAC molecular ion of m/z 174.1 to a reactant ion of m/z 101.1. To confirm the identity of the GUAC marker we selected a qualifier ion of 174.1 > 73. The alternative product ion results were found to agree more closely with the second tier HPLC-MS/MS results for GUAC. It was found that the alternative transition may be used for quantification of the GUAC marker with acceptable analytical performance (linearity, accuracy, and precision). On March 5, 2020, the method of analysis for GUAC was modified to use the alternative product ion. For a comparable 6-month period, the modified method reduced the number of samples requiring second tier testing by 98%, reduced the number of borderline results requiring a repeat sample by 87.5%, and reduced the number of referrals to specialty care centers by 85%. Using the modified method, the correlation (r-squared) of the first and second tier screening results for GUAC is greater than 0.95. Since the first-tier results correlate well with the second-tier results, the second-tier screening is no longer necessary with the modified method.
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Affiliation(s)
- Matthew Wojcik
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Mark Morrissey
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
| | - Kimberly Borden
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Bianca Teta
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Robert Sicko
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Showers
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Sherly Sunny
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Michele Caggana
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Blanchard-Rohner G, Peirolo A, Coulon L, Korff C, Horvath J, Burkhard PR, Gumy-Pause F, Ranza E, Jandus P, Dibra H, Taylor AMR, Fluss J. Childhood-Onset Movement Disorders Can Mask a Primary Immunodeficiency: 6 Cases of Classical Ataxia-Telangiectasia and Variant Forms. Front Immunol 2022; 13:791522. [PMID: 35154108 PMCID: PMC8831727 DOI: 10.3389/fimmu.2022.791522] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/07/2022] [Indexed: 02/02/2023] Open
Abstract
Ataxia-telangiectasia (A-T) is a neurodegenerative and primary immunodeficiency disorder (PID) characterized by cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure, and an increased risk of malignancies. It demands specialized care tailored to the individual patient’s needs. Besides the classical ataxia-telangiectasia (classical A-T) phenotype, a variant phenotype (variant A-T) exists with partly overlapping but some distinctive disease characteristics. Here we present a case series of 6 patients with classical A-T and variant A-T, which illustrates the phenotypic variability of A-T that can present in childhood with prominent extrapyramidal features, with or without cerebellar ataxia. We report the clinical data, together with a detailed genotype description, immunological analyses, and related expression of the ATM protein. We show that the presence of some residual ATM kinase activity leads to the clinical phenotype variant A-T that differs from the classical A-T. Our data illustrate that the diagnosis of the variant form of A-T can be delayed and difficult, while early recognition of the variant form as well as the classical A-T is a prerequisite for providing a correct prognosis and appropriate rehabilitation and support, including the avoidance of diagnostic X-ray procedures, given the increased risk of malignancies and the higher risk for side effects of subsequent cancer treatment.
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Affiliation(s)
- Geraldine Blanchard-Rohner
- Paediatric Immunology and Vaccinology Unit, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- *Correspondence: Geraldine Blanchard-Rohner,
| | - Anna Peirolo
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Ludivine Coulon
- Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christian Korff
- Pediatric Neurology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Judit Horvath
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre R. Burkhard
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Gumy-Pause
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuelle Ranza
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Harpreet Dibra
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Joel Fluss
- Pediatric Neurology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Bereau M, Tranchant C. [Abnormal movements]. Rev Prat 2022; 72:93-100. [PMID: 35258263] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Matthieu Bereau
- Service de neurologie, électrophysiologie clinique, CHU de Besançon, Besançon, France
| | - Christine Tranchant
- Service de pathologie du mouvement, neurologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
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Marion MH. Henry Meige: The man and his understanding of dystonia, at the turn of the 19th to 20th century. Rev Neurol (Paris) 2021; 178:532-538. [PMID: 34799079 DOI: 10.1016/j.neurol.2021.07.024] [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: 05/17/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Henry Meige (1866-1940), a French neurologist, the pupil of Charcot, is remembered for the eponym, the Meige syndrome, describing the clinical picture of craniocervical dystonia. This historical review highlights the controversies from his essay on "Le Juif Errant" (the Wandering Jew), and the evolution of his understanding of the movement disorders of the face and neck at the time of the encephalitis lethargica. RESULTS His thesis reported 5 patients from Eastern Europe, presenting with functional neurological disorders following traumatic life experiences. He wrote with Feindel the first book on movement disorders "Les tics et leur traitement". He pioneered the concept of focal dystonia and distinguished the facial median spasm as a dystonic movement disorder of the face. He highlighted the co-existence of psychopathology and the influence of the mental on tics and dystonia. He coined with Brissaud and Feindel the term "geste antagoniste" in cervical dystonia. He emphasized the importance of self-management and psycho-motor retraining for focal dystonia. CONCLUSION Meige made an invaluable contribution to our understanding of movement disorders, during his long medical career. The eponym Meige syndrome should be retained to describe an individual clinical entity.
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Affiliation(s)
- M-H Marion
- London BTX Centre, 280 King's road, SW3 5AW London, UK.
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van der Stouwe AMM, Tuitert I, Giotis I, Calon J, Gannamani R, Dalenberg JR, van der Veen S, Klamer MR, Telea AC, Tijssen MAJ. Next move in movement disorders (NEMO): developing a computer-aided classification tool for hyperkinetic movement disorders. BMJ Open 2021; 11:e055068. [PMID: 34635535 PMCID: PMC8506849 DOI: 10.1136/bmjopen-2021-055068] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Our aim is to develop a novel approach to hyperkinetic movement disorder classification, that combines clinical information, electromyography, accelerometry and video in a computer-aided classification tool. We see this as the next step towards rapid and accurate phenotype classification, the cornerstone of both the diagnostic and treatment process. METHODS AND ANALYSIS The Next Move in Movement Disorders (NEMO) study is a cross-sectional study at Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen. It comprises patients with single and mixed phenotype movement disorders. Single phenotype groups will first include dystonia, myoclonus and tremor, and then chorea, tics, ataxia and spasticity. Mixed phenotypes are myoclonus-dystonia, dystonic tremor, myoclonus ataxia and jerky/tremulous functional movement disorders. Groups will contain 20 patients, or 40 healthy participants. The gold standard for inclusion consists of interobserver agreement on the phenotype among three independent clinical experts. Electromyography, accelerometry and three-dimensional video data will be recorded during performance of a set of movement tasks, chosen by a team of specialists to elicit movement disorders. These data will serve as input for the machine learning algorithm. Labels for supervised learning are provided by the expert-based classification, allowing the algorithm to learn to predict what the output label should be when given new input data. Methods using manually engineered features based on existing clinical knowledge will be used, as well as deep learning methods which can detect relevant and possibly new features. Finally, we will employ visual analytics to visualise how the classification algorithm arrives at its decision. ETHICS AND DISSEMINATION Ethical approval has been obtained from the relevant local ethics committee. The NEMO study is designed to pioneer the application of machine learning of movement disorders. We expect to publish articles in multiple related fields of research and patients will be informed of important results via patient associations and press releases.
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Affiliation(s)
- A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge Tuitert
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ioannis Giotis
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Rahul Gannamani
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle R Dalenberg
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sterre van der Veen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Alex C Telea
- Department of Information and Computing Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Arita S, Nishiyama D, Taniguchi T, Fukui D, Yamanaka M, Yamada H. Feature selection to classify lameness using a smartphone-based inertial measurement unit. PLoS One 2021; 16:e0258067. [PMID: 34591946 PMCID: PMC8483374 DOI: 10.1371/journal.pone.0258067] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Gait can be severely affected by pain, muscle weakness, and aging resulting in lameness. Despite the high incidence of lameness, there are no studies on the features that are useful for classifying lameness patterns. Therefore, we aimed to identify features of high importance for classifying population differences in lameness patterns using an inertial measurement unit mounted above the sacral region. Methods Features computed exhaustively for multidimensional time series consisting of three-axis angular velocities and three-axis acceleration were carefully selected using the Benjamini–Yekutieli procedure, and multiclass classification was performed using LightGBM (Microsoft Corp., Redmond, WA, USA). We calculated the relative importance of the features that contributed to the classification task in machine learning. Results The most important feature was found to be the absolute value of the Fourier coefficients of the second frequency calculated by the one-dimensional discrete Fourier transform for real input. This was determined by the fast Fourier transformation algorithm using data of a single gait cycle of the yaw angular velocity of the pelvic region. Conclusions Using an inertial measurement unit worn over the sacral region, we determined a set of features of high importance for classifying differences in lameness patterns based on different factors. This completely new set of indicators can be used to advance the understanding of lameness.
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Affiliation(s)
- Satoshi Arita
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
- * E-mail:
| | - Takaya Taniguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Fukui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Yamanaka
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Billnitzer A, Jankovic J. The Clinical Value of Patient Home Videos in Movement Disorders. Tremor Other Hyperkinet Mov (N Y) 2021; 11:37. [PMID: 34692230 PMCID: PMC8485864 DOI: 10.5334/tohm.651] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022] Open
Abstract
Background Numerous studies have shown the value of patient home video recordings within the field of epilepsy. Despite the growing influence of mobile technology and telemedicine, there is a paucity of studies examining the role of home videos in the diagnosis of movement disorders. Objective To characterize the clinical value of patient home videos in a movement disorders practice. Methods We performed a retrospective review from our video database over the past 10 years and identified 20 encounters where an in-person, clinic evaluation and studio video were supplemented by a home video. We reviewed these encounters to determine if the home video added additional value to the clinic video. The home videos were screened by 3 movement disorders attendings and 3 movement disorders fellows to assess for quality and to determine whether or not the patient phenomenology could accurately be identified. Results Of the 20 videos identified, 10 (50%) were determined to be of additional clinical value. In 62.4% of evaluations movement disorders attendings and fellows were able to identify phenomenology from the home videos consistent with the final diagnosis. Videos rated as "poor" quality had significantly lower odds of leading to a correct phenomenology (odd ratio: 0.07, 95% confidence interval [0.01-0.72]) than those rated as "excellent" quality. Conclusions Patients should be encouraged to produce good quality home videos, particularly in paroxysmal or fluctuating movement disorders, as they may add value to the eventual diagnosis and management.
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Affiliation(s)
- Andrew Billnitzer
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Department of Neurology, Houston, Texas
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Department of Neurology, Houston, Texas
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Jain R, Pandey S, Raghav S. Movement Disorders in Children. Indian Pediatr 2021; 58:861-870. [PMID: 34016797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT Movement disorders represent a common presentation in pediatrics and are often a source of clinical and diagnostic dilemmas. In this review, we provide an overview of common causes along with simplified clinical approach and management options for major movement disorders. SOURCES This narrative review is based on contemporary evidence and personal experience. Medline was searched for recent advances, current understanding and consensus on classification, clinical features, diagnosis and treatment. RESULTS Movement disorders are classified as hyperkinetic and hypokinetic disorders, the latter being rare in childhood. The hyperkinetic disorders include dystonia, chorea, athetosis, tics and tremor, stereotypies, myoclonus, startle syndromes and functional disorders. Some movement disorders can be benign and developmental. A large proportion of conditions are genetic in origin with a guarded prognosis. Some of the conditions may be post-infectious, immune-mediated or drug induced. Multiple types of movement disorders are present in many conditions. The age at onset, type and distribution of abnormal movements and presence of associated neurological and systemic features help in narrowing the differential diagnosis. The pharmacotherapy of movement disorders is complex and evolving. CONCLUSION A synopsis of movement disorders presenting in pediatric age has been provided, incorporating the latest evidence. A simplified approach for clinical diagnosis has been developed for dystonia and chorea.
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Affiliation(s)
- Rahul Jain
- Department of Pediatrics, Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Rahul Jain, 7 Nixon Street, Kepnock, Queensland, Australia-4670.
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Sanjay Raghav
- Department of Neuroscience, Monash University, Clayton, Australia
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Hart K, Rohrwasser A, Wallis H, Golsan H, Shao J, Anderson T, Wang X, Szabo-Fresnais N, Morrissey M, Kay DM, Wojcik M, Galvin-Parton PA, Longo N, Caggana M, Pasquali M. Prospective identification by neonatal screening of patients with guanidinoacetate methyltransferase deficiency. Mol Genet Metab 2021; 134:60-64. [PMID: 34389248 DOI: 10.1016/j.ymgme.2021.07.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Guanidinoacetate methyltransferase (GAMT) deficiency is an inherited metabolic disorder that impairs the synthesis of creatine (CRE). Lack of CRE in the brain can cause intellectual disability, autistic-like behavior, seizures, and movement disorders. Identification at birth and immediate therapy can prevent intellectual disability and seizures. Here we report the first two cases of GAMT deficiency identified at birth by newborn screening (NBS) in Utah and New York. METHODS NBS dried blood spots were analyzed by tandem mass spectrometry (MS/MS) using either derivatized or non-derivatized assays to detect guanidinoacetate (GUAC) and CRE. For any positive samples, a second-tier test using a more selective method, ultra-performance liquid chromatography (UPLC) combined with MS/MS, was performed to separate GUAC from potential isobaric interferences. RESULTS NBS for GAMT deficiency began in Utah on June 1, 2015 using a derivatized method for the detection of GUAC and CRE. In May 2019, the laboratory and method transitioned to a non-derivatized method. GAMT screening was added to the New York State NBS panel on October 1, 2018 using a derivatized method. In New York, a total of 537,408 babies were screened, 23 infants were referred and one newborn was identified with GAMT deficiency. In Utah, a total of 273,902 infants were screened (195,425 with the derivatized method, 78,477 with the non-derivatized method), three infants referred and one was identified with GAMT deficiency. Mean levels of GUAC and CRE were similar between methods (Utah derivatized: GUAC = 1.20 ± 0.43 μmol/L, CRE = 238 ± 96 μmol/L; Utah non-derivatized: GUAC = 1.23 ± 0.61 μmol/L, CRE = 344 ± 150 μmol/L, New York derivatized: GUAC = 1.34 ± 0.57 μmol/L, CRE = 569 ± 155 μmol/L). With either Utah method, similar concentrations of GUAC are observed in first (collected around 1 day of age) and the second NBS specimens (routinely collected at 7-16 days of age), while CRE concentrations decreased in the second NBS specimens. Both infants identified with GAMT deficiency started therapy by 2 weeks of age and are growing and developing normally at 7 (Utah) and 4 (New York) months of age. CONCLUSIONS Newborn screening allows for the prospective identification of GAMT deficiency utilizing elevated GUAC concentration as a marker. First-tier screening may be incorporated into existing methods for amino acids and acylcarnitines without the need for new equipment or staff. Newborn screening performed by either derivatized or non-derivatized methods and coupled with second-tier testing, has a very low false positive rate and can prospectively identify affected children. SummaryCerebral creatine deficiency syndromes caused by defects in creatine synthesis can result in intellectual disability, and are preventable if therapy is initiated early in life. This manuscript reports the identification of two infants with GAMT deficiency (one of the cerebral creatine deficiency syndromes) by newborn screening and demonstrates NBS feasibility using a variety of methods.
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Affiliation(s)
- Kim Hart
- Utah Department of Health, Salt Lake City, UT, USA.
| | | | - Heidi Wallis
- Utah Department of Health, Salt Lake City, UT, USA; Association for Creatine Deficiencies, Carlsbad, CA, USA
| | | | - Jianyin Shao
- Utah Department of Health, Salt Lake City, UT, USA
| | | | - Xiaoli Wang
- Utah Department of Health, Salt Lake City, UT, USA
| | | | - Mark Morrissey
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Denise M Kay
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Matthew Wojcik
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | | | - Nicola Longo
- Department of Pathology, University of Utah, ARUP Laboratories, Salt Lake City, UT, USA; Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michele Caggana
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Marzia Pasquali
- Department of Pathology, University of Utah, ARUP Laboratories, Salt Lake City, UT, USA; Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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Affiliation(s)
- Hiroki Tamura
- General Medicine, Chiba University Hospital, Chiba, Japan
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Guo R, Shao X, Zhang C, Qian X. Sparse Adaptive Graph Convolutional Network for Leg Agility Assessment in Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2021; 28:2837-2848. [PMID: 33211661 DOI: 10.1109/tnsre.2020.3039297] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Motor disorder is a typical symptom of Parkinson's disease (PD). Neurologists assess the severity of PD motor symptoms using the clinical rating scale, i.e., MDS-UPDRS. However, this assessment method is time-consuming and easily affected by the perception difference of assessors. In the recent outbreak of coronavirus disease 2019, telemedicine for PD has become extremely urgent for clinical practice. To solve these problems, we developed an automated and objective assessment method of the leg agility task in the MDS-UPDRS using videos and a graph neural network. In this study, a sparse adaptive graph convolutional network (SA-GCN) was proposed to achieve fine-grained quantitative assessment of skeleton sequences extracted from videos. Specifically, the sparse adaptive graph convolutional unit with a prior knowledge constraint was proposed to perform adaptive spatial modeling of physical and logical dependency for skeleton sequences, thus achieving the sparse modeling of the discriminative spatial relationships. Subsequently, a temporal context module was introduced to construct the remote context dependency in the temporal dimension, hence determining the global changes of the task. A multi-domain attention learning module was also developed to integrate the static spatial features and dynamic temporal features, and then to emphasize the salient feature selection in the channel domain, thereby capturing the multi-domain fine-grained information. Finally, the evaluation results using a dataset with 148 patients and 870 samples confirmed the effectiveness and reliability of our scheme, and the method outperformed other related state-of-the-art methods. Our contactless method provides a new potential tool for automated PD assessment and telemedicine.
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Chen J, Zhou X, Lu Q, Jin L, Huang Y. Video electroencephalogram combined with electromyography in the diagnosis of hyperkinetic movement disorders with an unknown cause. Neurol Sci 2021; 42:3801-3811. [PMID: 33462635 DOI: 10.1007/s10072-021-05053-0] [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: 02/08/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnosis of hyperkinetic movement disorders with an unknown cause is usually challenging. The objective of this study is to learn about video electroencephalogram (VEEG) combined with electromyography (EMG) in the diagnosis of hyperkinetic movement disorders with an unknown cause. METHODS We performed an observational cohort study by recruiting consecutive patients with hyperkinetic movements as the main manifestation with an unknown cause for VEEG combined with EMG evaluations. RESULTS A total of 77 consecutive patients were enrolled for VEEG-EMG examination. Among them, 57 patients changed their diagnosis after VEEG-EMG assessment, with a mean final diagnosis age of 35.4 ± 20.3 years (range, 4-74 years). The mean duration between initial and final diagnosis was 54.8 ± 71.3 months (range 0.5-300 months). The most common misdiagnosed hyperkinetic movement disorders were myoclonus (40.4%), followed by tremors (24.6%), dystonia (15.8%), psychogenic movement disorders (10.5%), and periodic leg movement syndrome (PLMS) (7.0%). Outcomes of therapy were significantly improved after VEEG-EMG examination (p = 0.000). CONCLUSIONS Simultaneous VEEG and EMG are important in the diagnosis of hyperkinetic movement disorders with an unknown cause.
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Affiliation(s)
- Jianhua Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Xiangqin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Qiang Lu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
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