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Maffitt NJ, Germann M, Baker AME, Baker MR, Baker SN, Soteropoulos DS. Recovery of neurophysiological measures in post-COVID fatigue: a 12-month longitudinal follow-up study. Sci Rep 2024; 14:8874. [PMID: 38632415 PMCID: PMC11024107 DOI: 10.1038/s41598-024-59232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
One of the major consequences of the COVID-19 pandemic has been the significant incidence of persistent fatigue following resolution of an acute infection (i.e. post-COVID fatigue). We have shown previously that, in comparison to healthy controls, those suffering from post-COVID fatigue exhibit changes in muscle physiology, cortical circuitry, and autonomic function. Whether these changes preceded infection, potentially predisposing people to developing post-COVID fatigue, or whether the changes were a consequence of infection was unclear. Here we present results of a 12-month longitudinal study of 18 participants from the same cohort of post-COVID fatigue sufferers to investigate these correlates of fatigue over time. We report improvements in self-perception of the impact of fatigue via questionnaires, as well as significant improvements in objective measures of peripheral muscle fatigue and autonomic function, bringing them closer to healthy controls. Additionally, we found reductions in muscle twitch tension rise times, becoming faster than controls, suggesting that the improvement in muscle fatigability might be due to a process of adaptation rather than simply a return to baseline function.
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Affiliation(s)
- Natalie J Maffitt
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Maria Germann
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Anne M E Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Mark R Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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2
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Paranathala MP, Jaiser S, Hussain MA, Mirallave-Pescador A, Cowie CJA, Baker MR, Holliman D, Fry CA. In-House Intraoperative Monitoring in Neurosurgery in England - Benefits and Challenges. J Med Syst 2024; 48:24. [PMID: 38386137 DOI: 10.1007/s10916-024-02041-7] [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: 09/18/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Intraoperative neurophysiological monitoring (IOM) is a valuable adjunct for neurosurgical operative techniques, and has been shown to improve clinical outcomes in cranial and spinal surgery. It is not necessarily provided by NHS hospitals so may be outsourced to private companies, which are expensive and at cost to the NHS trusts. We discuss the benefits and challenges of developing an in-house service. METHODS We surveyed NHS neurosurgical departments across England regarding their expenditure on IOM over the period January 2018 - December 2022 on cranial neurosurgery and spinal surgery. Out of 24 units, all responded to our Freedom of Information requests and 21 provided data. The standard NHS England salary of NHS staff who would normally be involved in IOM, including physiologists and doctors, was also compiled for comparison. RESULTS The total spend on outsourced IOM, across the units who responded, was over £8 million in total for the four years. The annual total increased, between 2018 and 2022, from £1.1 to £3.5 million. The highest single unit yearly spend was £568,462. This is in addition to salaries for staff in neurophysiology departments. The mean NHS salaries for staff is also presented. CONCLUSION IOM is valuable in surgical decision-making, planning, and technique, having been shown to lead to fewer patient complications and shorter length of stay. Current demand for IOM outstrips the internal NHS provision in many trusts across England, leading to outsourcing to private companies. This is at significant cost to the NHS. Although there is a learning curve, there are many benefits to in-house provision, such as stable working relationships, consistent methods, training of the future IOM workforce, and reduced long-term costs, which planned expansion of NHS services may provide.
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Affiliation(s)
| | - Stephan Jaiser
- Department of Neurophysiology, Royal Victoria Infirmary, Newcastle, NE1 4LP, UK
| | | | | | | | - Mark R Baker
- Department of Neurophysiology, Royal Victoria Infirmary, Newcastle, NE1 4LP, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, NE1 4LP, UK
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Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Effects of non-invasive vagus nerve stimulation on clinical symptoms and molecular biomarkers in Parkinson's disease. Front Aging Neurosci 2024; 15:1331575. [PMID: 38384731 PMCID: PMC10879328 DOI: 10.3389/fnagi.2023.1331575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 02/23/2024] Open
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson's disease (PD) patients. In a subgroup of patients, we measured selected neurotrophins, inflammatory markers and markers of oxidative stress in serum. Thirty-three PD patients with freezing of gait (FOG) were randomized to either active nVNS or sham nVNS. After baseline assessments, patients were instructed to deliver six 2 min stimulations (12 min/day) of the active nVNS/sham nVNS device for 1 month at home. Patients were then re-assessed. After a one-month washout period, they were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters (speed, stance time and step length) were observed with active nVNS. While serum tumor necrosis factor- α decreased, glutathione and brain-derived neurotrophic factor levels increased significantly (p < 0.05) after active nVNS treatment. Here we present the first evidence of the efficacy and safety of nVNS in the treatment of gait in PD patients, and propose that nVNS can be used as an adjunctive therapy in the management of PD patients, especially those suffering from FOG. Clinical trial registration: identifier ISRCTN14797144.
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Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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4
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De Oliveira HM, Soma A, Baker MR, Turner MR, Talbot K, Williams TL. A survey of current practice in genetic testing in amyotrophic lateral sclerosis in the UK and Republic of Ireland: implications for future planning. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:405-413. [PMID: 36458618 DOI: 10.1080/21678421.2022.2150556] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Objective: To determine the current practice in genetic testing for patients with apparently sporadic motor neurone disease/amyotrophic lateral sclerosis (MND/ALS) and asymptomatic at-risk relatives of familial MND/ALS patients seen in specialized care centers in the UK. Methods: An online survey with 10 questions distributed to specialist healthcare professionals with a role in requesting genetic testing working at MND/ALS care centers. Results: Considerable variation in practice was found. Almost 30% of respondents reported some discomfort in discussing genetic testing with MND/ALS patients and a majority (77%) did not think that all patients with apparently sporadic disease should be routinely offered genetic testing at present. Particular concerns were identified in relation to testing asymptomatic at-risk individuals and the majority view was that clinical genetics services should have a role in supporting genetic testing in MND/ALS, especially in asymptomatic individuals at-risk of carrying pathogenic variants. Conclusions: Variation in practice in genetic testing among MND/ALS clinics may be driven by differences in experience and perceived competence, compounded by the increasing complexity of the genetic underpinnings of MND/ALS. Clear and accessible guidelines for referral pathways between MND/ALS clinics and clinical genetics may be the best way to standardize and improve current practice, ensuring that patients and relatives receive optimal and geographically equitable support.
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Affiliation(s)
- Hugo M De Oliveira
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Arunachalam Soma
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK, and
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences. Level 6, John Radcliffe Hospital, Oxford, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences. Level 6, John Radcliffe Hospital, Oxford, UK
| | - Timothy L Williams
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Choudhury S, Majumdar S, Islam N, Bayen AB, Banerjee S, Chowdhury MSJH, Schofield IS, Baker MR, Baker SN, Kumar H. A mobile application to measure the ability to stop in movement disorders. Parkinsonism Relat Disord 2023; 112:105482. [PMID: 37302361 DOI: 10.1016/j.parkreldis.2023.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Nazrul Islam
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | | | | | | | - Ian S Schofield
- The Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mark R Baker
- The Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom; Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Stuart N Baker
- The Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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Baker AME, Maffitt NJ, Del Vecchio A, McKeating KM, Baker MR, Baker SN, Soteropoulos DS. Neural dysregulation in post-COVID fatigue. Brain Commun 2023; 5:fcad122. [PMID: 37304792 PMCID: PMC10257363 DOI: 10.1093/braincomms/fcad122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 06/13/2023] Open
Abstract
Following infection with SARS-CoV-2, a substantial minority of people develop lingering after-effects known as 'long COVID'. Fatigue is a common complaint with a substantial impact on daily life, but the neural mechanisms behind post-COVID fatigue remain unclear. We recruited 37 volunteers with self-reported fatigue after a mild COVID infection and carried out a battery of behavioural and neurophysiological tests assessing the central, peripheral and autonomic nervous systems. In comparison with age- and sex-matched volunteers without fatigue (n = 52), we show underactivity in specific cortical circuits, dysregulation of autonomic function and myopathic change in skeletal muscle. Cluster analysis revealed no subgroupings, suggesting post-COVID fatigue is a single entity with individual variation, rather than a small number of distinct syndromes. Based on our analysis, we were also able to exclude dysregulation in sensory feedback circuits and descending neuromodulatory control. These abnormalities on objective tests may aid in the development of novel approaches for disease monitoring.
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Affiliation(s)
| | | | - Alessandro Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Friedrich–Alexander University Erlangen–Nürnberg, 91052 Erlangen, Germany
| | | | - Mark R Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Demetris S Soteropoulos
- Correspondence to: Dr Demetris S. Soteropoulos Biosciences Institute, Faculty of Medical Sciences, Framlington Place, Newcastle University Newcastle Upon Tyne, NE2 4HH, UK E-mail:
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Tarn J, Evans E, Traianos E, Collins A, Stylianou M, Parikh J, Bai Y, Guan Y, Frith J, Lendrem D, Macrae V, McKinnon I, Simon BS, Blake J, Baker MR, Taylor JP, Watson S, Gallagher P, Blamire A, Newton J, Ng WF. The Effects of Noninvasive Vagus Nerve Stimulation on Fatigue in Participants With Primary Sjögren's Syndrome. Neuromodulation 2023; 26:681-689. [PMID: 37032583 DOI: 10.1016/j.neurom.2022.08.461] [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: 01/22/2022] [Revised: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Fatigue is one of the most important symptoms needing improvement in Primary Sjögren's syndrome (PSS). Previous data from our group suggest that noninvasive stimulation of the vagus nerve (nVNS) may improve symptoms of fatigue. This experimental medicine study uses the gammaCore device (electroCore) and a sham device to investigate the relationship between nVNS and fatigue in PSS, and to explore potential mechanisms involved. MATERIALS AND METHODS Forty participants with PSS were randomly assigned to use active (n = 20) or sham (n = 20) nVNS devices twice daily for 54 days in a double-blind manner. Patient-reported measures of fatigue were collected at baseline and day 56: Profile of Fatigue (PRO-F)-Physical, PRO-F-Mental and Visual Analogue Scale of abnormal fatigue (fVAS). Neurocognitive tests, immunologic responses, electroencephalography alpha reactivity, muscle acidosis, and heart rate variability were compared between devices from baseline to day 56 using analysis of covariance. RESULTS PRO-F-Physical, PRO-F-Mental, and fVAS scores were significantly reduced at day 56 in the active group only (p = 0.02, 0.02, and 0.04, respectively). Muscle bioenergetics and heart rate variability showed no change between arms. There were significant improvements in digit span and a neurocognitive test (p = 0.03), and upon acute nVNS stimulation, frontal region alpha reactivity showed a significant negative relationship with fatigue scores in the active group (p < 0.01). CONCLUSIONS We observed significant improvements in three measures of fatigue at day 56 with the active device but not the sham device. Directly after device use, fatigue levels correlate with measures of alpha reactivity, suggesting modulation of cholinergic system integrity as a mechanism of action for nVNS.
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Affiliation(s)
- Jessica Tarn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Evelyn Evans
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle upon Tyne, UK
| | - Emmanuella Traianos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Collins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Mryto Stylianou
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Neuropathology Department, The Cyprus Institute of Neurology & Genetics, Nicosia, Cyprus
| | - Jehill Parikh
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yang Bai
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yu Guan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Frith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis Lendrem
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Victoria Macrae
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Iain McKinnon
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle upon Tyne, UK
| | | | | | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Watson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Blamire
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Newton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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8
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Bangel KA, Pang K, Baker MR. Cathodal Transcranial Direct Current Stimulation for Treatment of Rasmussen Encephalitis. Neurology 2023; 100:484-485. [PMID: 36460475 PMCID: PMC9990854 DOI: 10.1212/wnl.0000000000201644] [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: 06/07/2022] [Accepted: 10/18/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Katrin A Bangel
- From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
| | - Ki Pang
- From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Mark R Baker
- From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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9
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Sigurdsson HP, Hunter H, Alcock L, Wilson R, Pienaar I, Want E, Baker MR, Taylor JP, Rochester L, Yarnall AJ. Safety and tolerability of adjunct non-invasive vagus nerve stimulation in people with parkinson's: a study protocol. BMC Neurol 2023; 23:58. [PMID: 36737716 PMCID: PMC9896761 DOI: 10.1186/s12883-023-03081-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the fastest growing neurological condition worldwide. Recent theories suggest that symptoms of PD may arise due to spread of Lewy-body pathology where the process begins in the gut and propagate transynaptically via the vagus nerve to the central nervous system. In PD, gait impairments are common motor manifestations that are progressive and can appear early in the disease course. As therapies to mitigate gait impairments are limited, novel interventions targeting these and their consequences, i.e., reducing the risk of falls, are urgently needed. Non-invasive vagus nerve stimulation (nVNS) is a neuromodulation technique targeting the vagus nerve. We recently showed in a small pilot trial that a single dose of nVNS improved (decreased) discrete gait variability characteristics in those receiving active stimulation relative to those receiving sham stimulation. Further multi-dose, multi-session studies are needed to assess the safety and tolerability of the stimulation and if improvement in gait is sustained over time. DESIGN This will be an investigator-initiated, single-site, proof-of-concept, double-blind sham-controlled randomised pilot trial in 40 people with PD. Participants will be randomly assigned on a 1:1 ratio to receive either active or sham transcutaneous cervical VNS. All participants will undergo comprehensive cognitive, autonomic and gait assessments during three sessions over 24 weeks, in addition to remote monitoring of ambulatory activity and falls, and exploratory analyses of cholinergic peripheral plasma markers. The primary outcome measure is the safety and tolerability of multi-dose nVNS in PD. Secondary outcomes include improvements in gait, cognition and autonomic function that will be summarised using descriptive statistics. DISCUSSION This study will report on the proportion of eligible and enrolled patients, rates of eligibility and reasons for ineligibility. Adverse events will be recorded informing on the safety and device tolerability in PD. This study will additionally provide us with information for sample size calculations for future studies and evidence whether improvement in gait control is enhanced when nVNS is delivered repeatedly and sustained over time. TRIAL REGISTRATION This trial is prospectively registered at www.isrctn.com/ISRCTN19394828 . Registered August 23, 2021.
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Affiliation(s)
- Hilmar P. Sigurdsson
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Heather Hunter
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK ,grid.420004.20000 0004 0444 2244The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lisa Alcock
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Ross Wilson
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Ilse Pienaar
- grid.6572.60000 0004 1936 7486Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B12 2TT UK
| | - Elizabeth Want
- grid.7445.20000 0001 2113 8111Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Mark R. Baker
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - John-Paul Taylor
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Lynn Rochester
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Alison J. Yarnall
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK ,grid.420004.20000 0004 0444 2244The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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10
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Astin R, Banerjee A, Baker MR, Dani M, Ford E, Hull JH, Lim PB, McNarry M, Morten K, O'Sullivan O, Pretorius E, Raman B, Soteropoulos DS, Taquet M, Hall CN. Long COVID: mechanisms, risk factors and recovery. Exp Physiol 2023; 108:12-27. [PMID: 36412084 PMCID: PMC10103775 DOI: 10.1113/ep090802] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [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: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
NEW FINDINGS What is the topic of this review? The emerging condition of long COVID, its epidemiology, pathophysiological impacts on patients of different backgrounds, physiological mechanisms emerging as explanations of the condition, and treatment strategies being trialled. The review leads from a Physiological Society online conference on this topic. What advances does it highlight? Progress in understanding the pathophysiology and cellular mechanisms underlying Long COVID and potential therapeutic and management strategies. ABSTRACT Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS-CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss the current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome, and highlights how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology - including alterations in peripheral muscle function, ventilatory inefficiency and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to postural orthostatic tachycardia syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagus nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiological research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition.
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Affiliation(s)
- Rónan Astin
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Human Health and PerformanceInstitute for Sport Exercise and HealthUniversity College LondonLondonUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyBarts Health NHS TrustLondonUK
| | - Mark R. Baker
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Melanie Dani
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | | | - James H. Hull
- Institute of SportExercise and Health (ISEH)Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Brompton HospitalLondonUK
| | - Phang Boon Lim
- Imperial Syncope UnitImperial College Healthcare NHS TrustLondonUK
| | - Melitta McNarry
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
| | - Karl Morten
- Applied Sports, Technology, Exercise and Medicine Research CentreSwansea UniversitySwanseaUK
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - Oliver O'Sullivan
- Academic Department of Military RehabilitationDefence Medical Rehabilitation Centre Stanford HallLoughboroughUK
- School of MedicineUniversity of NottinghamNottinghamUK
| | - Etheresia Pretorius
- Department of Physiological SciencesFaculty of ScienceStellenbosch UniversityStellenboschSouth Africa
- Department of Biochemistry and Systems BiologyInstitute of SystemsMolecular and Integrative BiologyFaculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Betty Raman
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineUniversity of OxfordOxfordUK
- Radcliffe Department of MedicineDivision of Cardiovascular MedicineOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Maxime Taquet
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Catherine N. Hall
- School of Psychology and Sussex NeuroscienceUniversity of SussexFalmerUK
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11
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Rahman S, Siddique U, Choudhury S, Islam N, Roy A, Basu P, Anand SS, Islam MA, Shahi MS, Nayeem A, Chowdhury MTI, Chowdhury MSJH, Taylor JP, Baker MR, Baker SN, Kumar H. Comparing Stop Signal Reaction Times in Alzheimer's and Parkinson's Disease. Can J Neurol Sci 2022; 49:662-671. [PMID: 34321129 DOI: 10.1017/cjn.2021.184] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To investigate the relative contributions of cerebral cortex and basal ganglia to movement stopping, we tested the optimum combination Stop Signal Reaction Time (ocSSRT) and median visual reaction time (RT) in patients with Alzheimer's disease (AD) and Parkinson's disease (PD) and compared values with data from healthy controls. METHODS Thirty-five PD patients, 22 AD patients, and 29 healthy controls were recruited to this study. RT and ocSSRT were measured using a hand-held battery-operated electronic box through a stop signal paradigm. RESULT The mean ocSSRT was found to be 309 ms, 368 ms, and 265 ms in AD, PD, and healthy controls, respectively, and significantly prolonged in PD compared to healthy controls (p = 0.001). The ocSSRT but not RT could separate AD from PD patients (p = 0.022). CONCLUSION Our data suggest that subcortical networks encompassing dopaminergic pathways in the basal ganglia play a more important role than cortical networks in movement-stopping. Combining ocSSRT with other putative indices or biomarkers of AD (and other dementias) could increase the accuracy of early diagnosis.
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Affiliation(s)
- Simin Rahman
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | - Ummatul Siddique
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | - Supriyo Choudhury
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | - Nazrul Islam
- National Institute of Neurosciences & Hospital, Agargoan, Dhaka, Bangladesh
| | - Akash Roy
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | - Purba Basu
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | - Sidharth Shankar Anand
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
| | | | | | - Abu Nayeem
- National Institute of Neurosciences & Hospital, Agargoan, Dhaka, Bangladesh
| | | | | | | | - Mark R Baker
- Medical School, Newcastle University, Newcastle upon Tyne, UK
- Departments of Neurology and Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stuart N Baker
- Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Hrishikesh Kumar
- Department of Neurology, RGCM Research Centre, Institute of Neurosciences, Kolkata, India
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12
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De Oliveira HM, Silsby M, Jaiser SR, Lai HM, Pavey N, Kiernan MC, Williams TL, Vucic S, Baker MR. Electrodiagnostic findings in facial onset sensory motor neuronopathy (FOSMN). Clin Neurophysiol 2022; 140:228-238. [DOI: 10.1016/j.clinph.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 01/08/2023]
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13
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Ahmed N, Baker MR, Bashford J. The landscape of neurophysiological outcome measures in ALS interventional trials: A systematic review. Clin Neurophysiol 2022; 137:132-141. [PMID: 35313253 PMCID: PMC10166714 DOI: 10.1016/j.clinph.2022.02.020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We collated all interventional clinical trials in amyotrophic lateral sclerosis (ALS), which utilised at least one neurophysiological technique as a primary or secondary outcome measure. By identifying the strengths and limitations of these studies, we aim to guide study design in future trials. METHODS We conducted and reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were searched from inception. In total, 703 studies were retrieved for screening and eligibility assessment. RESULTS Dating back to 1986, 32 eligible interventional clinical trials were identified, recruiting a median of 30 patients per completed trial. The most widely employed neurophysiological techniques were electromyography, motor unit number estimation (including motor unit number index), neurophysiological index and transcranial magnetic stimulation (including resting motor threshold and short-interval intracortical inhibition). Almost 40% of trials reported a positive outcome with respect to at least one neurophysiological measure. The interventions targeted either ion channels, immune mechanisms or neuronal metabolic pathways. CONCLUSIONS Neurophysiology offers many promising biomarkers that can be utilised as outcome measures in interventional clinical trials in ALS. When selecting the most appropriate technique, key considerations include methodological standardisation, target engagement and logistical burden. SIGNIFICANCE Future trial design in ALS would benefit from a standardised, updated and easily accessible repository of neurophysiological outcome measures.
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Affiliation(s)
- N Ahmed
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - M R Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - J Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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14
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Baker MR, Williams TL, Larner AJ. Rehabilitating Romberg. ACNR 2022. [DOI: 10.47795/eonw6640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Few Neurologists will be unfamiliar with referral letters stating that the patient has “Rhomberg’s sign” or some “mild rhombergism” (capitalisation variable), a particularly irritating misnomer for the pedants among us. As Henry Higgins the fictional Professor of Phonetics [1] observed: ‘Does the same thing hold true in India, Pickering? Is there the peculiar habit of not only dropping a letter like the letter “h”, but using it where it doesn’t belong, like “hever” instead of “ever”?’ My Fair Lady – Act 1, Scene 5, p58 [1]. Or Rhomberg instead of Romberg! So, who was “Rhomberg,” and what did he describe?
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15
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Ng YS, Lax NZ, Blain AP, Erskine D, Baker MR, Polvikoski T, Thomas RH, Morris CM, Lai M, Whittaker RG, Gebbels A, Winder A, Hall J, Feeney C, Farrugia ME, Hirst C, Roberts M, Lawthom C, Chrysostomou A, Murphy K, Baird T, Maddison P, Duncan C, Poulton J, Nesbitt V, Hanna MG, Pitceathly RDS, Taylor RW, Blakely EL, Schaefer AM, Turnbull DM, McFarland R, Gorman GS. Forecasting stroke-like episodes and outcomes in mitochondrial disease. Brain 2022; 145:542-554. [PMID: 34927673 PMCID: PMC9014738 DOI: 10.1093/brain/awab353] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/16/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
In this retrospective, multicentre, observational cohort study, we sought to determine the clinical, radiological, EEG, genetics and neuropathological characteristics of mitochondrial stroke-like episodes and to identify associated risk predictors. Between January 1998 and June 2018, we identified 111 patients with genetically determined mitochondrial disease who developed stroke-like episodes. Post-mortem cases of mitochondrial disease (n = 26) were identified from Newcastle Brain Tissue Resource. The primary outcome was to interrogate the clinico-radiopathological correlates and prognostic indicators of stroke-like episode in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS). The secondary objective was to develop a multivariable prediction model to forecast stroke-like episode risk. The most common genetic cause of stroke-like episodes was the m.3243A>G variant in MT-TL1 (n = 66), followed by recessive pathogenic POLG variants (n = 22), and 11 other rarer pathogenic mitochondrial DNA variants (n = 23). The age of first stroke-like episode was available for 105 patients [mean (SD) age: 31.8 (16.1)]; a total of 35 patients (32%) presented with their first stroke-like episode ≥40 years of age. The median interval (interquartile range) between first and second stroke-like episodes was 1.33 (2.86) years; 43% of patients developed recurrent stroke-like episodes within 12 months. Clinico-radiological, electrophysiological and neuropathological findings of stroke-like episodes were consistent with the hallmarks of medically refractory epilepsy. Patients with POLG-related stroke-like episodes demonstrated more fulminant disease trajectories than cases of m.3243A>G and other mitochondrial DNA pathogenic variants, in terms of the frequency of refractory status epilepticus, rapidity of progression and overall mortality. In multivariate analysis, baseline factors of body mass index, age-adjusted blood m.3243A>G heteroplasmy, sensorineural hearing loss and serum lactate were significantly associated with risk of stroke-like episodes in patients with the m.3243A>G variant. These factors informed the development of a prediction model to assess the risk of developing stroke-like episodes that demonstrated good overall discrimination (area under the curve = 0.87, 95% CI 0.82-0.93; c-statistic = 0.89). Significant radiological and pathological features of neurodegeneration were more evident in patients harbouring pathogenic mtDNA variants compared with POLG: brain atrophy on cranial MRI (90% versus 44%, P < 0.001) and reduced mean brain weight (SD) [1044 g (148) versus 1304 g (142), P = 0.005]. Our findings highlight the often idiosyncratic clinical, radiological and EEG characteristics of mitochondrial stroke-like episodes. Early recognition of seizures and aggressive instigation of treatment may help circumvent or slow neuronal loss and abate increasing disease burden. The risk-prediction model for the m.3243A>G variant can help inform more tailored genetic counselling and prognostication in routine clinical practice.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Nichola Z Lax
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Alasdair P Blain
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Daniel Erskine
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Mark R Baker
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Tuomo Polvikoski
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Rhys H Thomas
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Christopher M Morris
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Ming Lai
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Roger G Whittaker
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Alasdair Gebbels
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Amy Winder
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Julie Hall
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Catherine Feeney
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Maria Elena Farrugia
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Claire Hirst
- Trust Headquarters, One Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot SA12 7BR, UK
| | - Mark Roberts
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford M6 8HD, UK
| | - Charlotte Lawthom
- Aneurin Bevan Epilepsy Specialist Team, Aneurin Bevan University Health Board, Newport, NP20 2UB, UK
| | - Alexia Chrysostomou
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Kevin Murphy
- Department of Neurology, Sligo University Hospital, Sligo F91 H684, Ireland
| | - Tracey Baird
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Paul Maddison
- Department of Neurology, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Callum Duncan
- Department of Neurology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UK
| | - Joanna Poulton
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Victoria Nesbitt
- Department of Paediatrics, Medical Sciences Division, Oxford University, Oxford OX3 9DU, UK
- Department of Paediatrics, The Children's Hospital, Oxford, OX3 9DU, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Emma L Blakely
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
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16
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Elwan M, Fowkes R, Lewis-Smith D, Winder A, Baker MR, Thomas RH. Late-onset cluster seizures and intellectual disability associated with a novel truncation variant in SMC1A. Epilepsy Behav Rep 2022; 19:100556. [PMID: 35712061 PMCID: PMC9194849 DOI: 10.1016/j.ebr.2022.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Epilepsy due to truncating SMC1A variants can present with onset in later childhood. People with to truncating SMC1A variants can have normal development prior to presentation. Seizures occur periodically in clusters and are poorly responsive to antiseizure medications.
SMC1A variants are known to cause Cornelia de Lange Syndrome (CdLS) which encompasses a clinical spectrum of intellectual disability, dysmorphic features (long or thick eyebrows, a hypomorphic philtrum and small nose) and, in some cases, epilepsy. More recently, SMC1A truncating variants have been described as the cause of a neurodevelopmental disorder with early-childhood onset drug-resistant epilepsy with seizures that occur in clusters, similar to that seen in PCDH19-related epilepsy, but without the classical features of CdLS. Here, we report the case of a 28-year-old woman with a de novo heterozygous truncating variant in SMC1A who unusually presented with seizures at the late age of 12 years and had normal development into adulthood.
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Affiliation(s)
- Menatalla Elwan
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Ross Fowkes
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - David Lewis-Smith
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Amy Winder
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Mark R. Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Rhys H. Thomas
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
- Corresponding author at: Intermediate Clinical Lecturer and Honorary Consultant in Epilepsy, Translational and Clinical Research Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne NE2 4HH.
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17
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Orcioli-Silva D, Islam A, Baker MR, Gobbi LTB, Rochester L, Pantall A. Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults. Front Aging Neurosci 2021; 13:739998. [PMID: 34924993 PMCID: PMC8681021 DOI: 10.3389/fnagi.2021.739998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm2 electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO2) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO2 and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Aisha Islam
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Pantall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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18
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Brito da Silva A, Pennifold J, Henley B, Chatterjee K, Bateman D, Whittaker RW, Joshi A, Kumar H, Nicholson C, Baker MR, Greenhill SD, Walsh R, Seri S, Jones RSG, Woodhall GL, Cunningham MO. The AMPA receptor antagonist perampanel suppresses epileptic activity in human focal cortical dysplasia. Epilepsia Open 2021; 7:488-495. [PMID: 34653311 PMCID: PMC9436284 DOI: 10.1002/epi4.12549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
Focal cortical dysplasia (FCD) is one of the most common malformations causing refractory epilepsy. Dysregulation of glutamatergic systems plays a critical role in the hyperexcitability of dysplastic neurons in FCD lesions. The pharmacoresistant nature of epilepsy associated with FCD may be due to a lack of well‐tolerated and precise antiepileptic drugs that can target glutamate receptors. Here, for the first time in human FCD brain slices, we show that the established, noncompetitive α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) receptor antagonist, perampanel has potent antiepileptic action. Moreover, we demonstrate that this effect is due to a reduction in burst firing behavior in human FCD microcircuits. These data support a potential role for the treatment of refractory epilepsy associated with FCD in human patients.
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Affiliation(s)
- Anderson Brito da Silva
- Institute of Neuroscience, The Medical School, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,CAPES Foundation, Ministry of Education of Brazil, 70040-020, Brazil
| | - Jane Pennifold
- Aston Brain Centre, Aston University, School of Life and Health Sciences, Birmingham, B4 7ET, UK
| | - Ben Henley
- Aston Brain Centre, Aston University, School of Life and Health Sciences, Birmingham, B4 7ET, UK
| | - Koustav Chatterjee
- Institute of Neurosciences Kolkata, AJC Bose Road, Kolkata, 700017, West Bengal, India
| | - David Bateman
- Department of Neurology, Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne & Wear, SR4 7TP, UK
| | - Roger W Whittaker
- Institute of Neuroscience, The Medical School, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Abhijit Joshi
- Department of Neuropathology, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Hrishikesh Kumar
- Institute of Neurosciences Kolkata, AJC Bose Road, Kolkata, 700017, West Bengal, India
| | - Claire Nicholson
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Mark R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Stuart D Greenhill
- Aston Brain Centre, Aston University, School of Life and Health Sciences, Birmingham, B4 7ET, UK
| | - Richard Walsh
- Children's Epilepsy Surgery Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK
| | - Stefano Seri
- Children's Epilepsy Surgery Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK
| | - Roland S G Jones
- Department of Pharmacology and Pharmacy, University of Bath, Bath, BA2 7AY, UK
| | - Gavin L Woodhall
- Aston Brain Centre, Aston University, School of Life and Health Sciences, Birmingham, B4 7ET, UK
| | - Mark O Cunningham
- Institute of Neuroscience, The Medical School, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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19
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Sigurdsson HP, Raw R, Hunter H, Baker MR, Taylor JP, Rochester L, Yarnall AJ. Noninvasive vagus nerve stimulation in Parkinson's disease: current status and future prospects. Expert Rev Med Devices 2021; 18:971-984. [PMID: 34461787 DOI: 10.1080/17434440.2021.1969913] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a common progressive neurodegenerative disorder with multifactorial etiology. While dopaminergic medication is the standard therapy in PD, it provides limited symptomatic treatment and non-pharmacological interventions are currently being trialed. AREAS COVERED Recent pathophysiological theories of Parkinson's suggest that aggregated α-synuclein form in the gut and spread to nuclei in the brainstem via autonomic connections. In this paper, we review the novel hypothesis that noninvasive vagus nerve stimulation (nVNS), targeting efferent and afferent vagal projections, is a promising therapeutic tool to improve gait and cognitive control and ameliorate non-motor symptoms in people with Parkinson's. We conducted an unstructured search of the literature for any studies employing nVNS in PD as well as for studies examining the efficacy of nVNS on improving cognitive function and where nVNS has been applied to co-occurring conditions in PD. EXPERT OPINION Evidence of nVNS as a novel therapeutic to improve gait in PD is preliminary, but early signs indicate the possibility that nVNS may be useful to target dopa-resistant gait characteristics in early PD. The evidence for nVNS as a therapeutic tool is, however, limited and further studies are needed in both brain health and disease.
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Affiliation(s)
- Hilmar P Sigurdsson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachael Raw
- Department of General Internal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Heather Hunter
- Department of Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark R Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Clinical Neurophysiology, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurosciences, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Older People's Medicine, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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20
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Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Non-invasive vagus nerve stimulation improves clinical and molecular biomarkers of Parkinson's disease in patients with freezing of gait. NPJ Parkinsons Dis 2021; 7:46. [PMID: 34045464 PMCID: PMC8160211 DOI: 10.1038/s41531-021-00190-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled crossover trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson’s disease (PD) patients. In a subgroup of patients, we measured selected neurotrophin levels and markers of inflammation and oxidative stress in serum, before and after the experimental intervention. Thirty-three PD patients with associated freezing of gait were randomised to either nVNS or sham. After baseline assessments, patients were instructed to deliver 6 two-minute stimulations (total 12 min/day) of the nVNS/sham device (electroCore, Inc. USA) for one month at home. Patients were then re-assessed. After a washout period of one month, the same patients were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters were observed with nVNS, including walking speed, stance time and step length, compared to sham. Similarly, overall motor function (MDS-UPDRS III) also improved significantly following nVNS stimulation. Serum Tumor Necrosis Factor (TNF)-α and glutathione levels decreased and brain-derived neurotrophic factor (BDNF) levels increased significantly (p < 0.05) after treatment with nVNS. Here we present the first double-blind sham-controlled trial evidence of the efficacy and safety of nVNS in the treatment of gait and motor function in patients with PD.
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Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle, UK
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21
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Affiliation(s)
- Timothy L Williams
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - David Bates
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Mark R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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22
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Murphy N, Killen A, Gupta RK, Graziadio S, Rochester L, Firbank M, Baker MR, Allan C, Collerton D, Taylor JP, Urwyler P. Exploring Bottom-Up Visual Processing and Visual Hallucinations in Parkinson's Disease With Dementia. Front Neurol 2021; 11:579113. [PMID: 33584490 PMCID: PMC7876258 DOI: 10.3389/fneur.2020.579113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023] Open
Abstract
Visual hallucinations (VH) are a common symptom of Parkinson's disease with dementia (PDD), affecting up to 65% of cases. Integrative models of their etiology posit that a decline in executive control of the visuo-perceptual system is a primary mechanism of VH generation. The role of bottom-up processing in the manifestation of VH in this condition is still not clear although visual evoked potential (VEP) differences have been associated with VH at an earlier stage of PD. Here we compared the amplitude and latency pattern reversal VEPs in healthy controls (n = 21) and PDD patients (n = 34) with a range of VH severities. PDD patients showed increased N2 latency relative to controls, but no significant differences in VEP measures were found for patients reporting complex VH (CVH) (n = 17) compared to those without VH. Our VEP findings support previous reports of declining visual system physiology in PDD and some evidence of visual system differences between patients with and without VH. However, we did not replicate previous findings of a major relationship s between the integrity of the visual pathway and VH.
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Affiliation(s)
- Nicholas Murphy
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Alison Killen
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rajnish Kumar Gupta
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sara Graziadio
- National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Allan
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel Collerton
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Prabitha Urwyler
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Neurorehabilitation Unit, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
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23
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Choudhury S, Baker MR, Chatterjee S, Kumar H. Botulinum Toxin: An Update on Pharmacology and Newer Products in Development. Toxins (Basel) 2021; 13:58. [PMID: 33466571 PMCID: PMC7828686 DOI: 10.3390/toxins13010058] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
Since its introduction as a treatment for strabismus, botulinum toxin (BoNT) has had a phenomenal journey and is now recommended as first-line treatment for focal dystonia, despite short-term clinical benefits and the risks of adverse effects. To cater for the high demand across various medical specialties, at least six US Food and Drug Administration (FDA)-approved formulations of BoNT are currently available for diverse labelled indications. The toxo-pharmacological properties of these formulations are not uniform and thus should not be used interchangeably. Synthetic BoNTs and BoNTs from non-clostridial sources are not far from clinical use. Moreover, the study of mutations in naturally occurring toxins has led to modulation in the toxo-pharmacokinetic properties of BoNTs, including the duration and potency. We present an overview of the toxo-pharmacology of conventional and novel BoNT preparations, including those awaiting imminent translation from the laboratory to the clinic.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
| | - Mark R. Baker
- Departments of Neurology and Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, UK;
- Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Suparna Chatterjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
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24
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de Boer EMJ, Orie VK, Williams T, Baker MR, De Oliveira HM, Polvikoski T, Silsby M, Menon P, van den Bos M, Halliday GM, van den Berg LH, Van Den Bosch L, van Damme P, Kiernan MC, van Es MA, Vucic S. TDP-43 proteinopathies: a new wave of neurodegenerative diseases. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-322983. [PMID: 33177049 PMCID: PMC7803890 DOI: 10.1136/jnnp-2020-322983] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/28/2020] [Accepted: 09/13/2020] [Indexed: 12/31/2022]
Abstract
Inclusions of pathogenic deposits containing TAR DNA-binding protein 43 (TDP-43) are evident in the brain and spinal cord of patients that present across a spectrum of neurodegenerative diseases. For instance, the majority of patients with sporadic amyotrophic lateral sclerosis (up to 97%) and a substantial proportion of patients with frontotemporal lobar degeneration (~45%) exhibit TDP-43 positive neuronal inclusions, suggesting a role for this protein in disease pathogenesis. In addition, TDP-43 inclusions are evident in familial ALS phenotypes linked to multiple gene mutations including the TDP-43 gene coding (TARDBP) and unrelated genes (eg, C9orf72). While TDP-43 is an essential RNA/DNA binding protein critical for RNA-related metabolism, determining the pathophysiological mechanisms through which TDP-43 mediates neurodegeneration appears complex, and unravelling these molecular processes seems critical for the development of effective therapies. This review highlights the key physiological functions of the TDP-43 protein, while considering an expanding spectrum of neurodegenerative diseases associated with pathogenic TDP-43 deposition, and dissecting key molecular pathways through which TDP-43 may mediate neurodegeneration.
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Affiliation(s)
- Eva Maria Johanna de Boer
- Department of Neurology, Brain Centre Rudolf Magnus, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Viyanti K Orie
- Department of Neurology, Brain Centre Rudolf Magnus, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Timothy Williams
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Hugo M De Oliveira
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tuomo Polvikoski
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Neuropathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Matthew Silsby
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mehdi van den Bos
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Glenda M Halliday
- Brain and Mind Center, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Rudolf Magnus, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Ludo Van Den Bosch
- Department of Neurosciences, Experimental Neurology and Leuven Brain Institute (LBI), University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | - Philip van Damme
- Department of Neurosciences, Experimental Neurology and Leuven Brain Institute (LBI), University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Matthew C Kiernan
- Brain and Mind Center, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael A van Es
- Department of Neurology, Brain Centre Rudolf Magnus, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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25
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Bashford J, Baker MR. Excitability in amyotrophic lateral sclerosis: What goes up must come down. Clin Neurophysiol 2020; 131:2617-2620. [PMID: 32927217 DOI: 10.1016/j.clinph.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- James Bashford
- Maurice Wohl Clinical Neuroscience Institute, King's College London, 5 Cutcombe Rd, London SE5 9RT, UK.
| | - Mark R Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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26
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Collins AF, Brown STR, Baker MR. Minimum Electromyographic Burst Duration in Healthy Controls: Implications for Electrodiagnosis in Movement Disorders. Mov Disord Clin Pract 2020; 7:827-833. [PMID: 33033737 PMCID: PMC7533965 DOI: 10.1002/mdc3.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Electromyogram (EMG) burst duration can provide additional diagnostic information when investigating hyperkinetic movement disorders, particularly when a functional movement disorder is suspected. It is generally accepted that EMG bursts <50 milliseconds are pathological. Objective To reassess minimum physiological EMG burst duration. Methods Surface EMG was recorded from face, trunk, and limb muscles in controls (n = 60; ages 19–85). Participants were instructed to generate the briefest possible ballistic movements involving each muscle (40 repetitions) or, in muscles spanning joints, to generate rapid rhythmic alternating movements (20–30 seconds), or both. Results We found no effect of age on EMG burst duration. However, EMG burst duration varied significantly between body regions. Rhythmic EMG bursts were shorter than ballistic bursts but only significantly so for lower limbs (P < 0.001). EMG bursts of duration <50 milliseconds were frequently observed, particularly in appendicular muscles. Conclusion We present normal reference data for minimum EMG burst duration, which may assist clinical interpretation when investigating hyperkinetic movement disorders.
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Affiliation(s)
- Alexis F Collins
- Translational and Clinical Research Institute, The Medical School Newcastle University Newcastle upon Tyne United Kingdom.,Sheffield Institute for Translational Neuroscience The University of Sheffield Sheffield United Kingdom
| | - Steven T R Brown
- Translational and Clinical Research Institute, The Medical School Newcastle University Newcastle upon Tyne United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, The Medical School Newcastle University Newcastle upon Tyne United Kingdom.,Department of Neurology Royal Victoria Infirmary Newcastle upon Tyne United Kingdom.,Department of Clinical Neurophysiology Royal Victoria Infirmary Newcastle upon Tyne United Kingdom
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27
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Sarkar S, Choudhury S, Islam N, Chowdhury MSJH, Chowdhury MTI, Baker MR, Baker SN, Kumar H. Effects of Diazepam on Reaction Times to Stop and Go. Front Hum Neurosci 2020; 14:567177. [PMID: 33132880 PMCID: PMC7573484 DOI: 10.3389/fnhum.2020.567177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/31/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction: The ability to stop the execution of a movement in response to an external cue requires intact executive function. The effect of psychotropic drugs on movement inhibition is largely unknown. Movement stopping can be estimated by the Stop Signal Reaction Time (SSRT). In a recent publication, we validated an improved measure of SSRT (optimum combination SSRT, ocSSRT). Here we explored how diazepam, which enhances transmission at GABAA receptors, affects ocSSRT. Methods: Nine healthy individuals were randomized to receive placebo, 5 mg or 10 mg doses of diazepam. Each participant received both the dosage of drug and placebo orally on separate days with adequate washout. The ocSSRT and simple reaction time (RT) were estimated through a stop-signal task delivered via a battery-operated box incorporating green (Go) and red (Stop) light-emitting diodes. The task was performed just before and 1 h after dosing. Result: The mean change in ocSSRT after 10 mg diazepam was significantly higher (+27 ms) than for placebo (−1 ms; p = 0.012). By contrast, the mean change in simple response time remained comparable in all three dosing groups (p = 0.419). Conclusion: Our results confirm that a single therapeutic adult dose of diazepam can alter motor inhibition in drug naïve healthy individuals. The selective effect of diazepam on ocSSRT but not simple RT suggests that GABAergic neurons may play a critical role in movement-stopping.
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Affiliation(s)
- Swagata Sarkar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India.,Department of Physiology, University of Calcutta, Kolkata, India
| | - Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Nazrul Islam
- Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | | | | | - Mark R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.,The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stuart N Baker
- The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
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28
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Roy A, Choudhury S, Basu P, Baker MR, Baker SN, Kumar H. Stop Signal Reaction Time measured with a portable device validates optimum STN-DBS programming. Brain Stimul 2020; 13:1609-1611. [PMID: 32950719 DOI: 10.1016/j.brs.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/08/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Akash Roy
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India; Department of Physiology, University of Calcutta, Kolkata, India.
| | - Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India.
| | - Purba Basu
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India.
| | - Mark R Baker
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle Upon Tyne, NE1 4LP, United Kingdom; Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle Upon Tyne, NE1 4LP, United Kingdom; The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, United Kingdom.
| | - Stuart N Baker
- The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, United Kingdom.
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India.
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29
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Shefner JM, Al-Chalabi A, Baker MR, Cui LY, de Carvalho M, Eisen A, Grosskreutz J, Hardiman O, Henderson R, Matamala JM, Mitsumoto H, Paulus W, Simon N, Swash M, Talbot K, Turner MR, Ugawa Y, van den Berg LH, Verdugo R, Vucic S, Kaji R, Burke D, Kiernan MC. A proposal for new diagnostic criteria for ALS. Clin Neurophysiol 2020; 131:1975-1978. [PMID: 32387049 DOI: 10.1016/j.clinph.2020.04.005] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Jeremy M Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, USA.
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, UK
| | - Mark R Baker
- Department of Clinical Neurophysiology, Royal Victoria Infirmary and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mamede de Carvalho
- Physiology Institute, Faculty of Medicine-iMM-CHULN, University of Lisbon, Lisbon, Portugal
| | - Andrew Eisen
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | | | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Robert Henderson
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Jose Manuel Matamala
- Department of Neurological Sciences and Biomedical Neuroscience Institute (BNI), Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Neil Simon
- Northern Clinical School, University of Sydney, Sydney, Australia
| | | | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | | | - Renato Verdugo
- Neurology and Psychiatry, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Steven Vucic
- Western Clinical School, University of Sydney, Department of Neurology, Westmead Hospital, Australia
| | - Ryuji Kaji
- National Hospital Organization Utano Hospital, Kyoto, Japan
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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30
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Wildman J, Baker MR, Price DA, Tiwari S, Kumar H, Rice GI, Crow YJ, Thomas RH. Clinical Reasoning: A 25-year-old woman with recurrent episodes of collapse and loss of consciousness. Neurology 2020; 94:994-999. [PMID: 32358219 DOI: 10.1212/wnl.0000000000009533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jack Wildman
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Mark R Baker
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - D Ashley Price
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Sarbesh Tiwari
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Hrishikesh Kumar
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Gillian I Rice
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Yanick J Crow
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France
| | - Rhys H Thomas
- From the Departments of Neurology (J.W., M.R.B., R.H.T.), Clinical Neurophysiology (M.R.B.), and Infectious Disease (D.A.P.), Royal Victoria Infirmary; Institute of Neuroscience (M.R.B., R.H.T.), Newcastle-Upon-Tyne, UK; Institute of Neurosciences Kolkata (S.T., H.K.), India; Division of Evolution and Genomic Sciences (G.I.R.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Centre for Genomic and Experimental Medicine (Y.C.), MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; and Laboratory of Neurogenetics and Neuroinflammation (Y.C.), Institut Imagine, Paris Descartes University, France.
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Choudhury S, Singh R, Shobhana A, Sen D, Anand SS, Shubham S, Gangopadhyay S, Baker MR, Kumar H, Baker SN. A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors. Neurorehabil Neural Repair 2020; 34:600-608. [PMID: 32452275 PMCID: PMC8207486 DOI: 10.1177/1545968320926162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004). Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.
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Affiliation(s)
| | - Ravi Singh
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - A Shobhana
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - Dwaipayan Sen
- Institute of Neurosciences, Kolkata, West Bengal, India
| | | | | | | | - Mark R Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Stuart N Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Choudhury S, Shobhana A, Singh R, Sen D, Anand SS, Shubham S, Baker MR, Kumar H, Baker SN. The Relationship Between Enhanced Reticulospinal Outflow and Upper Limb Function in Chronic Stroke Patients. Neurorehabil Neural Repair 2019; 33:375-383. [DOI: 10.1177/1545968319836233] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background. Recent evidence from both monkey and human studies suggests that the reticulospinal tract may contribute to recovery of arm and hand function after stroke. In this study, we evaluated a marker of reticulospinal output in stroke survivors with varying degrees of motor recovery. Methods. We recruited 95 consecutive stroke patients presenting 6 months to 12 years after their index stroke, and 19 heathy control subjects. Subjects were asked to respond to a light flash with a rapid wrist flexion; at random, the flash was paired with either a quiet or loud (startling) sound. The mean difference in electromyogram response time after flash with quiet sound compared with flash with loud sound measured the StartReact effect. Upper limb function was assessed by the Action Research Arm Test (ARAT), spasticity was graded using the Modified Ashworth Scale (MAS) and active wrist angular movement using an electrogoniometer. Results. StartReact was significantly larger in stroke patients than healthy participants (78.4 vs 45.0 ms, P < .005). StartReact showed a significant negative correlation with the ARAT score and degree of active wrist movement. The StartReact effect was significantly larger in patients with higher spasticity scores. Conclusion. We speculate that in some patients with severe damage to their corticospinal tract, recovery led to strengthening of reticulospinal connections and an enhanced StartReact effect, but this did not occur for patients with milder impairment who could use surviving corticospinal connections to mediate recovery.
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Affiliation(s)
| | | | - Ravi Singh
- Institute of Neurosciences, Kolkata, India
| | | | | | | | - Mark R. Baker
- Department of Clinical Neurophysiology and Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Stuart N. Baker
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Morris R, Yarnall AJ, Hunter H, Taylor J, Baker MR, Rochester L. Noninvasive vagus nerve stimulation to target gait impairment in Parkinson's disease. Mov Disord 2019; 34:918-919. [DOI: 10.1002/mds.27664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Rosie Morris
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
- Oregon Health and Science University Portland Oregon USA
| | - Alison J. Yarnall
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
| | - Heather Hunter
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
| | - John‐Paul Taylor
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
| | - Mark R. Baker
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
- Department of Clinical NeurophysiologyRoyal Victoria Infirmary Newcastle upon Tyne UK
| | - Lynn Rochester
- Institute of NeuroscienceNewcastle University Newcastle upon Tyne UK
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Mondal B, Choudhury S, Simon B, Baker MR, Kumar H. Noninvasive vagus nerve stimulation improves gait and reduces freezing of gait in Parkinson's disease. Mov Disord 2019; 34:917-918. [DOI: 10.1002/mds.27662] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Banashree Mondal
- Department of Neurology and Ram Gopal Chamaria Medical Research Centre (RGC)Institute of Neurosciences Kolkata India
| | - Supriyo Choudhury
- Department of Neurology and Ram Gopal Chamaria Medical Research Centre (RGC)Institute of Neurosciences Kolkata India
| | - Bruce Simon
- ElectroCore LLC Basking Ridge New Jersey USA
| | - Mark R. Baker
- Department of NeurologyRoyal Victoria Infirmary Newcastle upon Tyne UK
- Department of Clinical NeurophysiologyRoyal Victoria Infirmary Newcastle UK
- Institute of Neurosciences, Newcastle University Newcastle upon Tyne UK
| | - Hrishikesh Kumar
- Department of Neurology and Ram Gopal Chamaria Medical Research Centre (RGC)Institute of Neurosciences Kolkata India
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Abstract
Mills' syndrome is an idiopathic, slowly progressive, spastic hemiparesis. We describe three cases that have been under review for a minimum of 11 years (range 11-19). In all patients, symptoms started in a leg, with a mean age of onset of 59 years (range 53-63). The only abnormality on laboratory investigations was a mildly elevated CSF protein in one case. MRI demonstrated focal T2 hyper-intensity located eccentrically in the cervical cord ipsilateral to the symptomatic side. No cerebral abnormality was demonstrated. Whilst visual and somatosensory evoked potentials were unremarkable, motor evoked potentials were abnormal in all patients: central motor conduction times were significantly prolonged unilaterally in two patients and bilaterally but asymmetrically in the third. Beta-band (15-30 Hz) intermuscular coherence, a potentially more sensitive method of assessing upper motor neuron integrity, was absent unilaterally in one patient and bilaterally in the other two. One patient developed amyotrophy and thus a picture of amyotrophic lateral sclerosis after 16 years, suggesting that Mills' syndrome is part of the motor neuron disease spectrum. Both amyotrophy and subclinical contralateral upper motor neuron disease can therefore be features of Mills' syndrome. However, even with the most sensitive electrodiagnostic techniques, unilateral upper motor neuron disease can remain the only abnormality for as long as 10 years. We conclude that whilst Mills' syndrome should be classified as a motor neuron disorder, it is a distinct nosological entity which can be distinguished from amyotrophic lateral sclerosis, upper motor neuron-dominant amyotrophic lateral sclerosis and primary lateral sclerosis. We propose diagnostic criteria for Mills' syndrome, and estimate a point prevalence of at least 1.2:1,000,000 based on our well-defined referral population in the North of England.
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Affiliation(s)
- Stephan R Jaiser
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Dipayan Mitra
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Department of Neuroradiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Timothy L Williams
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Mark R Baker
- Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. .,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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Choudhury S, Singh R, Chatterjee P, Trivedi S, Shubham S, Baker MR, Kumar H, Baker SN. Abnormal Blink Reflex and Intermuscular Coherence in Writer's Cramp. Front Neurol 2018; 9:517. [PMID: 30013510 PMCID: PMC6037196 DOI: 10.3389/fneur.2018.00517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Writer's cramp (WC) is a task-specific focal hand dystonia presenting with pain, stiffness and/or tremor while writing. We explored the involvement of cortical and brainstem circuits by measuring intermuscular coherence (IMC) and pre-pulse inhibition (PPI) of the blink reflex. Methods: IMC was measured in 10 healthy controls and 20 WC patients (10 with associated tremor) while they performed a precision grip task at different force levels. Blink responses were evaluated in 9 healthy controls and 10 WC patients by stimulating the right supraorbital nerve and recording surface EMG from the orbicularis oculi muscles bilaterally. PPI involved conditioning this stimulation with a prior shock to the right median nerve (100 ms interval), and measuring the reduction in the R2 component of the blink reflex. Results: Significant IMC at 3-7 Hz was present in WC patients, but not in healthy controls. Compared to healthy controls, in WC patients the R2 component of the blink reflex showed significantly less PPI. IMC at 3-7 Hz could reliably discriminate WC patients from healthy controls. Conclusion: Cortical or sub-cortical circuits generating theta (3-7 Hz) oscillations might play an important role in the pathogenesis of WC. Moreover, the lack of PPI implicates abnormalities in brainstem inhibition in the emergence of WC. IMC may merit further development as an electrodiagnostic test for focal dystonia.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Ravi Singh
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Payel Chatterjee
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Santosh Trivedi
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Shantanu Shubham
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Mark R. Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hrishikesh Kumar
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Stuart N. Baker
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
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Bansagi B, Phan V, Baker MR, O'Sullivan J, Jennings MJ, Whittaker RG, Müller JS, Duff J, Griffin H, Miller JAL, Gorman GS, Lochmüller H, Chinnery PF, Roos A, Swan LE, Horvath R. Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo PTEN mutation. Neurology 2018; 90:e1842-e1848. [PMID: 29720545 PMCID: PMC5962916 DOI: 10.1212/wnl.0000000000005566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/01/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To describe a patient with a multifocal demyelinating motor neuropathy with onset in childhood and a mutation in phosphatase and tensin homolog (PTEN), a tumor suppressor gene associated with inherited tumor susceptibility conditions, macrocephaly, autism, ataxia, tremor, and epilepsy. Functional implications of this protein have been investigated in Parkinson and Alzheimer diseases. METHODS We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts. RESULTS The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related hamartoma tumor syndrome. Extensive tumor screening did not detect any malignancies. We detected a novel de novo heterozygous c.269T>C, p.(Phe90Ser) PTEN variant, which was absent in both parents. The pathogenicity of the variant is supported by altered expression of several PTEN-associated proteins involved in tumorigenesis. Moreover, fibroblasts showed a defect in catalytic activity of PTEN against the secondary substrate, phosphatidylinositol 3,4-trisphosphate. In support of our findings, focal hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice. CONCLUSION We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway.
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Affiliation(s)
- Boglarka Bansagi
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Vietxuan Phan
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Mark R Baker
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Julia O'Sullivan
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Matthew J Jennings
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Roger G Whittaker
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Juliane S Müller
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Jennifer Duff
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Helen Griffin
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - James A L Miller
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Grainne S Gorman
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Hanns Lochmüller
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Patrick F Chinnery
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Andreas Roos
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Laura E Swan
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Rita Horvath
- From the Wellcome Centre for Mitochondrial Research (G.S.G.), Institute of Genetic Medicine (B.B., M.J., J.S.M., J.D., H.G., H.L., P.F.C., A.R., R.H.), and Institute of Neuroscience (M.R.B., R.G.W., G.S.G.), Newcastle University, Newcastle upon Tyne, UK; Leibniz-Institute für Analytische Wissenschaften-ISAS-e.V. (V.P., A.R.), Dortmund, Germany; Departments of Neurology (M.R.B., J.A.L.M., G.S.G.) and Clinical Neurophysiology (M.R.B., R.G.W., R.H.), Royal Victoria Infirmary, Newcastle upon Tyne; Department of Cellular and Molecular Physiology (J.O., L.E.S.), Institute of Translational Medicine, University of Liverpool; Department of Clinical Neurosciences (P.F.C.), University of Cambridge, Cambridge Biomedical Campus, UK; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; and Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.
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Baker MR, Dharmadasa T, Jaiser SR, Kiernan MC. Amyotrophic lateral sclerosis - Time for beta testing? Clin Neurophysiol 2018; 129:1455-1456. [PMID: 29754830 DOI: 10.1016/j.clinph.2018.04.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK; Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK; Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - T Dharmadasa
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - S R Jaiser
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK; Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - M C Kiernan
- Brain and Mind Centre, The University of Sydney, Sydney, Australia; Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
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Keogh MJ, Jaiser SR, Steele HE, Horvath R, Chinnery PF, Baker MR. PLP1 mutations and central demyelination: Evidence from electrophysiologic phenotyping in female manifesting carriers. Neurol Clin Pract 2018; 7:451-454. [PMID: 29620084 DOI: 10.1212/cpj.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/30/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Michael J Keogh
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
| | - Stephan R Jaiser
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
| | - Hannah E Steele
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
| | - Rita Horvath
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
| | - Patrick F Chinnery
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
| | - Mark R Baker
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Centre for Life (MJK, HES, RH, PFC), and Institute of Neuroscience (SRJ, MRB), Newcastle University; Departments of Neurology (MJK, SRJ, HES, RH, PFC, MRB) and Neurophysiology (SRJ, MRB), Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurosciences (MJK, PFC), University Neurology Unit, Cambridge Biomedical Campus, UK
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Ng YS, van Ruiten H, Lai HM, Scott R, Ramesh V, Horridge K, Taylor RW, Turnbull DM, Gorman GS, McFarland R, Baker MR. The adjunctive application of transcranial direct current stimulation in the management of de novo refractory epilepsia partialis continua in adolescent-onset POLG-related mitochondrial disease. Epilepsia Open 2018; 3:103-108. [PMID: 29588995 PMCID: PMC5839316 DOI: 10.1002/epi4.12094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/30/2022] Open
Abstract
Focal status epilepticus in POLG-related mitochondrial disease is highly refractory to pharmacological agents, including general anesthesia. We report the challenges in managing a previously healthy teenager who presented with de novo epilepsia partialis continua and metabolic stroke resulting from the homozygous p.Ala467Thr POLG mutation, the most common pathogenic variant identified in the Caucasian population. We applied transcranial direct current stimulation (tDCS; 2 mA; 20 min) daily as an adjunctive therapy because her focal seizures failed to respond to five antiepileptic drugs at maximal doses. The electrical and clinical seizures stopped after 3 days of tDCS. The second course of tDCS was administered for 14 days when the focal seizures re-emerged a month later. The patient tolerated the procedure well. Following 4 months of hospitalization and prolonged community rehabilitation, our patient has now returned to full-time education with support, and there is no report of cognitive deficit. We have demonstrated the safety and efficacy of tDCS in treating refractory focal motor seizures caused by mitochondrial disease.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastleUnited Kingdom
| | - Henriette van Ruiten
- Department of Paediatric NeurologyRoyal Victoria InfirmaryNewcastle upon TyneUnited Kingdom
| | - H. Ming Lai
- Department of Clinical NeurophysiologyRoyal Victoria InfirmaryNewcastleUnited Kingdom
| | - Rebecca Scott
- Department of Paediatric NeurologyRoyal Victoria InfirmaryNewcastle upon TyneUnited Kingdom
| | - Venkateswaran Ramesh
- Department of Paediatric NeurologyRoyal Victoria InfirmaryNewcastle upon TyneUnited Kingdom
| | - Karen Horridge
- Department of PaediatricsCity Hospitals Sunderland NHS Foundation TrustSunderlandUnited Kingdom
| | - Robert W. Taylor
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastleUnited Kingdom
| | - Doug M. Turnbull
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastleUnited Kingdom
| | - Gráinne S. Gorman
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastleUnited Kingdom
| | - Robert McFarland
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastleUnited Kingdom
- Department of Paediatric NeurologyRoyal Victoria InfirmaryNewcastle upon TyneUnited Kingdom
| | - Mark R. Baker
- Department of Clinical NeurophysiologyRoyal Victoria InfirmaryNewcastleUnited Kingdom
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
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Simpson AJ, Cunningham MO, Baker MR. Electrodiagnostic applications of somatosensory evoked high-frequency EEG oscillations: Technical considerations. Brain Res Bull 2018; 137:351-355. [PMID: 29366907 DOI: 10.1016/j.brainresbull.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High frequency oscillations (HFOs) embedded within the somatosensory evoked potential (SEP) are not routinely recorded/measured as part of standard clinical SEPs. However, HFOs could provide important additional diagnostic/prognostic information in various patient groups in whom SEPs are tested routinely. One area is the management of patients with hypoxic ischaemic encephalopathy (HIE) in the intensive care unit (ICU). However, the sensitivity of standard clinical SEP recording techniques for detecting HFOs is unknown. METHODS SEPs were recorded using routine clinical methods in 17 healthy subjects (median nerve stimulation; 0.5 ms pulse width; 5 Hz; maximum 4000 stimuli) in an unshielded laboratory. Bipolar EEG recordings were acquired (gain 50 k; bandpass 3Hz-2 kHz; sampling rate 5 kHz; non-inverting electrode 2 cm anterior to C3/C4; inverting electrode 2 cm posterior to C3/C4). Data analysis was performed in MATLAB. RESULTS SEP-HFOs were detected in 65% of controls using standard clinical recording techniques. In 3 controls without significant HFOs, experiments were repeated using a linear electrode array with higher spatial sampling frequency. SEP-HFOs were observed in all 3 subjects. CONCLUSIONS Currently standard clinical methods of recording SEPs are not sufficiently sensitive to permit the inclusion of SEP-HFOs in routine clinical diagnostic/prognostic assessments. Whilst an increase in the number/density of EEG electrodes should improve the sensitivity for detecting SEP-HFOs, this requires confirmation. By improving and standardising clinical SEP recording protocols to permit the acquisition/analysis of SEP-HFOs, it should be possible to gain important insights into the pathophysiology of neurological disorders and refine the management of conditions such as HIE.
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Affiliation(s)
- A J Simpson
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK
| | - M O Cunningham
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK
| | - M R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK; Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK; Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
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Kersey J, Jackson A, Baker MR. 1139 Epidural stimulation of the ventral and dorsal cervical spinal cord. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Physicians can come across patients who are exposed to certain prescription drugs or toxins that can result in adverse effects and complications which have high rates of morbidity and mortality. OBJECTIVE To summarise the key clinical features and management of the common movement disorder toxidromes relevant to physicians (with an interest in neurology). METHODS We searched PUBMED from 1946 to 2016 for papers relating to movement toxidromes and their treatment. The findings from those studies were then summarised and are presented here. RESULTS The key features of 6 of the common movement disorder toxidromes and their treatment are tabulated and highlighted. The management of toxidromes with the highest mortality like neuroleptic malignant syndrome and serotonin syndrome are discussed in detail. CONCLUSION There are several toxidromes that have the potential to become a serious life-threatening emergency if there is a delay in recognition of key clinical features and instituting the appropriate treatment at the earliest is crucial.
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Affiliation(s)
- N Malek
- Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
| | - M R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle -upon-Tyne, UK
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle-upon-Tyne, UK
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Cruz S, Schaefer AM, Joshi A, Baker MR. Clinical Reasoning: A 71-year-old woman with subacute progressive distal weakness and paresthesia after vaccination. Neurology 2017; 88:e168-e173. [DOI: 10.1212/wnl.0000000000003869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kendall T, Morriss R, Mayo-Wilson E, Meyer TD, Jones SH, Oud M, Baker MR. NICE guidance on psychological treatments for bipolar disorder. Lancet Psychiatry 2016; 3:317-20. [PMID: 27063379 DOI: 10.1016/s2215-0366(16)00082-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Tim Kendall
- National Collaborating Centre for Mental Health, London, UK; Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK.
| | - Richard Morriss
- Nottinghamshire Healthcare NHS Trust, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Evan Mayo-Wilson
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas HSC at Houston, Houston, TX, USA
| | | | - Matthijs Oud
- Department of Care Innovation, Trimbos Institute, Utrecht, Netherlands
| | - Mark R Baker
- Centre for Clinical Practice, the National Institute for Health and Care Excellence, London
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Abstract
Introduction The effects of age, height, and gender on magnetic central and peripheral motor conduction times (CMCT, PMCT) were analyzed using a multiple regression model. Methods Motor evoked potentials were recorded in 91 healthy volunteers. Magnetic stimulation was performed over the primary motor cortex (cortical latency) and over the cervical and lumbar spines (spinal latency). The spinal latency was taken as an estimate of PMCT and was subtracted from cortical latency to yield CMCT. Results Lower limb CMCT correlated significantly with height only; there were no significant predictors for upper limb CMCT. Upper and lower limb PMCT correlated with both age and height. Conclusions This is among the largest studies of CMCT in normal subjects. The multiple regression model unifies previously reported simple regression analyses, reconciles past discrepancies, and allows normal ranges to be individualized. Muscle Nerve51:706–712, 2015
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Affiliation(s)
- Stephan R Jaiser
- Institute of Neuroscience, Henry Wellcome Building, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
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Galán F, Baker MR, Alter K, Baker SN. Degraded EEG decoding of wrist movements in absence of kinaesthetic feedback. Hum Brain Mapp 2014; 36:643-54. [PMID: 25307551 PMCID: PMC4312958 DOI: 10.1002/hbm.22653] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/10/2014] [Accepted: 09/29/2014] [Indexed: 12/31/2022] Open
Abstract
A major assumption of brain–machine interface research is that patients with disconnected neural pathways can still volitionally recall precise motor commands that could be decoded for naturalistic prosthetic control. However, the disconnected condition of these patients also blocks kinaesthetic feedback from the periphery, which has been shown to regulate centrally generated output responsible for accurate motor control. Here, we tested how well motor commands are generated in the absence of kinaesthetic feedback by decoding hand movements from human scalp electroencephalography in three conditions: unimpaired movement, imagined movement, and movement attempted during temporary disconnection of peripheral afferent and efferent nerves by ischemic nerve block. Our results suggest that the recall of cortical motor commands is impoverished in the absence of kinaesthetic feedback, challenging the possibility of precise naturalistic cortical prosthetic control. Hum Brain Mapp 36:643–654, 2015. © 2014 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ferran Galán
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
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Pfeffer G, Gorman GS, Griffin H, Kurzawa-Akanbi M, Blakely EL, Wilson I, Sitarz K, Moore D, Murphy JL, Alston CL, Pyle A, Coxhead J, Payne B, Gorrie GH, Longman C, Hadjivassiliou M, McConville J, Dick D, Imam I, Hilton D, Norwood F, Baker MR, Jaiser SR, Yu-Wai-Man P, Farrell M, McCarthy A, Lynch T, McFarland R, Schaefer AM, Turnbull DM, Horvath R, Taylor RW, Chinnery PF. Mutations in the SPG7 gene cause chronic progressive external ophthalmoplegia through disordered mitochondrial DNA maintenance. Brain 2014; 137:1323-36. [PMID: 24727571 PMCID: PMC3999722 DOI: 10.1093/brain/awu060] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [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] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/12/2014] [Accepted: 01/30/2014] [Indexed: 12/12/2022] Open
Abstract
Despite being a canonical presenting feature of mitochondrial disease, the genetic basis of progressive external ophthalmoplegia remains unknown in a large proportion of patients. Here we show that mutations in SPG7 are a novel cause of progressive external ophthalmoplegia associated with multiple mitochondrial DNA deletions. After excluding known causes, whole exome sequencing, targeted Sanger sequencing and multiplex ligation-dependent probe amplification analysis were used to study 68 adult patients with progressive external ophthalmoplegia either with or without multiple mitochondrial DNA deletions in skeletal muscle. Nine patients (eight probands) were found to carry compound heterozygous SPG7 mutations, including three novel mutations: two missense mutations c.2221G>A; p.(Glu741Lys), c.2224G>A; p.(Asp742Asn), a truncating mutation c.861dupT; p.Asn288*, and seven previously reported mutations. We identified a further six patients with single heterozygous mutations in SPG7, including two further novel mutations: c.184-3C>T (predicted to remove a splice site before exon 2) and c.1067C>T; p.(Thr356Met). The clinical phenotype typically developed in mid-adult life with either progressive external ophthalmoplegia/ptosis and spastic ataxia, or a progressive ataxic disorder. Dysphagia and proximal myopathy were common, but urinary symptoms were rare, despite the spasticity. Functional studies included transcript analysis, proteomics, mitochondrial network analysis, single fibre mitochondrial DNA analysis and deep re-sequencing of mitochondrial DNA. SPG7 mutations caused increased mitochondrial biogenesis in patient muscle, and mitochondrial fusion in patient fibroblasts associated with the clonal expansion of mitochondrial DNA mutations. In conclusion, the SPG7 gene should be screened in patients in whom a disorder of mitochondrial DNA maintenance is suspected when spastic ataxia is prominent. The complex neurological phenotype is likely a result of the clonal expansion of secondary mitochondrial DNA mutations modulating the phenotype, driven by compensatory mitochondrial biogenesis.
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Affiliation(s)
- Gerald Pfeffer
- 1 Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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Fisher KM, Chinnery PF, Baker SN, Baker MR. Enhanced reticulospinal output in patients with (REEP1) hereditary spastic paraplegia type 31. J Neurol 2013; 260:3182-4. [PMID: 24221643 PMCID: PMC3843367 DOI: 10.1007/s00415-013-7178-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/27/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022]
Affiliation(s)
- K M Fisher
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
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