1
|
Usnich T, Becker LF, Nagel I, Bäumer T, Münchau A. Partially Levodopa-Responsive Parkinsonism in a Carrier of a Novel Pathogenic CLTC Variant. Mov Disord Clin Pract 2024. [PMID: 38586890 DOI: 10.1002/mdc3.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Tatiana Usnich
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Leonie F Becker
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Department of Pediatrics, University Hospital Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Inga Nagel
- Institute of Human Genetics, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| |
Collapse
|
2
|
Sondermann S, Boppel T, Fieseler K, Schramm P, Bäumer T, Trillenberg P. Needle electromyography does not meaningfully impact findings in MR-neurography/-myography. Muscle Nerve 2024; 69:409-415. [PMID: 38323736 DOI: 10.1002/mus.28049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Magnetic resonance neurography (MRN) and myography (MRM) are emerging imaging methods for detecting diseases of the peripheral nerve system (PNS). Most patients with PNS diseases also undergo needle electromyography (EMG). This study examined whether EMG led to lesions that were detectable using MRN/MRM and whether these lesions could impair image interpretation. METHODS Ten patients who underwent clinically indicated EMG were recruited. MRN/MRM was performed before and 2-6 h after EMG, and if achievable, 2-3 days later. T2 signal intensity (SI) of the tibialis anterior muscle (TA) was quantified, and sizes and SI of the new lesions were measured. Visual rating was performed independently by three neuroradiologists. RESULTS T2 lesions at the site of needle insertion, defined as focal edema, were detectable in 9/10 patients. The mean edema size was 31.72 mm2 (SD = 14.42 mm2 ) at the first follow-up. Susceptibility-weighted imaging lesions, defined as (micro) hematomas were detected in 5/10 patients (mean size, 23.85 mm2 [SD = 12.59 mm2 ]). General muscle SI of the TA did not differ between pre- and post-EMG examinations. Lesions size was relatively small, and the readers described image interpretation as not impaired by these lesions. DISCUSSION This study showed that focal edema and hematomas frequently occurred after needle EMG and could be observed using MRN/MRM. As general muscle SI was not affected and image interpretation was not impaired, we concluded that needle EMG did not interfere with MRN/MRM.
Collapse
Affiliation(s)
- Stefan Sondermann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Katharina Fieseler
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University of Lübeck, Lübeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
3
|
Münster ND, Schmalbrock P, Bäumer T, Hommel B, Beste C, Münchau A, Frings C. Separating binding and retrieval of event files in older adults. Acta Psychol (Amst) 2024; 244:104190. [PMID: 38368782 DOI: 10.1016/j.actpsy.2024.104190] [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: 12/11/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024] Open
Abstract
In the literature on human action control, it is assumed that features of stimuli (S) and responses (R) are integrated into internal representations (so-called event files) that are involved in the execution of an action. Experimentally, the impact of this integration on action control is typically analyzed via S-R binding effects. Recent theorizing in the BRAC framework (Frings et al., 2020) suggests to disentangle the processes of S-R binding proper from S-R retrieval as two independent components contributing to S-R binding effects. Since the literature on age effects on S-R binding effects is scarce and does not provide information on whether the existing findings about the two processes can be generalized to older age groups, this is the first study addressing the effects of older age separately on S-R binding proper vs. S-R retrieval. In two established variants of S-R binding tasks (cumulative n = 262), we contrasted binding (by using a saliency manipulation at the time of binding proper) versus retrieval processes (by manipulating the onset of the distractor at the time of retrieval), replicating previous results in younger (18-30 years) and also in older healthy controls (50-70 years). We therefore found no evidence for age effects on S-R binding proper or S-R retrieval. We thus conclude that the processes contributing to S-R binding effects are - at least in the age groups analyzed in this study - robust and age-independent. STATEMENT OF SIGNIFICANCE: In human action control, binding proper and retrieval of features in stimulus-response episodes typically lead to so-called S-R binding effects. Against the background of recent theorizing, binding proper and retrieval should be studied independently. In this article, we ran a younger and an older age group and analyzed possible age-related differences in integration or retrieval. Both groups showed the expected pattern for binding and retrieval as expected from the literature.
Collapse
Affiliation(s)
- Nicolas D Münster
- Department of Psychology, Cognitive Psychology, University of Trier, Trier, Germany; Institute for Cognitive & Affective Neuroscience (ICAN), University of Trier, Trier, Germany.
| | - Philip Schmalbrock
- Department of Psychology, Cognitive Psychology, University of Trier, Trier, Germany; Institute for Cognitive & Affective Neuroscience (ICAN), University of Trier, Trier, Germany.
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
| | - Bernhard Hommel
- Faculty of Medicine, University Neuropsychology Center, TU Dresden, Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, People's Republic of China.
| | - Christian Beste
- Department of Child and Adolescent Psychiatry, Cognitive Neurophysiology, Faculty of Medicine, TU Dresden, Dresden, Germany.
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
| | - Christian Frings
- Department of Psychology, Cognitive Psychology, University of Trier, Trier, Germany; Institute for Cognitive & Affective Neuroscience (ICAN), University of Trier, Trier, Germany.
| |
Collapse
|
4
|
Jacksch C, Loens S, Mueller J, Tadic V, Bäumer T, Zeuner KE. Impact of Physiotherapy in the Treatment of Pain in Cervical Dystonia. Tremor Other Hyperkinet Mov (N Y) 2024; 14:11. [PMID: 38464912 PMCID: PMC10921958 DOI: 10.5334/tohm.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024] Open
Abstract
Background Cervical dystonia (CD) is the most common form of focal dystonia in adults. Studies show that physiotherapy (PT) in combination with BoNT has an effect on pain in cervical dystonia. We intended to test this hypothesis in a real-world setting to answer the question of whether pain is a good target symptom for prescribing PT. We also aimed to assess which form of PT is most appropriate for the treatment of pain. Methods Study design: cross-sectional survey-based study of 91 patients with a confirmed diagnosis of cervical dystonia. The survey consisted of a questionnaire on type, frequency and content of physiotherapy, an assessment of quality of life with the Craniocervical Dystonia Questionnaire 24 (CDQ 24) and subjective pain scores. Results 53.8% of patients received physiotherapy, mostly a mixture of exercises to either correct the abnormal posture or to reduce the muscle tone. Additional therapies included stress-reducing exercises (14.3%), psychotherapy (9.9%) and EMG biofeedback (2.2%). Patients who received PT showed a non-significant tendency towards higher pain scores. The severity of dystonia-associated pain was significantly associated with the patients' quality of life (F (1,54) = 22.9, adjusted R2 = 0.286, p < 0.001). Discussion Pain is a frequent problem in patients with CD and severely affects quality of life. Physiotherapy could therefore be a valuable treatment option for patients with CD and pain. Highlights Our uncontrolled study illustrates the high frequency of physiotherapy in addition to BoNT treatment in a real-life cohort of patients with cervical dystonia. We were able to show that PT reduces patients' perceived pain in a patient reported outcome measure. This highlights the importance of PT in reducing CD-related pain, which considerably impairs quality of life.
Collapse
Affiliation(s)
- Clemens Jacksch
- Department of Neurology, Christian Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Loens
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Centre of rare diseases, University Hospital Lübeck, Lübeck, Germany
| | - Joerg Mueller
- Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany
| | - Vera Tadic
- Department of Neurology, University Hospital Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Centre of rare diseases, University Hospital Lübeck, Lübeck, Germany
| | - Kirsten E. Zeuner
- Department of Neurology, Christian Albrechts-University of Kiel, Kiel, Germany
| |
Collapse
|
5
|
Thomsen M, Marth K, Loens S, Everding J, Junker J, Borngräber F, Ott F, Jesús S, Gelderblom M, Odorfer T, Kuhlenbäumer G, Kim HJ, Schaeffer E, Becktepe J, Kasten M, Brüggemann N, Pfister R, Kollewe K, Krauss JK, Lohmann E, Hinrichs F, Berg D, Jeon B, Busch H, Altenmüller E, Mir P, Kamm C, Volkmann J, Zittel S, Ferbert A, Zeuner KE, Rolfs A, Bauer P, Kühn AA, Bäumer T, Klein C, Lohmann K. Large-Scale Screening: Phenotypic and Mutational Spectrum in Isolated and Combined Dystonia Genes. Mov Disord 2024; 39:526-538. [PMID: 38214203 DOI: 10.1002/mds.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pathogenic variants in several genes have been linked to genetic forms of isolated or combined dystonia. The phenotypic and genetic spectrum and the frequency of pathogenic variants in these genes have not yet been fully elucidated, neither in patients with dystonia nor with other, sometimes co-occurring movement disorders such as Parkinson's disease (PD). OBJECTIVES To screen >2000 patients with dystonia or PD for rare variants in known dystonia-causing genes. METHODS We screened 1207 dystonia patients from Germany (DysTract consortium), Spain, and South Korea, and 1036 PD patients from Germany for pathogenic variants using a next-generation sequencing gene panel. The impact on DNA methylation of KMT2B variants was evaluated by analyzing the gene's characteristic episignature. RESULTS We identified 171 carriers (109 with dystonia [9.0%]; 62 with PD [6.0%]) of 131 rare variants (minor allele frequency <0.005). A total of 52 patients (48 dystonia [4.0%]; four PD [0.4%, all with GCH1 variants]) carried 33 different (likely) pathogenic variants, of which 17 were not previously reported. Pathogenic biallelic variants in PRKRA were not found. Episignature analysis of 48 KMT2B variants revealed that only two of these should be considered (likely) pathogenic. CONCLUSION This study confirms pathogenic variants in GCH1, GNAL, KMT2B, SGCE, THAP1, and TOR1A as relevant causes in dystonia and expands the mutational spectrum. Of note, likely pathogenic variants only in GCH1 were also found among PD patients. For DYT-KMT2B, the recently described episignature served as a reliable readout to determine the functional effect of newly identified variants. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Mirja Thomsen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katrin Marth
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Judith Everding
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanna Junker
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Fabian Ott
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ebba Lohmann
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Frauke Hinrichs
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hauke Busch
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arndt Rolfs
- Medical Faculty, University of Rostock, Rostock, Germany
- Agyany Pharmaceuticals, Jerusalem, Israel
| | | | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Rare Diseases, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| |
Collapse
|
6
|
Graessner H, Reinhard C, Bäumer T, Baumgärtner A, Brockmann K, Brüggemann N, Bültmann E, Erdmann J, Heise K, Höglinger G, Hüning I, Kaiser FJ, Klein C, Klopstock T, Krägeloh-Mann I, Kraemer M, Luedtke K, Mücke M, Musacchio T, Nadke A, Osmanovic A, Ritter G, Röse K, Schippers C, Schöls L, Schüle R, Schulz JB, Sproß J, Stasch E, Wunderlich G, Münchau A. Recommendations for optimal interdisciplinary management and healthcare settings for patients with rare neurological diseases. Orphanet J Rare Dis 2024; 19:62. [PMID: 38347616 PMCID: PMC10863275 DOI: 10.1186/s13023-024-03023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In 2017, the German Academy for Rare Neurological Diseases (Deutsche Akademie für Seltene Neurologische Erkrankungen; DASNE) was founded to pave the way for an optimized personalized management of patients with rare neurological diseases (RND) in all age groups. Since then a dynamic national network for rare neurological disorders has been established comprising renowned experts in neurology, pediatric neurology, (neuro-) genetics and neuroradiology. DASNE has successfully implemented case presentations and multidisciplinary discussions both at yearly symposia and monthly virtual case conferences, as well as further educational activities covering a broad spectrum of interdisciplinary expertise associated with RND. Here, we present recommendation statements for optimized personalized management of patients with RND, which have been developed and reviewed in a structured Delphi process by a group of experts. METHODS An interdisciplinary group of 37 RND experts comprising DASNE experts, patient representatives, as well as healthcare professionals and managers was involved in the Delphi process. First, an online collection was performed of topics considered relevant for optimal patient care by the expert group. Second, a two-step Delphi process was carried out to rank the importance of the selected topics. Small interdisciplinary working groups then drafted recommendations. In two consensus meetings and one online review round these recommendations were finally consented. RESULTS 38 statements were consented and grouped into 11 topics: health care structure, core neurological expertise and core mission, interdisciplinary team composition, diagnostics, continuous care and therapy development, case conferences, exchange / cooperation between Centers for Rare Diseases and other healthcare partners, patient advocacy group, databases, translation and health policy. CONCLUSIONS This German interdisciplinary Delphi expert panel developed consented recommendations for optimal care of patients with RND in a structured Delphi process. These represent a basis for further developments and adjustments in the health care system to improve care for patients with RND and their families.
Collapse
Affiliation(s)
- Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany.
| | - Carola Reinhard
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
| | | | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children With Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Göttingen, Germany
| | - Norbert Brüggemann
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Schleswig-Holstein, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Eva Bültmann
- Institute of Diagnostic Und Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, and University Heart Center Lübeck, University of Lübeck, Lübeck, Germany
| | - Kirstin Heise
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, USA
- Department of Movement Sciences, Movement Control and Neural Plasticity Research Group, KU Leuven, Louvain, Belgium
| | - Günter Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Feodor-Lynen-Straße 17, 81377, Munich, Germany
| | - Irina Hüning
- Institute of Human Genetics, University of Lübeck, Lübeck, Germany
| | - Frank J Kaiser
- Essen Center for Rare Diseases (Essener Zentrum Für Seltene Erkrankungen, EZSE), University Hospital Essen, Essen, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck and University Hospital Medical Center , Schleswig-Holstein, Germany
| | - Thomas Klopstock
- Friedrich Baur Institute at the Department of Neurology, University Hospital, LMU , Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric and Developmental Neurology, Social Pediatrics, University of Tübingen, Tübingen, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital Essen, Essen, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kerstin Luedtke
- Department of Physiotherapy, Institute of Health Sciences, University of Lübeck, Lübeck, Germany
| | - Martin Mücke
- Institute for Digitalization and General Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Rare Diseases Aachen (ZSEA), RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Thomas Musacchio
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- Center for Rare Diseases, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andreas Nadke
- Deutsche Heredo-Ataxie-Gesellschaft E.V., Stuttgart, Germany
| | - Alma Osmanovic
- Essen Center for Rare Diseases (Essener Zentrum Für Seltene Erkrankungen, EZSE), University Hospital Essen, Essen, Germany
| | - Gabriele Ritter
- Klinikum Ameos, 23774 Heiligenhafen Friedrich Ebertstrrasse 100 Huntington Zentrum Nord, Heiligenhafen, Germany
| | - Katharina Röse
- Institute of Health Sciences, University of Lübeck, Lübeck, Germany
| | | | - Ludger Schöls
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Rebecca Schüle
- Division of Neurodegenerative Diseases, Department of Neurology, Heidelberg University Hospital and Faculty of Medicine, Heidelberg, Germany
- Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jörg B Schulz
- Department of Neurology and Center for Rare Diseases, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Joachim Sproß
- Deutsche Gesellschaft Für Muskelkranke e.V. Im Moos 4, 79112, Freiburg, Germany
| | - Eveline Stasch
- Deutsche PSP-Gesellschaft e.V. Weingartenstr. 28a, 61231, Bad Nauheim, Germany
| | - Gilbert Wunderlich
- Faculty of Medicine and University Hospital, Department of Neurology, University of Cologne, Cologne, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
| |
Collapse
|
7
|
Hamami F, Bäumer T. [Pain and cervical dystonia]. Schmerz 2024; 38:41-47. [PMID: 38265520 DOI: 10.1007/s00482-024-00790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Dystonia is a hyperkinetic movement disorder that results in twisting, cramps and tremors due to sustained or intermittent muscle contractions. Cervical dystonia is the most common form of dystonia, in which the head, neck and/or shoulder areas are affected. In addition to these motor symptoms, pain and psychiatric symptoms are frequent in (cervical) dystonia. OBJECTIVE Description of the incidence and evaluation of pain in cervical dystonia, summary and discussion of treatment options and effects. MATERIAL AND METHODS In this review article the results in the scientific literature on pain in dystonia are summarized and discussed. RESULTS Compared to other forms of dystonia, pain occurs most frequently in patients with cervical dystonia. A large proportion of patients with cervical dystonia suffer from pain, which contributes most to impairment of the patient. The motor symptoms of dystonia are usually treated with botulinum toxin injections. These have a muscle relaxing effect and also relieve pain. The study situation on the occurrence and treatment of pain in other forms of dystonia is so far very limited. Pain can dominate the clinical picture in patients with cervical dystonia. Evaluation of pain in cervical dystonia can be performed using standardized questionnaires. CONCLUSION It is important to ask patients with cervical dystonia about pain and to consider it in treatment planning and evaluation. Vice versa, if pain is present the possibility of a causative dystonia should also be considered. For pain assessment there are some newly developed questionnaires to assess pain in a standardized way in patients with dystonia. Further research is needed to better understand the pathomechanisms of pain in dystonia.
Collapse
Affiliation(s)
- Feline Hamami
- Institut für Systemische Motorikforschung, Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| |
Collapse
|
8
|
Junker J, Hall J, Berman BD, Vidailhet M, Roze E, Bäumer T, Malaty IA, Shukla AW, Jankovic J, Reich SG, Espay AJ, Duque KR, Patel N, Perlmutter JS, Jinnah HA, Brandt V, Brüggemann N. Longitudinal predictors of health-related quality of life in isolated dystonia. J Neurol 2024; 271:852-863. [PMID: 37839041 PMCID: PMC10827910 DOI: 10.1007/s00415-023-12022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine longitudinal predictors of health-related quality of life (HR-QoL) in an international multicenter cohort of patients with isolated dystonia. METHODS Out of 603 dystonia patients prospectively enrolled in the Natural History Dystonia Coalition study, 155 were assessed three times within 2 years for HR-QoL, symptoms of depression, generalized anxiety disorder (GAD), and social anxiety disorder (SAD), as well as dystonia severity and dystonic tremor. In addition, the impact of botulinum neurotoxin (BoNT) injections on HR-QoL was evaluated after 1 year. RESULTS Depressive symptoms at baseline predicted lower HR-QoL on all subscales after 2 years (all p ≤ 0.001). Higher GAD scores at baseline predicted lower HR-QoL related to general health, pain and emotional well-being, whereas higher SAD scores predicted higher pain-related QoL after 2 years (all p ≤ 0.006). Dystonia severity at baseline predicted social functioning (p = 0.002). Neither dystonic tremor, age, or sex predicted HR-QoL at 2 years. Two latent categories were revealed across the three-time points: Category 1 with higher total HR-QoL scores (mean HR-QoL = 74.4% ± 16.1), susceptible to symptoms of depression and SAD, and Category 2 with lower total HR-QoL scores (mean HR-QoL = 45.5% ± 17.6), susceptible to symptoms of GAD. HR-QoL improved over the course of 1 year irrespective of the use of BoNT. CONCLUSION The longitudinal impact of psychiatric symptoms on HR-QoL emphasizes the importance of incorporating mental health treatment, in particular also the therapy of anxiety disorders, into treatment regimens for dystonia.
Collapse
Affiliation(s)
- Johanna Junker
- Department of Neurology, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, SH, Germany
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - James Hall
- Southampton Education School, University of Southampton, Southampton, UK
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marie Vidailhet
- Departement de Neurologie, AP-HP, Hopital de La Pitie-Salpetriere, Paris, France
- Institut du Cerveau_ Paris Brain Institute-ICM, INSERM 1127, CNRS 7225, Sorbonne Université, Paris, France
| | - Emmanuel Roze
- Departement de Neurologie, AP-HP, Hopital de La Pitie-Salpetriere, Paris, France
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurologic Disorders, University of Florida, Gainesville, FL, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Stephen G Reich
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Kevin R Duque
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Neepa Patel
- RUSH Parkinson's Disease and Movement Disorders Center, Department of Neurological Science, RUSH University Medical Center Chicago, Chicago, IL, USA
| | - Joel S Perlmutter
- Departments of Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - H A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Valerie Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, SH, Germany.
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany.
| |
Collapse
|
9
|
Becker LF, Rawish T, Bäumer T, Beste C, Roessner V, Münchau A, Verrel J. "The Rush Video-Based Tic Rating Scale-Revised: A Practice-Oriented Revision". Mov Disord Clin Pract 2024; 11:105-106. [PMID: 38291838 PMCID: PMC10828614 DOI: 10.1002/mdc3.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Leonie Felicia Becker
- Institute of Systems Motor Science, University of LübeckLübeckGermany
- Department of PediatricsUniversity Hospital Medical Center Schleswig‐HolsteinLübeckGermany
| | - Tina Rawish
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of MedicineTU DresdenDresdenGermany
- University Neuropsychology Centre, Faculty of Medicine, TU DresdenDresdenGermany
- Cognitive Psychology, Faculty of PsychologyShandong Normal UniversityJinanChina
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of MedicineTU DresdenDresdenGermany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| | - Julius Verrel
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| |
Collapse
|
10
|
Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Laskawi R, Paus S, Pflug C, Schroeder AS, Spittau B, Steffen A, Wilken B, Winterholler M, Berweck S. Botulinum neurotoxin type A in the interdisciplinary treatment of sialorrhea in adults and children-update and practice recommendations. Front Neurol 2023; 14:1275807. [PMID: 38162447 PMCID: PMC10757066 DOI: 10.3389/fneur.2023.1275807] [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: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to currently used non-drug treatment and systemic drugs, intraglandular Botulinum Neurotoxin A (BoNT/A) injections have been examined in case studies, controlled trials and clinical practice. Two pivotal Phase III trials recently led to market approval in the USA and EU for IncobotulinumtoxinA [Xeomin®, IncoBoNT/A, Clostridium botulinum neurotoxin type A (150 kD), free from complexing proteins, Merz Pharmaceuticals GmbH] for treatment of chronic sialorrhea in adults and pediatric patients. This review provides a multidisciplinary approach to discuss the current state of sialorrhea therapy as well as benefits and current limitations of BoNT/A injections. A consensus regarding treatment recommendations made available to physicians in Germany in 2022 has now been updated here for presentation to an international audience. This review provides a framework including a flow chart for patient selection, recommendations for dosing and the injection process, as well as a discussion of therapeutic goals, long-term benefits and safety aspects. This review is aimed at supporting physicians in developing multidisciplinary and individualized treatment approaches to achieve optimal benefits for patients.
Collapse
Affiliation(s)
| | - Tobias Bäumer
- Institute of Systemic Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Ulrich Birkmann
- Department of Neurology, Schluckambulanz, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Carsten Buhmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Rainer Laskawi
- Department of Otorhinolaryngology, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Paus
- Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Sebastian Schroeder
- Clinic for Child Neurology and Social Pediatrics, Child Center Maulbronn, Maulbronn, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Martin Winterholler
- Department of Neurology, Sana Hospital Rummelsberg, Nuremberg/Schwarzenbruck, Germany
| | - Steffen Berweck
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic, Vogtareuth, Germany
| |
Collapse
|
11
|
Boz D, Kilic‐Berkmen G, Perlmutter JS, Norris SA, Wright LJ, Klein C, Bäumer T, Löns S, Feuerstein JS, Mahajan A, Wagle‐Shukla A, Malaty I, LeDoux MS, Ondo W, Pantelyat A, Frank S, Saunders‐Pullman R, Jinnah H. An Empirical Comparison of Commonly Used Universal Rating Scales for Dystonia. Mov Disord Clin Pract 2023; 10:1777-1786. [PMID: 38094647 PMCID: PMC10715345 DOI: 10.1002/mdc3.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/19/2023] [Accepted: 10/08/2023] [Indexed: 02/01/2024] Open
Abstract
Background There are several widely used clinical rating scales for documenting the severity and distribution of various types of dystonia. Objectives The goal of this study was to evaluate the performance of the most commonly used scales in a large group of adults with the most common types of isolated dystonia. Methods Global Dystonia Rating Scale (GDRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) scores were obtained for 3067 participants. Most had focal or segmental dystonia, with smaller numbers of multifocal or generalized dystonia. These scales were also compared for 209 adults with cervical dystonia that had Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores and 210 adults with blepharospasm that had Blepharospasm Severity Scale (BSRS) scores. Results There were strong correlations between the GDRS and BFM total scores (r = 0.79) and moderate correlations for their sub scores (r > 0.5). Scores for both scales showed positive skew, with an overabundance of low scores. BFM sub-scores were not normally distributed, due to artifacts caused by the provoking factor. Relevant sub-scores of the GDRS and BFM also showed moderate correlations with the TWSTRS (r > 0.5) for cervical dystonia and the BSRS (r > 0.5) for blepharospasm. Conclusions The BFM is more widely used than the GDRS, but these results suggest the GDRS may be preferable for focal and segmental dystonias. The overabundance of very low scores for both scales highlights challenges associated with discriminating very mild dystonia from other abnormal movements or variants of normal behavior.
Collapse
Affiliation(s)
- Deniz Boz
- College of Arts & SciencesGeorgia State UniversityAtlantaGeorgiaUSA
| | | | - Joel S. Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational TherapyWashington University School of MedicineSt LouisMissouriUSA
| | - Scott A. Norris
- Department of Neurology and RadiologyWashington UniversitySt LouisMissouriUSA
| | - Laura J. Wright
- Department of Neurology at Washington University at St LouisSt LouisMissouriUSA
| | | | - Tobias Bäumer
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
| | - Sebastian Löns
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
| | | | - Abhimanyu Mahajan
- Rush Parkinson's disease and Movement disorders program, Department of Neurological SciencesChicagoIllinoisUSA
| | - Aparna Wagle‐Shukla
- Fixel Institute for Neurological Disease, University of Florida Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Irene Malaty
- Fixel Institute for Neurological Disease, University of Florida Department of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Mark S. LeDoux
- Department of PsychologyUniversity of Memphis, Memphis, TN, USA; Veracity Neuroscience LLCMemphisTennesseeUSA
| | - William Ondo
- Department of Neurology, Methodist Neurological InstituteHouston TX and Weill Cornell Medical SchoolNew YorkNew YorkUSA
| | - Alexander Pantelyat
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Samuel Frank
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Rachel Saunders‐Pullman
- Department of NeurologyIcahn School of Medicine at Mount Sinai, and Mount Sinai Beth IsraelNew YorkNew YorkUSA
| | - H.A. Jinnah
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
| |
Collapse
|
12
|
Loens S, Boppel T, Bäumer T. Hypertrophy of the Spinalis Cervicis Muscle in Cervical Dystonia. Tremor Other Hyperkinet Mov (N Y) 2023; 13:42. [PMID: 37954036 PMCID: PMC10637288 DOI: 10.5334/tohm.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background Botulinum neurotoxin A (BoNT) is the first line treatment for cervical dystonia (CD) and treatment outcome significantly depends on the correct identification of the muscles involved. Phenomenology shown In a case with insufficient response to BoNT treatment further work up with magnetic resonance imaging (MRI) of the neck revealed a hypertrophic spinalis cervicis muscle, that is not commonly involved in CD. Educational value This highlights the use of MRI for muscle selection in treatment refractory CD cases.
Collapse
Affiliation(s)
- Sebastian Loens
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
13
|
Bergmans B, Clark V, Isaacson SH, Bäumer T. Recommendations for a paradigm shift in approach to increase the recognition and treatment of sialorrhea in Parkinson's disease. Clin Park Relat Disord 2023; 9:100223. [PMID: 38021341 PMCID: PMC10643485 DOI: 10.1016/j.prdoa.2023.100223] [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: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes one of the most frequent and bothersome complaints of patients with Parkinson's disease (PD), affecting up to 84% of them. Sialorrhea is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, poor oral health, and aspiration pneumonia. To better understand the burden of sialorrhea on patients with PD, Parkinson's Europe carried out a worldwide patient survey which showed that sialorrhea remains an underrecognized and undertreated issue in patients with PD. This is especially problematic because effective therapeutic options are available. This article presents the results of the Parkinson's Europe Sialorrhea Survey, which were considered by a multidisciplinary panel of experts to provide recommendations for improving the awareness, diagnosis, management, and treatment of sialorrhea in patients with PD. A shift in the treatment paradigm for sialorrhea in patients with PD is emerging. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all those involved to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of botulinum toxin and speech and language therapy as first-line therapies.
Collapse
Affiliation(s)
- Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, 8000 Bruges, Belgium
- Department of Neurology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Veronica Clark
- Independent Researcher, Malta Parkinson’s, PO Box 17, Marsa MTP 1001, Malta
- Private Practice, UK
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, 951 NW 13th Street, Bldg. 5-E, Boca Raton, FL 33486, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, CBBM (Building 66), Ratzeburger Allee 160, 23562 Lübeck, Germany
| |
Collapse
|
14
|
Herzog R, Bolte C, Radecke JO, von Möller K, Lencer R, Tzvi E, Münchau A, Bäumer T, Weissbach A. Neuronavigated Cerebellar 50 Hz tACS: Attenuation of Stimulation Effects by Motor Sequence Learning. Biomedicines 2023; 11:2218. [PMID: 37626715 PMCID: PMC10452137 DOI: 10.3390/biomedicines11082218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebellar transcranial alternating current stimulation (tACS) is an emerging non-invasive technique that induces electric fields to modulate cerebellar function. Although the effect of cortical tACS seems to be state-dependent, the impact of concurrent motor activation and the duration of stimulation on the effects of cerebellar tACS has not yet been examined. In our study, 20 healthy subjects received neuronavigated 50 Hz cerebellar tACS for 40 s or 20 min, each during performance using a motor sequence learning task (MSL) and at rest. We measured the motor evoked potential (MEP) before and at two time points after tACS application to assess corticospinal excitability. Additionally, we investigated the online effect of tACS on MSL. Individual electric field simulations were computed to evaluate the distribution of electric fields, showing a focal electric field in the right cerebellar hemisphere with the highest intensities in lobe VIIb, VIII and IX. Corticospinal excitability was only increased after tACS was applied for 40 s or 20 min at rest, and motor activation during tACS (MSL) cancelled this effect. In addition, performance was better (shorter reaction times) for the learned sequences after 20 min of tACS, indicating more pronounced learning under 20 min of tACS compared to tACS applied only in the first 40 s.
Collapse
Affiliation(s)
- Rebecca Herzog
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Christina Bolte
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan-Ole Radecke
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Kathinka von Möller
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Rebekka Lencer
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Elinor Tzvi
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hohe Bleichen 8, 20354 Hamburg, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| |
Collapse
|
15
|
Weissbach A, Moyé J, Takacs A, Verrel J, Chwolka F, Friedrich J, Paulus T, Zittel S, Bäumer T, Frings C, Pastötter B, Beste C, Münchau A. Perception-Action Integration Is Altered in Functional Movement Disorders. Mov Disord 2023; 38:1399-1409. [PMID: 37315159 DOI: 10.1002/mds.29458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Although functional neurological movement disorders (FMD) are characterized by motor symptoms, sensory processing has also been shown to be disturbed. However, how the integration of perception and motor processes, essential for the control of goal-directed behavior, is altered in patients with FMD is less clear. A detailed investigation of these processes is crucial to foster a better understanding of the pathophysiology of FMD and can systematically be achieved in the framework of the theory of event coding (TEC). OBJECTIVE The aim was to investigate perception-action integration processes on a behavioral and neurophysiological level in patients with FMD. METHODS A total of 21 patients and 21 controls were investigated with a TEC-related task, including concomitant electroencephalogram (EEG) recording. We focused on EEG correlates established to reflect perception-action integration processes. Temporal decomposition allowed to distinguish between EEG codes reflecting sensory (S-cluster), motor (R-cluster), and integrated sensory-motor processing (C-cluster). We also applied source localization analyses. RESULTS Behaviorally, patients revealed stronger binding between perception and action, as evidenced by difficulties in reconfiguring previously established stimulus-response associations. Such hyperbinding was paralleled by a modulation of neuronal activity clusters, including reduced C-cluster modulations of the inferior parietal cortex and altered R-cluster modulations in the inferior frontal gyrus. Correlations of these modulations with symptom severity were also evident. CONCLUSIONS Our study shows that FMD is characterized by altered integration of sensory information with motor processes. Relations between clinical severity and both behavioral performance and neurophysiological abnormalities indicate that perception-action integration processes are central and a promising concept for the understanding of FMD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Anne Weissbach
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Josephine Moyé
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Adam Takacs
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Fabian Chwolka
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Christian Frings
- Department of Cognitive Psychology, Trier University Trier, Trier, Germany
| | - Bernhard Pastötter
- Department of Cognitive Psychology, Trier University Trier, Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| |
Collapse
|
16
|
Al-Fatly B, Giesler SJ, Oxenford S, Li N, Dembek TA, Achtzehn J, Krause P, Visser-Vandewalle V, Krauss JK, Runge J, Tadic V, Bäumer T, Schnitzler A, Vesper J, Wirths J, Timmermann L, Kühn AA, Koy A. Neuroimaging-based analysis of DBS outcomes in pediatric dystonia: Insights from the GEPESTIM registry. Neuroimage Clin 2023; 39:103449. [PMID: 37321142 PMCID: PMC10275720 DOI: 10.1016/j.nicl.2023.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established treatment in patients of various ages with pharmaco-resistant neurological disorders. Surgical targeting and postoperative programming of DBS depend on the spatial location of the stimulating electrodes in relation to the surrounding anatomical structures, and on electrode connectivity to a specific distribution pattern within brain networks. Such information is usually collected using group-level analysis, which relies on the availability of normative imaging resources (atlases and connectomes). Analysis of DBS data in children with debilitating neurological disorders such as dystonia would benefit from such resources, especially given the developmental differences in neuroimaging data between adults and children. We assembled pediatric normative neuroimaging resources from open-access datasets in order to comply with age-related anatomical and functional differences in pediatric DBS populations. We illustrated their utility in a cohort of children with dystonia treated with pallidal DBS. We aimed to derive a local pallidal sweetspot and explore a connectivity fingerprint associated with pallidal stimulation to exemplify the utility of the assembled imaging resources. METHODS An average pediatric brain template (the MNI brain template 4.5-18.5 years) was implemented and used to localize the DBS electrodes in 20 patients from the GEPESTIM registry cohort. A pediatric subcortical atlas, analogous to the DISTAL atlas known in DBS research, was also employed to highlight the anatomical structures of interest. A local pallidal sweetspot was modeled, and its degree of overlap with stimulation volumes was calculated as a correlate of individual clinical outcomes. Additionally, a pediatric functional connectome of 100 neurotypical subjects from the Consortium for Reliability and Reproducibility was built to allow network-based analyses and decipher a connectivity fingerprint responsible for the clinical improvements in our cohort. RESULTS We successfully implemented a pediatric neuroimaging dataset that will be made available for public use as a tool for DBS analyses. Overlap of stimulation volumes with the identified DBS-sweetspot model correlated significantly with improvement on a local spatial level (R = 0.46, permuted p = 0.019). The functional connectivity fingerprint of DBS outcomes was determined to be a network correlate of therapeutic pallidal stimulation in children with dystonia (R = 0.30, permuted p = 0.003). CONCLUSIONS Local sweetspot and distributed network models provide neuroanatomical substrates for DBS-associated clinical outcomes in dystonia using pediatric neuroimaging surrogate data. Implementation of this pediatric neuroimaging dataset might help to improve the practice and pave the road towards a personalized DBS-neuroimaging analyses in pediatric patients.
Collapse
Affiliation(s)
- Bassam Al-Fatly
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
| | - Sabina J Giesler
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Oxenford
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany
| | - Ningfei Li
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Johannes Achtzehn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany
| | - Patricia Krause
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim Runge
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Vera Tadic
- Department of Neurology, University Medical Center Schleswig Holstein, Lübeck Campus, Lübeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University Medical Center Schleswig Holstein, Lübeck Campus, Lübeck, Germany
| | - Alfons Schnitzler
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Vesper
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jochen Wirths
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Andrea A Kühn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
| | - Anne Koy
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
17
|
Brügge NS, Sallandt GM, Schappert R, Li F, Siekmann A, Grzegorzek M, Bäumer T, Frings C, Beste C, Stenger R, Roessner V, Fudickar S, Handels H, Münchau A. Automated Motor Tic Detection: A Machine Learning Approach. Mov Disord 2023. [PMID: 37166278 DOI: 10.1002/mds.29439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Video-based tic detection and scoring is useful to independently and objectively assess tic frequency and severity in patients with Tourette syndrome. In trained raters, interrater reliability is good. However, video ratings are time-consuming and cumbersome, particularly in large-scale studies. Therefore, we developed two machine learning (ML) algorithms for automatic tic detection. OBJECTIVE The aim of this study was to evaluate the performances of state-of-the-art ML approaches for automatic video-based tic detection in patients with Tourette syndrome. METHODS We used 64 videos of n = 35 patients with Tourette syndrome. The data of six subjects (15 videos with ratings) were used as a validation set for hyperparameter optimization. For the binary classification task to distinguish between tic and no-tic segments, we established two different supervised learning approaches. First, we manually extracted features based on landmarks, which served as input for a Random Forest classifier (Random Forest). Second, a fully automated deep learning approach was used, where regions of interest in video snippets were input to a convolutional neural network (deep neural network). RESULTS Tic detection F1 scores (and accuracy) were 82.0% (88.4%) in the Random Forest and 79.5% (88.5%) in the deep neural network approach. CONCLUSIONS ML algorithms for automatic tic detection based on video recordings are feasible and reliable and could thus become a valuable assessment tool, for example, for objective tic measurements in clinical trials. ML algorithms might also be useful for the differential diagnosis of tics. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Nele Sophie Brügge
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
- German Research Center for Artificial Intelligence, Lübeck, Germany
| | - Gesine Marie Sallandt
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Knowledge Engineering, University of Economics in Katowice, Katowice, Poland
| | - Ronja Schappert
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Frédéric Li
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Alina Siekmann
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
- Department of Psychology, University of Trier, Trier, Germany
| | - Tobias Bäumer
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christian Frings
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Beste
- Faculty of Medicine, University Neuropsychology Center, TU Dresden, Dresden, Germany
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Roland Stenger
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Veit Roessner
- Faculty of Medicine, University Neuropsychology Center, TU Dresden, Dresden, Germany
| | | | - Heinz Handels
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
- German Research Center for Artificial Intelligence, Lübeck, Germany
| | - Alexander Münchau
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
18
|
Loens S, Hamami F, Lohmann K, Odorfer T, Ip CW, Zittel S, Zeuner KE, Everding J, Becktepe J, Marth K, Borngräber F, Kollewe K, Kamm C, Kühn AA, Gelderblom M, Volkmann J, Klein C, Bäumer T. Tremor is associated with familial clustering of dystonia. Parkinsonism Relat Disord 2023; 110:105400. [PMID: 37086575 DOI: 10.1016/j.parkreldis.2023.105400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Dystonia is a movement disorder of variable etiology and clinical presentation and is accompanied by tremor in about 50% of cases. Monogenic causes in dystonia are rare, but also in the group of non-monogenic dystonias 10-30% of patients report a family history of dystonia. This points to a number of patients currently classified as idiopathic that have at least in part an underlying genetic contribution. The present study aims to identify clinical and demographic features associated with heritability of yet idiopathic dystonia. METHODS Seven hundred thirty-three datasets were obtained from the DysTract dystonia registry, patients with acquired dystonia or monogenic causes were excluded. Affected individuals were assigned to a familial and sporadic group, and clinical features were compared across these groups. Additionally, the history of movement disorders was also counted in family members. RESULTS 18.2% of patients reported a family history of dystonia. Groups differed in age at onset, disease duration and presence of tremor on a descriptive level. Logistic regression analysis revealed that tremor was the only predictor for a positive family history of dystonia (OR 2.49, CI = 1.54-4.11, p < 0.001). Tremor turned out to be the most common movement disorder in available relatives of patients, and presence of tremor in relatives was associated with tremor in index patients (X2(1) = 16.2, p < 0.001). CONCLUSIONS Tremor is associated with an increased risk of familial clustering of dystonia and with a family history of tremor itself. This indicates a hereditable dystonia-tremor syndrome with a clinical spectrum ranging from tremor-predominant diseases to dystonia.
Collapse
Affiliation(s)
- Sebastian Loens
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany.
| | - Feline Hamami
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Judith Everding
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Kiel, Kiel, Germany
| | - Katrin Marth
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Department of Rare Diseases, University Hospital Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
19
|
Paulus T, Wernecke L, Lundie A, Friedrich J, Verrel J, Rawish T, Weissbach A, Frings C, Beste C, Bäumer T, Münchau A. The Role of the Left Inferior Parietal Cortex in Gilles de la Tourette Syndrome—An rTMS Study. Biomedicines 2023; 11:biomedicines11030980. [PMID: 36979959 PMCID: PMC10046361 DOI: 10.3390/biomedicines11030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Increased activity in the left inferior parietal cortex (BA40) plays a role in the generation of tics in the Gilles de la Tourette syndrome (GTS). Thus, inhibitory repetitive transcranial magnetic stimulation (rTMS) applied to BA40 was hypothesized to alleviate symptoms in GTS. We investigated the immediate effects of single-session 1 Hz rTMS and sham stimulation delivered to the left BA40 on tics assessed with the Rush video protocol in 29 adults with GTS. There were no significant effects on tic symptoms following rTMS or sham stimulation. Moreover, there was no difference when comparing the effects of both stimulation conditions. Bayesian statistics indicated substantial evidence against an intervention effect. The left BA40 appears not to be a useful target for 1 Hz rTMS to modulate tic symptoms in GTS patients.
Collapse
Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University of Lübeck, 23562 Lübeck, Germany
| | - Lynn Wernecke
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Annik Lundie
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Tina Rawish
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
| | - Christian Frings
- Department of Cognitive Psychology, Faculty of Psychology, University of Trier, 54296 Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Neuropsychology Centre, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan 250014, China
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-3101-8215
| |
Collapse
|
20
|
Verrel J, Chwolka F, Filevich E, Moyé J, Paulus T, Zittel S, Bäumer T, Münchau A, Weissbach A. Impaired Metacognition of Voluntary Movement in Functional Movement Disorder. Mov Disord 2023; 38:435-443. [PMID: 36606550 DOI: 10.1002/mds.29303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Motor symptoms in functional movement disorders (FMDs) are experienced as involuntary but share characteristics of voluntary action. Clinical and experimental evidence indicate alterations in monitoring, control, and subjective experience of self-performed movements. OBJECTIVE The objective of this study was to test the prediction that FMDs are associated with a reduced ability to make accurate (metacognitive) judgments about self-performed movements. METHODS We compared 24 patients with FMD (including functional gait disturbance, functional tremor, and functional tics) with 24 age- and sex-matched healthy control subjects in a novel visuomotor-metacognitive paradigm. Participants performed target-directed movements on a graphics tablet with restricted visual feedback, decided which of two visually presented trajectories was closer to their preceding movement, and reported their confidence in the visuomotor decision. We quantified individual metacognitive performance as participants' ability to assign high confidence preferentially to correct visuomotor decisions. RESULTS Patients and control subjects showed comparable motor performance, response accuracy, and use of the confidence scale. However, visuomotor sensitivity in the trajectory judgment was reduced in patients with FMD compared with healthy control subjects. Moreover, metacognitive performance was impaired in patients, that is, their confidence ratings were less predictive of the correctness of visuomotor decisions. Exploratory subgroup analyses suggest metacognitive deficits to be most pronounced in patients with a functional gait disturbance or functional tremor. CONCLUSIONS Patients with FMD exhibited deficits both when making visuomotor decisions about their own movements and in the metacognitive evaluation of these decisions. Reduced metacognitive insight into voluntary motor control may play a role in FMD pathophysiology and could lay the groundwork for new treatment strategies. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Fabian Chwolka
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Elisa Filevich
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josephine Moyé
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| |
Collapse
|
21
|
Bartha S, Bluschke A, Rawish T, Naumann KER, Wendiggensen P, Bäumer T, Roessner V, Münchau A, Beste C. Extra Movements in Healthy People: Challenging the Definition and Diagnostic Practice of Tic Disorders. Ann Neurol 2023; 93:472-478. [PMID: 36565297 DOI: 10.1002/ana.26586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
The occurrence of motor/vocal tics, that is, "extra movements" and/or "extra vocalizations," is the leading diagnostic criterion for tic disorders. We show that extra movements are common also in healthy controls, so that a surplus of movements per se is not indicative of the presence of a tic disorder. This questions the usefulness of Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria for tic disorders in clinical practice. Apparently, it is not solely a surplus of movements that defines tic disorders. Instead, movement characteristics and patterns seem to play a crucial role. ANN NEUROL 2023;93:472-478.
Collapse
Affiliation(s)
- Stefanie Bartha
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Tina Rawish
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Kim E R Naumann
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Paul Wendiggensen
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,University Neuropsychology Center, Faculty of Medicine, TU Dresden, Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| |
Collapse
|
22
|
Defazio G, Gigante AF, Hallett M, Berardelli A, Perlmutter JS, Berman BD, Jankovic J, Bäumer T, Comella C, Ercoli T, Ferrazzano G, Fox SH, Kim HJ, Moukheiber ES, Richardson SP, Weissbach A, Jinnah HA. Motor and psychiatric features in idiopathic blepharospasm: A data-driven cluster analysis. Parkinsonism Relat Disord 2022; 104:94-98. [PMID: 36306537 DOI: 10.1016/j.parkreldis.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/05/2022] [Accepted: 10/07/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Idiopathic blepharospasm is a clinically heterogeneous dystonia also characterized by non motor symptoms. METHODS We used a k-means cluster analysis to assess 188 patients with idiopathic blepharospasm in order to identify relatively homogeneous subpopulations of patients, using a set of motor and psychiatric variables to generate the cluster solution. RESULTS Blepharospasm patients reached higher scores on scales assessing depressive- and anxiety-related disorders than healthy/disease controls. Cluster analysis suggested the existence of three groups of patients that differed by type of spasms, overall motor severity, and presence/severity of psychiatric problems. The greater severity of motor symptoms was observed in Group 1, the least severity in Group 3, while the severity of blepharospasm in Group 2 was between that observed in Groups 1 and 3. The three motor subtypes also differed by psychiatric features: the lowest severity of psychiatric symptoms was observed in the group with least severe motor symptoms (group 3), while the highest psychiatric severity scores were observed in group 2 that carried intermediate motor severity rather than in the group with more severe motor symptoms (group 1). The three groups did not differ by disease duration, age of onset, sex or other clinical features. CONCLUSIONS The present study suggests that blepharospasm patients may be classified in different subtypes according to the type of spasms, overall motor severity and presence/severity of depressive symptoms and anxiety.
Collapse
Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St Louis, MO, USA
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | | | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Susan H Fox
- Toronto Western Hospital, Krembil Brain Institute, University of Toronto, Canada
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Centre, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Anne Weissbach
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; Institute of Systems Motor Science and Institute of Neurogenetics, University of Lübeck, Germany
| | - Hyder A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| |
Collapse
|
23
|
Defazio G, Hallett M, Berardelli A, Perlmutter JS, Berman BD, Jankovic J, Bäumer T, Comella C, Ercoli T, Ferrazzano G, Fox SH, Kim H, Moukheiber ES, Pirio Richardson S, Weissbach A, Gigante AF, Jinnah HA. Measurement Properties of Clinical Scales Rating the Severity of Blepharospasm: A Multicenter Observational Study. Mov Disord Clin Pract 2022; 9:949-955. [PMID: 36247913 PMCID: PMC9547140 DOI: 10.1002/mdc3.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Several scales have been proposed to clinically evaluate the Motor Severity of Blepharospasm (BSP) but information about their measurement properties as a multicenter instrument is limited. Objective To compare the measurement properties of four clinical scales in rating the severity of BSP in a large sample of patients from multiple sites. Methods The Burke-Fahn-Marsden Scale (BFMS), the Global Dystonia Severity Rating Scale (GDRS), the Jankovic Rating Scale (JRS), and the Blepharospasm Severity Rating Scale (BSRS) were administered to 211 patients across 10 sites who were also requested to self-complete the Blepharospasm Disability Index (BDI). Measurement properties to be assessed included inter-/intra-observer agreement, item-to-total correlation, internal consistency, floor and ceiling effect, convergent/discriminant validity, and adherence to the distribution of BDI. Results The BFMS had unsatisfactory measurement properties, the GDRS had acceptable reliability but other properties could not be completely testable; the JRS had satisfactory measurement properties but the scale did not accurately reflect the distribution of disability parameter (BDI) in the sample, and the BSRS had satisfactory measurement properties and also showed the best adherence to the distribution of BDI in the assessed sample. Conclusion The comparison of the measurement properties of four rating scales to assess the motor state of the BSP in a large sample of patients from multiple sites showed that the GDRS should be used to simultaneously assess BSP and dystonia in other body parts, while the JRS (easier to use) and BSRS (better to discriminate severity) should be used to assess BSP alone.
Collapse
Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Mark Hallett
- Human Motor Control Section, NINDS, NIHBethesdaMDUSA
| | - Alfredo Berardelli
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
- IRCCS NEUROMEDPozzilliItaly
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational TherapyWashington University in St. LouisSt LouisMOUSA
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTXUSA
| | - Tobias Bäumer
- Institute of Systems Motor ScienceUniversity of LuebeckLuebeckGermany
| | | | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Susan H. Fox
- Toronto Western Hospital, Krembil Brain InstituteUniversity of TorontoTorontoONCanada
| | - Han‐Joon Kim
- Department of Neurology and Movement Disorder CentreSeoul National University HospitalSeoulSouth Korea
| | | | | | - Anne Weissbach
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTXUSA
- Institute of Systems Motor Science and Institute of NeurogeneticsUniversity of Lübeck, LübeckGermany
| | | | - Hyder A. Jinnah
- Department of Neurology and Human GeneticsEmory UniversityAtlantaGAUSA
| |
Collapse
|
24
|
Langelage J, Verrel J, Friedrich J, Siekmann A, Schappert R, Bluschke A, Roessner V, Paulus T, Bäumer T, Frings C, Beste C, Münchau A. Urge-tic associations in children and adolescents with Tourette syndrome. Sci Rep 2022; 12:16008. [PMID: 36163482 PMCID: PMC9512906 DOI: 10.1038/s41598-022-19685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Premonitory urges preceding tics are a cardinal feature of Gilles de la Tourette syndrome (GTS), a developmental disorder usually starting during middle childhood. However, the temporal relation between urges and tics has only been investigated in adults. In 25 children and adolescents with GTS (8–18 years), we assess urge-tic associations, including inter-individual differences, correlation to clinical measures, and in comparison to a previously reported sample of adult GTS patients. Group-level analyses confirmed positive associations between urges and tics. However, at the individual level, less than half of participants showed positive associations, a similar proportion did not, and in two participants, the association was reversed. Tic expression and subjective urge levels correlated with corresponding clinical scores and participants with more severe tics during the urge monitor exhibited stronger urge-tic associations. Associations between reported urge levels and instantaneous tic intensity tended to be less pronounced in children and adolescents than in adult GTS patients. The observed heterogeneity of urge-tic associations cast doubt on the notion that tics are directly caused by urges. More severe tics may facilitate anticipation of tics and thereby lead to more pronounced urge-tic associations, consistent with a hypothesis of urges as a byproduct of tics.
Collapse
Affiliation(s)
- Jennifer Langelage
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alina Siekmann
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.,Department of Neurology, Universität zu Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Frings
- Cognitive Psychology, Department of Psychology, University of Trier, Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| |
Collapse
|
25
|
Herzog R, Berger TM, Pauly MG, Xue H, Rueckert E, Münchau A, Bäumer T, Weissbach A. Cerebellar transcranial current stimulation – An intraindividual comparison of different techniques. Front Neurosci 2022; 16:987472. [PMID: 36188449 PMCID: PMC9521312 DOI: 10.3389/fnins.2022.987472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial current stimulation (tCS) techniques have been shown to induce cortical plasticity. As an important relay in the motor system, the cerebellum is an interesting target for plasticity induction using tCS, aiming to modulate its excitability and connectivity. However, until now it remains unclear, which is the most effective tCS method for inducing plasticity in the cerebellum. Thus, in this study, the effects of anodal transcranial direct current stimulation (tDCS), 50 Hz transcranial alternating current stimulation (50 Hz tACS), and high frequency transcranial random noise stimulation (tRNS) were compared with sham stimulation in 20 healthy subjects in a within-subject design. tCS was applied targeting the cerebellar lobe VIIIA using neuronavigation. We measured corticospinal excitability, short-interval intracortical inhibition (SICI), short-latency afferent inhibition (SAI), and cerebellar brain inhibition (CBI) and performed a sensor-based movement analysis at baseline and three times after the intervention (post1 = 15 min; post2 = 55 min; post3 = 95 min). Corticospinal excitability increased following cerebellar tACS and tRNS compared to sham stimulation. This effect was most pronounced directly after stimulation but lasted for at least 55 min after tACS. Cortico-cortical and cerebello-cortical conditioning protocols, as well as sensor-based movement analyses, did not change. Our findings suggest that cerebellar 50 Hz tACS is the most effective protocol to change corticospinal excitability.
Collapse
Affiliation(s)
- Rebecca Herzog
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Till M. Berger
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Martje G. Pauly
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Honghu Xue
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | | | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- *Correspondence: Anne Weissbach,
| |
Collapse
|
26
|
Borngräber F, Hoffmann M, Paulus T, Junker J, Bäumer T, Altenmüller E, Kühn AA, Schmidt A. Characterizing the temporal discrimination threshold in musician's dystonia. Sci Rep 2022; 12:14939. [PMID: 36056047 PMCID: PMC9440005 DOI: 10.1038/s41598-022-18739-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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
The temporal discrimination threshold (TDT) has been established as a biomarker of impaired temporal processing and endophenotype in various forms of focal dystonia patients, such as cervical dystonia, writer's cramp or blepharospasm. The role of TDT in musician's dystonia (MD) in contrast is less clear with preceding studies reporting inconclusive results. We therefore compared TDT between MD patients, healthy musicians and non-musician controls using a previously described visual, tactile, and visual-tactile paradigm. Additionally, we compared TDT of the dystonic and non-dystonic hand and fingers in MD patients and further characterized the biomarker regarding its potential influencing factors, i.e. musical activity, disease variables, and personality profiles. Repeated measures ANOVA and additional Bayesian analyses revealed lower TDT in healthy musicians compared to non-musicians. However, TDTs in MD patients did not differ from both healthy musicians and non-musicians, although pairwise Bayesian t-tests indicated weak evidence for group differences in both comparisons. Analyses of dystonic and non-dystonic hands and fingers revealed no differences. While in healthy musicians, age of first instrumental practice negatively correlated with visual-tactile TDTs, TDTs in MD patients did not correlate with measures of musical activity, disease variables or personality profiles. In conclusion, TDTs in MD patients cannot reliably be distinguished from healthy musicians and non-musicians and are neither influenced by dystonic manifestation, musical activity, disease variables nor personality profiles. Unlike other isolated focal dystonias, TDT seems not to be a reliable biomarker in MD.
Collapse
Affiliation(s)
- Friederike Borngräber
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Movement Disorder and Neuromodulation Unit, Department of Neurology, Berlin, Germany.
- Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Martina Hoffmann
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany
- Charité-Universitätsmedizin, Department of Neurology, Berlin, Germany
| | - Theresa Paulus
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Johanna Junker
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Andrea A Kühn
- Charité-Universitätsmedizin Berlin, Movement Disorder and Neuromodulation Unit, Department of Neurology, Berlin, Germany
| | - Alexander Schmidt
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany
| |
Collapse
|
27
|
Heinzel S, Mascalzoni D, Bäumer T, Berg D, Kasten M, Brüggemann N. Clinical relevance and translational impact of reduced penetrance in genetic movement disorders. MED GENET-BERLIN 2022. [DOI: 10.1515/medgen-2022-2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Reduced penetrance is an important but underreported aspect in monogenic diseases. It refers to the phenomenon that carriers of pathogenic variants do not manifest with an overt disease. Clinical expressivity, on the other hand, describes the degree to which certain disease characteristics are present. In this article, we discuss the implications of reduced penetrance on genetic testing and counseling, outline how penetrance can be estimated in rare diseases using large cohorts and review the ethical, legal and social implications of studying non-manifesting carriers of pathogenic mutations. We highlight the interplay between reduced penetrance and the prodromal phase of a neurodegenerative disorder through the example of monogenic Parkinson’s disease and discuss the therapeutic implications.
Collapse
Affiliation(s)
- Sebastian Heinzel
- Department of Neurology , Christian-Albrechts University of Kiel , Kiel , Germany
| | - Deborah Mascalzoni
- Institute for Biomedicine , Eurac Research , Affiliated Institute of the University of Lübeck , Bolzano , Italy
- Center for Research Ethics and Bioethics , Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
| | - Tobias Bäumer
- Institute of Systems Motor Science , University of Lübeck , Lübeck , Germany
| | - Daniela Berg
- Department of Neurology , Christian-Albrechts University of Kiel , Kiel , Germany
| | - Meike Kasten
- Department of Psychiatry and Psychotherapy , University of Lübeck , Lübeck , Germany
- Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
- Department of Neurology, Center for Brain, Behavior and Metabolism , University of Lübeck , Lübeck , Germany
| |
Collapse
|
28
|
Kilic-Berkmen G, Defazio G, Hallett M, Berardelli A, Ferrazzano G, Belvisi D, Klein C, Bäumer T, Weissbach A, Perlmutter JS, Feuerstein J, Jinnah HA. Diagnosis and classification of blepharospasm: Recommendations based on empirical evidence. J Neurol Sci 2022; 439:120319. [PMID: 35716653 PMCID: PMC9357089 DOI: 10.1016/j.jns.2022.120319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blepharospasm is one of the most common subtypes of dystonia, and often spreads to other body regions. Despite published guidelines, the approach to diagnosis and classification of affected body regions varies among clinicians. OBJECTIVE To delineate the clinical features used by movement disorder specialists in the diagnosis and classification of blepharospasm according to body regions affected, and to develop recommendations for a more consistent approach. METHODS Cross-sectional data for subjects diagnosed with all types of isolated dystonia were acquired from the Dystonia Coalition, an international, multicenter collaborative research network. Data were evaluated to determine how examinations recorded by movement disorder specialists were used to classify blepharospasm as focal, segmental, or multifocal. RESULTS Among all 3222 participants with isolated dystonia, 210 (6.5%) had a diagnosis of focal blepharospasm. Among these 210 participants, 34 (16.2%) had dystonia outside of upper face region. Factors such as dystonia severity across different body regions and number of body regions affected influenced the classification of blepharospasm as focal, segmental, or multifocal. CONCLUSIONS Although focal blepharospasm is the second most common type of dystonia, a high percentage of individuals given this diagnosis had dystonia outside of the eye/upper face region. These findings are not consistent with existing guidelines for the diagnosis and classification of focal blepharospasm, and point to the need for more specific guidelines for more consistent application of existing recommendations for diagnosis and classification.
Collapse
Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Daniele Belvisi
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Anne Weissbach
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany; Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Joel S Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | | | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
29
|
Sondermann S, Bäumer T, Suss J, Bohn B, Fieseler K, Schramm P, Tueshaus L, Boppel T. Detection of Traumatic and Postoperative Nerve Lesions following Upper Extremity Fractures in a Pediatric Cohort Using MR Neurography. Eur J Pediatr Surg 2022. [PMID: 35853469 DOI: 10.1055/s-0042-1751221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fractures of the upper extremity are common traumatic injuries in children. Nerve lesions are a rare but typical complication of these fractures. Additional to physical, electrophysiological, and sonographic examinations, magnetic resonance neurography (MRN) can be used to assess the degree and exact localization of nerve damage. This retrospective study was conducted to evaluate the potential role of this examination technique for children and to test a proposed MRN classification of traumatic nerve injury according to Chhabra in a pediatric cohort. MATERIALS AND METHODS Pediatric patients undergoing MRN for traumatic nerve injury from January 2016 to December 2020 were retrospectively identified. A total of 12 consecutive patients with sufficient clinical data, an MRN, and if available follow-up examination were enrolled and analyzed. RESULTS In 10 of 12 cases one or more nerve lesions could be identified by MRN using the classification proposed by Chhabra et al. MRN was used to assess nerve injuries, imaging results were compared with clinical course. Clinical follow-up examinations of 10 patients showed an overall good clinical recovery, even in one case with severe trauma and nerve surgery. CONCLUSION MRN as a noninvasive procedure can help in the evaluation of nerve injury, especially for the identification of lower grade nerve damage and to objectify suspected nerve damage in case of uncertain clinical examination results; thus, can help in decision making whether surgical revision or conservative treatment is preferable.
Collapse
Affiliation(s)
- Stefan Sondermann
- Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children's Hospital Hamburg, Hamburg, Germany
| | - Boy Bohn
- Department of Orthopedics and Trauma Surgery, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Katharina Fieseler
- Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Ludger Tueshaus
- Department of Pediatric Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| |
Collapse
|
30
|
Bäumer T, Maisonobe P, Bannach J, Zaragatski E, Schramm A. Protocol for the SMART Study: Effectiveness and Safety of SMART AbobotulinumtoxinA Therapy in Patients With Chronic Post-Stroke Upper Limb Spasticity in a Real-World Setting. Toxicon 2022. [DOI: 10.1016/j.toxicon.2022.05.011] [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: 11/30/2022]
|
31
|
Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Mlynczak U, Paus S, Pflug C, Schröder S, Steffen A, Wilken B, Berweck S. [Correction: Treatment of Sialorrhea with Botulinum Neurotoxin Type A - Consensus Practice Recommendations for Children and Adults]. Fortschr Neurol Psychiatr 2022; 90:e1. [PMID: 35705185 PMCID: PMC9200476 DOI: 10.1055/a-1855-8833] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM; Sektion Zentrum für Seltene Erkrankungen, Universität zu Lübeck/Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andrea Bevot
- Neuropädiatrie, Entwicklungsneurologie, Sozialpädiatrie, Universitätsklinik für Kinder und Jugendmedizin, Tübingen, Germany
| | | | - Carsten Buhmann
- Neurologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- HNO-Uniklinik Köln, Universität zu Köln, Medizinische Fakultät, Köln, Deutschland Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany
| | | | - Ute Mlynczak
- UniReha GmbH, Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Germany
| | - Sebastian Paus
- Fachabteilung Neurologie, GFO Kliniken Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Schröder
- Pädiatrische Neurologie, Entwicklungsneurologie, iSPZ, Dr. von Haunersches Kinderspital, Klinikum der Universität München, München, Germany
| | - Armin Steffen
- Klinik für HNO-Heilkunde, Universität zu Lübeck/UKSH Campus Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Neuropädiatrie mit Sozialpädiatrischem Zentrum, Klinikum Kassel, Kassel, Germany
| | - Steffen Berweck
- Fachzentrum für Pädiatrische Neurologie, Neurorehabilitation und Epileptologie, Schön Klinik, Vogtareuth, Vogtareuth, Germany
| |
Collapse
|
32
|
Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Mlynczak U, Paus S, Pflug C, Schröder S, Steffen A, Wilken B, Berweck S. [Treatment of Sialorrhea with Botulinum Neurotoxin Type A - Consensus Practice Recommendations for Children and Adults]. Fortschr Neurol Psychiatr 2022; 90:212-221. [PMID: 35453158 PMCID: PMC9113851 DOI: 10.1055/a-1802-6006] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sialorrhea, uncontrolled, excessive drooling, accompanies different, mostly neurological disorders from childhood to adulthood. With incobotulinumtoxinA (Xeomin, IncoBoNT/A, Merz Pharmaceuticals GmbH), an approved medication for the treatment of sialorrhea has been available since 2019. Patient selection, possible therapy goals, treatment and the management of specific treatment situations build the focus of this interdisciplinary expert consensus recommendations with the intent to facilitate access to treatment and to contribute to qualified botulinum toxin therapy.
Collapse
Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM; Sektion Zentrum für Seltene Erkrankungen, Universität zu Lübeck/Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andrea Bevot
- Neuropädiatrie, Entwicklungsneurologie, Sozialpädiatrie, Universitätsklinik für Kinder und Jugendmedizin, Tübingen, Germany
| | | | - Carsten Buhmann
- Neurologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Klinik für Neurologie und Ambulanzzentrum Bereich Neurologie, Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Ute Mlynczak
- UniReha GmbH, Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Germany
| | - Sebastian Paus
- Fachabteilung Neurologie, GFO Kliniken Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Schröder
- Pädiatrische Neurologie, Entwicklungsneurologie, iSPZ, Dr. von Haunersches Kinderspital, Klinikum der Universität München, München, Germany
| | - Armin Steffen
- Klinik für HNO-Heilkunde, Universität zu Lübeck/UKSH Campus Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Neuropädiatrie mit Sozialpädiatrischem Zentrum, Klinikum Kassel, Kassel, Germany
| | - Steffen Berweck
- Fachzentrum für Pädiatrische Neurologie, Neurorehabilitation und Epileptologie, Schön Klinik, Vogtareuth, Vogtareuth, Germany
| |
Collapse
|
33
|
Jost WH, Bäumer T, Berweck S, Laskawi R, Spittau B, Steffen A, Winterholler M. [Therapy of Sialorrhea with Botulinum Toxin - An Update]. Fortschr Neurol Psychiatr 2022; 90:222-232. [PMID: 35453157 DOI: 10.1055/a-1802-3867] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The most important salivary glands are the paired parotid and submandibular glands. Adults produce 1 to 1.5 liters of saliva which are then regularly swallowed. When the act of swallowing is disturbed, salivation occurs. More rarely, the cause can be found in increased saliva production, for example, when caused through medication. Sialorrhea impairs the quality of life substantially and is frequently often socially stigmatizing. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, as well as, in selected cases, radiation and surgical measures. Over the last 20 years, local injection of botulinum toxin has been successfully applied in the treatment of this condition. With approval of incobotulinumtoxinA toxin for children and adults, this procedure will become the therapy of choice for chronic sialorrhea. The results of the phase III registration trials have demonstrated high efficacy and good safety of the injection treatment in both children and adults.
Collapse
Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM, Sektion Zentrum für Seltene Erkrankungen, UKSH, Universität zu Lübeck, Lübeck, Germany
| | - Steffen Berweck
- Schön Klinik Vogtareuth, Vogtareuth, Germany.,Dr von Haunersches Kinderspital Kinderklinik und Kinderpoliklinik der Ludwig Maximilian Universitat München, München, Germany
| | - Rainer Laskawi
- Georg-August-Universitat Göttingen HNO-Klinik, Göttingen, Germany
| | - Björn Spittau
- Anatomie und Zellbiologie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Germany
| | - Armin Steffen
- Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lübeck, Germany
| | | |
Collapse
|
34
|
Weissbach A, Steinmeier A, Pauly M, Al-Shorafat DM, Saranza G, Lang A, Brüggemann N, Tadic V, Klein C, Münchau A, Bäumer T, Brown MJN. Longitudinal evaluations of somatosensory-motor inhibition in Dopa-responsive dystonia. Parkinsonism Relat Disord 2022; 95:40-46. [PMID: 34999542 DOI: 10.1016/j.parkreldis.2021.12.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION GCH1 mutations have been linked to decreased striatal dopamine and development of dopa-responsive dystonia (DRD) and Parkinsonism. Sensory and sensorimotor integration impairments have been documented in various forms of dystonia. DRD patients with confirmed GCH1 mutations have demonstrated normal short-latency afferent inhibition (SAI), a measure of sensorimotor inhibition, under chronic dopaminergic replacement therapy (DRT), but reduced inhibition after a single l-dopa dose following 24 h withdrawal. Studies have revealed normal SAI in other forms of dystonia but reductions with DRT in Parkinson's disease. Longitudinal changes in sensorimotor inhibition are unknown. METHODS We analyzed sensorimotor inhibition using two different measures: SAI and somatosensory-motor inhibition using dual-site transcranial magnetic stimulation (ds-TMS). SAI was measured using digit stimulation 25 ms prior to contralateral primary motor cortex (M1) TMS. DS-TMS was measured using TMS over the somatosensory cortex 1 or 2.5 ms prior to ipsilateral M1 stimulation. A total of 20 GCH1 mutation carriers and 20 age-matched controls were included in the study. SAI and ds-TMS were evaluated in GCH1 mutation carriers both OFF and ON DRT compared to controls. Furthermore, longitudinal changes of SAI were examined in a subset of the same individuals that were measured ∼five years earlier. RESULTS Neither SAI nor ds-TMS were significantly different in GCH1 mutation carriers relative to controls. No effects of DRT on SAI or ds-TMS were seen but SAI decreased over time in mutation carriers OFF DRT. CONCLUSION Our longitudinal results suggest changes in SAI that could be associated with plasticity changes in sensorimotor networks.
Collapse
Affiliation(s)
- Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Annika Steinmeier
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Martje Pauly
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Duha M Al-Shorafat
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Neuroscience Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Internal Medicine, Chong Hua Hospital, Cebu, Philippines
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany; Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Vera Tadic
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Matt J N Brown
- Department of Kinesiology, California State University Sacramento, Sacramento, USA.
| |
Collapse
|
35
|
Paulus T, Schappert R, Bluschke A, Alvarez-Fischer D, Naumann KER, Roessner V, Bäumer T, Beste C, Münchau A. Questioning the definition of Tourette syndrome-evidence from machine learning. Brain Commun 2021; 3:fcab282. [PMID: 34993475 PMCID: PMC8728701 DOI: 10.1093/braincomms/fcab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Tics in Tourette syndrome are often difficult to discern from single spontaneous movements or vocalizations in healthy people. In this study, videos of patients with Tourette syndrome and healthy controls were taken and independently scored according to the Modified Rush Videotape Rating Scale. We included n = 101 patients with Tourette syndrome (71 males, 30 females, mean age 17.36 years ± 10.46 standard deviation) and n = 109 healthy controls (57 males, 52 females, mean age 17.62 years ± 8.78 standard deviation) in a machine learning-based analysis. The results showed that the severity of motor tics, but not vocal phenomena, is the best predictor to separate and classify patients with Tourette syndrome and healthy controls. This finding questions the validity of current diagnostic criteria for Tourette syndrome requiring the presence of both motor and vocal tics. In addition, the negligible importance of vocalizations has implications for medical practice, because current recommendations for Tourette syndrome probably also apply to the large group with chronic motor tic disorders.
Collapse
Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University of Lübeck, 23538 Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
| | | | - Kim Ezra Robin Naumann
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Qianfoshan Campus, No. 88 East Wenhua Road, Lixia District, Jinan, 250014, China
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| |
Collapse
|
36
|
Wang M, Sajobi T, Morgante F, Adler C, Agarwal P, Bäumer T, Berardelli A, Berman BD, Blumin J, Borsche M, Brashear A, Deik A, Duque K, Espay AJ, Ferrazzano G, Feuerstein J, Fox S, Frank S, Hallett M, Jankovic J, LeDoux MS, Leegwater-Kim J, Mahajan A, Malaty IA, Ondo W, Pantelyat A, Pirio-Richardson S, Roze E, Saunders-Pullman R, Suchowersky O, Truong D, Vidailhet M, Shukla AW, Perlmutter JS, Jinnah HA, Martino D. Predictive modeling of spread in adult-onset isolated dystonia: Key properties and effect of tremor inclusion. Eur J Neurol 2021; 28:3999-4009. [PMID: 34296504 PMCID: PMC9100858 DOI: 10.1111/ene.15031] [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: 05/18/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Several clinical and demographic factors relate to anatomic spread of adult-onset isolated dystonia, but a predictive model is still lacking. The aims of this study were: (i) to develop and validate a predictive model of anatomic spread of adult-onset isolated dystonia; and (ii) to evaluate whether presence of tremor associated with dystonia influences model predictions of spread. METHODS Adult-onset isolated dystonia participants with focal onset from the Dystonia Coalition Natural History Project database were included. We developed two prediction models, one with dystonia as sole disease manifestation ("dystonia-only") and one accepting dystonia OR tremor in any body part as disease manifestations ("dystonia OR tremor"). Demographic and clinical predictors were selected based on previous evidence, clinical plausibility of association with spread, or both. We used logistic regressions and evaluated model discrimination and calibration. Internal validation was carried out based on bootstrapping. RESULTS Both predictive models showed an area under the curve of 0.65 (95% confidence intervals 0.62-0.70 and 0.62-0.69, respectively) and good calibration after internal validation. In both models, onset of dystonia in body regions other than the neck, older age, depression and history of neck trauma were predictors of spread. CONCLUSIONS This predictive modeling of spread in adult-onset isolated dystonia based on accessible predictors (demographic and clinical) can be easily implemented to inform individuals' risk of spread. Because tremor did not influence prediction of spread, our results support the argument that tremor is a part of the dystonia syndrome, and not an independent or coincidental disorder.
Collapse
Affiliation(s)
- Meng Wang
- Department of Community Health Sciences, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Charles Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Pinky Agarwal
- Booth Gardner Parkinson’s Center, Evergreen Health, Kirkland, Washington, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center for Rare Diseases, University Medical Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Alfredo Berardelli
- Department of Human Neurosciences, University of Rome “La Sapienza”, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joel Blumin
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Allison Brashear
- Department of Neurology, University of California, Davis, Sacramento, California, USA
| | - Andres Deik
- Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Duque
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gina Ferrazzano
- Department of Human Neurosciences, University of Rome “La Sapienza”, Rome, Italy
| | - Jeanne Feuerstein
- Department of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Susan Fox
- Movement Disorder Clinic, Edmond J Safra Program in Parkinson Disease, Toronto Western Hospital, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Frank
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark S. LeDoux
- Department of Psychology and School of Health Sciences, University of Memphis, and Veracity Neuroscience, Memphis, Tennessee, USA
| | - Julie Leegwater-Kim
- Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Abhimanyu Mahajan
- Rush Parkinson’s disease and movement disorders program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Irene A. Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - William Ondo
- Houston Methodist Hospital, Houston, Texas, USA
- Weill Cornell Medical School, New York, New York, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Pirio-Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Emmanuel Roze
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, Paris, France
| | - Rachel Saunders-Pullman
- Department of Neurology, Icahn School of Medicine at Mount Sinai and Mount Sinai Beth Israel, New York, New York, USA
| | - Oksana Suchowersky
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Truong
- Department of Neurosciences, UC Riverside, Riverside, California, USA
- The Parkinson and Movement Disorder Institute, Fountain Valley, California, USA
| | - Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, Paris, France
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Joel S. Perlmutter
- Departments of Neurology, Psychiatry, Radiology, Neurobiology, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A. Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Davide Martino
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
37
|
Adelhöfer N, Paulus T, Mückschel M, Bäumer T, Bluschke A, Takacs A, Tóth-Fáber E, Tárnok Z, Roessner V, Weissbach A, Münchau A, Beste C. Increased scale-free and aperiodic neural activity during sensorimotor integration-a novel facet in Tourette syndrome. Brain Commun 2021; 3:fcab250. [PMID: 34805995 PMCID: PMC8599001 DOI: 10.1093/braincomms/fcab250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Tourette syndrome is a common neurodevelopmental disorder defined by multiple motor and phonic tics. Tics in Tourette syndrome resemble spontaneously occurring movements in healthy controls and are therefore sometimes difficult to distinguish from these. Tics may in fact be mis-interpreted as a meaningful action, i.e. a signal with social content, whereas they lack such information and could be conceived a surplus of action or 'motor noise'. These and other considerations have led to a 'neural noise account' of Tourette syndrome suggesting that the processing of neural noise and adaptation of the signal-to-noise ratio during information processing is relevant for the understanding of Tourette syndrome. So far, there is no direct evidence for this. Here, we tested the 'neural noise account' examining 1/f noise, also called scale-free neural activity as well as aperiodic activity, in n = 74 children, adolescents and adults with Tourette syndrome and n = 74 healthy controls during task performance using EEG data recorded during a sensorimotor integration task. In keeping with results of a previous study in adults with Tourette syndrome, behavioural data confirmed that sensorimotor integration was also stronger in this larger Tourette syndrome cohort underscoring the relevance of perceptual-action processes in this disorder. More importantly, we show that 1/f noise and aperiodic activity during sensorimotor processing is increased in patients with Tourette syndrome supporting the 'neural noise account'. This implies that asynchronous/aperiodic neural activity during sensorimotor integration is stronger in patients with Tourette syndrome compared to healthy controls, which is probably related to abnormalities of GABAergic and dopaminergic transmission in these patients. Differences in 1/f noise and aperiodic activity between patients with Tourette syndrome and healthy controls were driven by high-frequency oscillations and not lower-frequency activity currently discussed to be important in the pathophysiology of tics. This and the fact that Bayesian statistics showed that there is evidence for the absence of a correlation between neural noise and clinical measures of tics, suggest that increased 1/f noise and aperiodic activity are not directly related to tics but rather represents a novel facet of Tourette syndrome.
Collapse
Affiliation(s)
- Nico Adelhöfer
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany.,Department of Neurology, University of Lübeck, 23538 Lübeck, Germany
| | - Moritz Mückschel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Adam Takacs
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Eszter Tóth-Fáber
- Doctoral School of Psychology, ELTE Eötvös Loránd University, 1064 Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, 1053 Budapest, Hungary
| | - Zsanett Tárnok
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Qianfoshan Campus, No. 88 East Wenhua Road, Lixia District, Ji'nan, 250014, China
| |
Collapse
|
38
|
Choukair D, Hauck F, Bettendorf M, Krude H, Klein C, Bäumer T, Berner R, Lee-Kirsch MA, Grasemann C, Burgard P, Hoffmann GF. An Integrated clinical pathway for diagnosis, treatment and care of rare diseases: model, operating procedures, and results of the project TRANSLATE-NAMSE funded by the German Federal Joint Committee. Orphanet J Rare Dis 2021; 16:474. [PMID: 34772435 PMCID: PMC8588640 DOI: 10.1186/s13023-021-02092-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis, treatment, and care of patients with rare diseases require multidisciplinary cooperation between medical and paramedical specialities and with patients and families. Innovative genetic diagnostics, whole exome and whole genome sequencing (WES, WGS) has enlarged the diagnostic toolkit but also increased the complexity of the endeavour. Structured multidisciplinary clinical pathways (CPW) can guide diagnosis, treatment, and care of patients with rare diseases, link scientific evidence to clinical practice and optimise clinical outcomes whilst maximising clinical efficiency. RESULTS In contrast to the common approach of appending disease-specific CPWs to disease-specific guidelines, we suggest a generic CPW manoeuvring the patient along the way of finding the correct diagnosis by applying the best diagnostic strategy into an appropriate system of treatment and care. Available guidelines can be integrated into the generic CPW in the course of its application. The approach also applies to situations where a diagnosis remains unsolved. The backbone of the generic CPW is a set of multidisciplinary structured case conferences projecting and evaluating diagnostic and/or therapeutic steps, enforcing to integrate best scientific evidence with clinical experience. The generic CPW is stated as a flowchart and a checklist which can be used to record and document parsimoniously the structure, process and results of a patient's pathway, but also as a data model for research. It was applied in a multicentre setting with 587 cases each with a presumptive diagnosis of a rare disease. In 369 cases (62.8%) a diagnosis could be confirmed, and multidisciplinary treatment and/or care was initiated. The median process time from first contact until confirmation of diagnosis by WES was 109 days and much shorter than diagnostic delays reported in the literature. Application of the CPW is illustrated by two case reports. CONCLUSIONS Our model is a tool to change the diagnostic odyssey into an organised and trackable route. It can also be used to inform patients and families about the stages of their individual route, to update health care providers only partially involved or attending specialised treatment and care, like the patient's or family's primary physician, and finally to train novices in the field.
Collapse
Affiliation(s)
- Daniela Choukair
- Center for Child and Adolescent Medicine and Center for Rare Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr Von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases, LMU Munich, 80337, Munich, Germany
| | - Markus Bettendorf
- Center for Child and Adolescent Medicine and Center for Rare Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Heiko Krude
- Institute for Experimental Pediatric Endocrinology, and Berlin Center for Rare Diseases, Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr Von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases, LMU Munich, 80337, Munich, Germany
| | - Tobias Bäumer
- Institute of Systems Motorscience and Center for Rare Diseases, University of Lübeck, 23562, Lübeck, Germany
| | - Reinhard Berner
- Department of Pediatrics and University Center for Rare Diseases, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Department of Pediatrics and University Center for Rare Diseases, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Corinna Grasemann
- Department of Pediatrics, St-Josef Hospital Bochum and and Center for Rare Diseases, Ruhr-University Bochum, 44791, Bochum, Germany
| | - Peter Burgard
- Center for Child and Adolescent Medicine and Center for Rare Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany.
| | - Georg F Hoffmann
- Center for Child and Adolescent Medicine and Center for Rare Diseases, University Hospital Heidelberg, 69120, Heidelberg, Germany
| |
Collapse
|
39
|
Xue H, Herzog R, Berger TM, Bäumer T, Weissbach A, Rueckert E. Using Probabilistic Movement Primitives in Analyzing Human Motion Differences Under Transcranial Current Stimulation. Front Robot AI 2021; 8:721890. [PMID: 34595209 PMCID: PMC8476753 DOI: 10.3389/frobt.2021.721890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
In medical tasks such as human motion analysis, computer-aided auxiliary systems have become the preferred choice for human experts for their high efficiency. However, conventional approaches are typically based on user-defined features such as movement onset times, peak velocities, motion vectors, or frequency domain analyses. Such approaches entail careful data post-processing or specific domain knowledge to achieve a meaningful feature extraction. Besides, they are prone to noise and the manual-defined features could hardly be re-used for other analyses. In this paper, we proposed probabilistic movement primitives (ProMPs), a widely-used approach in robot skill learning, to model human motions. The benefit of ProMPs is that the features are directly learned from the data and ProMPs can capture important features describing the trajectory shape, which can easily be extended to other tasks. Distinct from previous research, where classification tasks are mostly investigated, we applied ProMPs together with a variant of Kullback-Leibler (KL) divergence to quantify the effect of different transcranial current stimulation methods on human motions. We presented an initial result with 10 participants. The results validate ProMPs as a robust and effective feature extractor for human motions.
Collapse
Affiliation(s)
- Honghu Xue
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Rebecca Herzog
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Till M Berger
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Elmar Rueckert
- Chair of Cyber-Physical-Systems, Montanuniversität Leoben, Leoben, Austria
| |
Collapse
|
40
|
Defazio G, Jinnah HA, Berardelli A, Perlmutter JS, Berkmen GK, Berman BD, Jankovic J, Bäumer T, Comella C, Cotton AC, Ercoli T, Ferrazzano G, Fox S, Kim HJ, Moukheiber ES, Richardson SP, Weissbach A, Wrigth LJ, Hallett M. Diagnostic criteria for blepharospasm: A multicenter international study. Parkinsonism Relat Disord 2021; 91:109-114. [PMID: 34583301 DOI: 10.1016/j.parkreldis.2021.09.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are no widely accepted criteria to aid the physician in diagnosing BSP. OBJECTIVE To validate recently proposed diagnostic criteria for blepharospasm in a larger and geographically diverse population and to develop a screening system for blepharospasm. METHODS Video-recordings from 211 blepharospasm patients and 166 healthy/disease controls were examined by 8 raters. Agreement for presence of orbicularis oculi spasms, sensory trick, and increased blinking was measured by k statistics. Inability to voluntarily suppress the spasms was asked by the examiner but not captured in the video. Patients/controls were also requested to fill a self-administered questionnaire addressing relevant blepharospasm clinical aspects. The diagnosis at each site was the gold standard for sensitivity/specificity. RESULTS All the study items yielded satisfactory inter/intra-observer agreement. Combination of items rather than each item alone reached satisfactory sensitivity/specificity. The combined algorithm started with recognition of spasms followed by sensory trick. In the absence of a sensory trick, including "increased blinking" or "inability to voluntarily suppress the spasms" or both items yielded 88-92% sensitivity and 79-83% specificity. No single question of the questionnaire yielded high sensitivity/specificity. Serial application of the questionnaire to our blepharospasm and control subjects and subsequent clinical examination of subjects screening positive by the validated diagnostic algorithms yielded 78-81% sensitivity and 83-91% specificity. CONCLUSION These results support the use of proposed diagnostic criteria in multi-ethnic, multi-center cohorts. We also propose a case-finding procedure to screen blepharospasm in a given population with less effort than would be required by examination of all subjects.
Collapse
Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Hyder A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Alfredo Berardelli
- Sapienza University of Rome, Rome, and IRCSS NEUROMED, Pozzilli (Is), Italy
| | | | - Gamze Kilic Berkmen
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany
| | | | - Adam C Cotton
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gina Ferrazzano
- Sapienza University of Rome, Rome, and IRCSS NEUROMED, Pozzilli (Is), Italy
| | - Susan Fox
- Toronto Western Hospital, University of Toronto, Canada
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Centre, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Anne Weissbach
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany; Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | | | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA
| |
Collapse
|
41
|
Paulus T, Bäumer T, Verrel J, Weissbach A, Roessner V, Beste C, Münchau A. Pandemic Tic-like Behaviors Following Social Media Consumption. Mov Disord 2021; 36:2932-2935. [PMID: 34558735 DOI: 10.1002/mds.28800] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Currently, there is a marked increase of young people with sudden onset of tic-like behaviors (TLBs) resembling movements and vocalizations presented on social media videos as "Tourette's syndrome." OBJECTIVE To delineate clinical phenomenology of TLBs after social media exposure in comparison with clinical features of Tourette's syndrome. METHODS We compared demographic and clinical variables between 13 patients with TLBs and 13 age- and sex-related patients with Tourette's syndrome. RESULTS Patients with TLBs had several characteristics allowing to distinguish them from patients with Tourette's syndrome, some of which discriminated perfectly (ie, abrupt symptom onset, lack of spontaneous symptom fluctuations, symptom deterioration in the presence of others) and some nearly perfectly (ie, predominantly complex movements involving trunk/extremities). Also, symptom onset was significantly later. CONCLUSIONS TLBs after social media consumption differ from tics in Tourette's syndrome, strongly suggesting that these phenomena are categorically different conditions. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,TU Dresden, University Neuropsychology Centre, Faculty of Medicine, Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| |
Collapse
|
42
|
Scorr LM, Factor SA, Parra SP, Kaye R, Paniello RC, Norris SA, Perlmutter JS, Bäumer T, Usnich T, Berman BD, Mailly M, Roze E, Vidailhet M, Jankovic J, LeDoux MS, Barbano R, Chang FCF, Fung VSC, Pirio Richardson S, Blitzer A, Jinnah HA. Oromandibular Dystonia: A Clinical Examination of 2,020 Cases. Front Neurol 2021; 12:700714. [PMID: 34603182 PMCID: PMC8481678 DOI: 10.3389/fneur.2021.700714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis. Methods: First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers. Results: In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology. Conclusions: This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.
Collapse
Affiliation(s)
- Laura M. Scorr
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Stewart A. Factor
- Department of Neurology, Emory University, Atlanta, GA, United States
| | | | - Rachel Kaye
- Department of Otolaryngology, Rutgers University, Newark, NJ, United States
| | - Randal C. Paniello
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Scott A. Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tobias Bäumer
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Tatiana Usnich
- Department of Neurology, Institute of Systems Motor Science, Universität of Lübeck, Lübeck, Germany
| | - Brian D. Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie Mailly
- Department of ENT and Head and Neck Surgery, Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joseph Jankovic
- Baylor St. Luke's Medical Center, Houston, TX, United States
| | - Mark S. LeDoux
- Veracity Neuroscience LLC, Memphis, TN, United States
- Department of Neurology, University of Memphis, Memphis, TN, United States
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Florence C. F. Chang
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Victor S. C. Fung
- Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Andrew Blitzer
- Head and Neck Surgical Group, New York, NY, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
| |
Collapse
|
43
|
Schmidt T, Ebersbach G, Oelsner H, Sprock A, König IR, Bäumer T, Münchau A, Weissbach A. Evaluation of Individualized Multi-Disciplinary Inpatient Treatment for Functional Movement Disorders. Mov Disord Clin Pract 2021; 8:911-918. [PMID: 34401405 PMCID: PMC8354066 DOI: 10.1002/mdc3.13268] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Functional movement disorders (FMD) are associated with considerable morbidity and impairment of quality of life. Specialized treatment is scarce and data on efficacy of different therapies are limited. OBJECTIVE To evaluate a multi-modal inpatient treatment program for patients with FMD. METHODS Thirty-one patients with FMD were analyzed before (t1) and after multi-modal inpatient treatment (t2) by a blinded video rating using the Psychogenic Movement Disorder Rating Scale (PMDRS), the simplified Functional Movement Disorder Rating Scale (S-FMDRS), and the Clinical Global Impression Scale of Severity (CGI-S), as well as patients' self-rating. In 23 out of 31 patients a 5 months follow-up investigation was performed (t3). Wilcoxon signed-rank test and Friedman test were used for rating scale and self-rating comparisons over time. Spearman correlation was used for correlation of symptom improvement and clinical characteristics. RESULTS Video rating revealed significant reduction of scores after therapy (median PMDRS t1 = 24, t2 = 8, P = 0.0006; S-FMDRS t1 = 11, t2 = 4, P = 0.008; CGI-S t1 = 4, t2 = 3, P = 0.000136) with sustained score decrease in follow-up evaluations (PMDRS t1 = 31, t2 = 8, t3 = 7, P = 0.000032; S-FMDRS t1 = 12, t2 = 4, t3 = 3, P = 0.000888; CGI-S t1 = 4, t2 = 3, t3 = 3, P = 0.000032). Patients reported a stable reduction of symptoms in the self-rating (CGI-S t1 = 5, t2 = 4, t3 = 4, P = 0.016). Age correlated with treatment response with older patients showing better improvement, but disease duration did not correlate with outcome. Patients who suffered from physical trauma, sexual or physical abuse had smaller score reductions. CONCLUSION Blinded video and self-rating assessment showed significant score reduction in patients with FMD after an individualized interdisciplinary inpatient intervention.
Collapse
Affiliation(s)
- Tamara Schmidt
- Movement Disorders ClinicKliniken Beelitz GmbHBeelitz‐HeilstättenGermany
| | - Georg Ebersbach
- Movement Disorders ClinicKliniken Beelitz GmbHBeelitz‐HeilstättenGermany
| | - Henriette Oelsner
- Movement Disorders ClinicKliniken Beelitz GmbHBeelitz‐HeilstättenGermany
| | - Anette Sprock
- Movement Disorders ClinicKliniken Beelitz GmbHBeelitz‐HeilstättenGermany
| | - Inke R. König
- Institute of Medical Biometry and StatisticsUniversity of LübeckLübeckGermany
| | - Tobias Bäumer
- Institute of Systems Motor ScienceUniversity of LübeckLübeckGermany
| | | | - Anne Weissbach
- Institute of Systems Motor ScienceUniversity of LübeckLübeckGermany
| |
Collapse
|
44
|
Beste C, Mückschel M, Rauch J, Bluschke A, Takacs A, Dilcher R, Toth-Faber E, Bäumer T, Roessner V, Li SC, Münchau A. Distinct Brain-Oscillatory Neuroanatomical Architecture of Perception-Action Integration in Adolescents With Tourette Syndrome. Biological Psychiatry Global Open Science 2021; 1:123-134. [PMID: 36324991 PMCID: PMC9616364 DOI: 10.1016/j.bpsgos.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/25/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Gilles de la Tourette Syndrome (GTS) is a neurodevelopmental disorder with a peak of symptom severity around late childhood and early adolescence. Previous findings in adult GTS suggest that changes in perception-action integration, as conceptualized in the theory of event coding framework, are central for the understanding of GTS. However, the neural mechanisms underlying these processes in adolescence are elusive. Methods A total of 59 children/adolescents aged 9 to 18 years (n = 32 with GTS, n = 27 typically developing youths) were examined using a perception-action integration task (event file task) derived from the theory of event coding. Event-related electroencephalogram recordings (theta and beta band activity) were analyzed using electroencephalogram–beamforming methods. Results Behavioral data showed robust event file binding effects in both groups without group differences. Neurophysiological data showed that theta and beta band activity were involved in event file integration in both groups. However, the functional neuroanatomical organization was markedly different for theta band activity between the groups. The typically developing group mainly relied on superior frontal regions, whereas the GTS group engaged parietal and inferior frontal regions. A more consistent functional neuroanatomical activation pattern was observed for the beta band, engaging inferior parietal and temporal regions in both groups. Conclusions Perception-action integration processes lag behind in persisting GTS but not in the GTS population as a whole, underscoring differences in developmental trajectories and the importance of longitudinal investigations for the understanding of GTS. The findings corroborate known differences in the functional/structural brain organization in GTS and suggest an important role of theta band activity in these patients.
Collapse
|
45
|
Sun YV, Li C, Hui Q, Huang Y, Barbano R, Rodriguez R, Malaty IA, Reich S, Bambarger K, Holmes K, Jankovic J, Patel NJ, Roze E, Vidailhet M, Berman BD, LeDoux MS, Espay AJ, Agarwal P, Pirio-Richardson S, Frank SA, Ondo WG, Saunders-Pullman R, Chouinard S, Natividad S, Berardelli A, Pantelyat AY, Brashear A, Fox SH, Kasten M, Krämer UM, Neis M, Bäumer T, Loens S, Borsche M, Zittel S, Maurer A, Gelderblom M, Volkmann J, Odorfer T, Kühn AA, Borngräber F, König IR, Cruchaga C, Cotton AC, Kilic-Berkmen G, Freeman A, Factor SA, Scorr L, Bremner JD, Vaccarino V, Quyyumi AA, Klein C, Perlmutter JS, Lohmann K, Jinnah HA. A Multi-center Genome-wide Association Study of Cervical Dystonia. Mov Disord 2021; 36:2795-2801. [PMID: 34320236 PMCID: PMC8688173 DOI: 10.1002/mds.28732] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Several monogenic causes for isolated dystonia have been identified, but they collectively account for only a small proportion of cases. Two genome-wide association studies have reported a few potential dystonia risk loci; but conclusions have been limited by small sample sizes, partial coverage of genetic variants, or poor reproducibility. OBJECTIVE To identify robust genetic variants and loci in a large multicenter cervical dystonia cohort using a genome-wide approach. METHODS We performed a genome-wide association study using cervical dystonia samples from the Dystonia Coalition. Logistic and linear regressions, including age, sex, and population structure as covariates, were employed to assess variant- and gene-based genetic associations with disease status and age at onset. We also performed a replication study for an identified genome-wide significant signal. RESULTS After quality control, 919 cervical dystonia patients compared with 1491 controls of European ancestry were included in the analyses. We identified one genome-wide significant variant (rs2219975, chromosome 3, upstream of COL8A1, P-value 3.04 × 10-8 ). The association was not replicated in a newly genotyped sample of 473 cervical dystonia cases and 481 controls. Gene-based analysis identified DENND1A to be significantly associated with cervical dystonia (P-value 1.23 × 10-6 ). One low-frequency variant was associated with lower age-at-onset (16.4 ± 2.9 years, P-value = 3.07 × 10-8 , minor allele frequency = 0.01), located within the GABBR2 gene on chromosome 9 (rs147331823). CONCLUSION The genetic underpinnings of cervical dystonia are complex and likely consist of multiple distinct variants of small effect sizes. Larger sample sizes may be needed to provide sufficient statistical power to address the presumably multi-genic etiology of cervical dystonia. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengchen Li
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Yunfeng Huang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Richard Barbano
- Movement Disorders Division, University of Rochester, Rochester, New York, USA
| | | | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Stephen Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kimberly Bambarger
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katie Holmes
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Neepa J Patel
- Department of Neurology, Henry Ford Health System, Henry Ford Hospital, Detroit, Michigan, USA
| | - Emmanuel Roze
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle; Assistance Publique - Hôpitaux de Paris, Hôpital Salpêtrière, Département de Neurologie, Paris, France
| | - Marie Vidailhet
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle; Assistance Publique - Hôpitaux de Paris, Hôpital Salpêtrière, Département de Neurologie, Paris, France
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark S LeDoux
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Alberto J Espay
- James J and Joan A Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, Evergreen Health, Kirkland, Washington, USA
| | | | - Samuel A Frank
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William G Ondo
- Department of Neurology, Methodist Neurological Institute, Weill Cornell Medical School, Houston, Texas, USA
| | - Rachel Saunders-Pullman
- Icahn School of Medicine at Mount Sinai, Movement Disorders, Department of Neurology, Mount Sinai Beth Israel, New York, New York, USA
| | - Sylvain Chouinard
- Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Stover Natividad
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome and IRCCS Neuromed, Rome, Italy
| | - Alexander Y Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Brashear
- Neurology, University of California, Davis, Sacramento, California, USA
| | - Susan H Fox
- University of Toronto, Edmond J Safra Program in Parkinson Disease; Movement Disorder Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Miriam Neis
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute for Health Sciences, Department of Midwifery Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systemic Motor Research, University of Lübeck, Lübeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Institute of Systemic Motor Research, University of Lübeck, Lübeck, Germany
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Maurer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adam C Cotton
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alan Freeman
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, Georgia, USA.,Departments of Psychiatry & Behavioral Sciences and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Joel S Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Hyder A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
46
|
Schubert L, Verrel J, Behm A, Bäumer T, Beste C, Münchau A. Inter-individual differences in urge-tic associations in Tourette syndrome. Cortex 2021; 143:80-91. [PMID: 34391084 DOI: 10.1016/j.cortex.2021.06.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/26/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Premonitory urges are a cardinal feature in Tourette syndrome (GTS) and are commonly viewed as a driving force of tics. However, inter-individual differences in experimentally measured urges, tics and urge-tic associations, as well as possible relations to clinical characteristics and abnormal perception-action processing recently demonstrated in these patients have not been investigated in detail. Here, we analyze the temporal associations between urges and tics in 21 adult patients with GTS including inter-individual differences and the relation of such associations with clinical measures and experimentally tested perception-action coupling. At the group level, our results confirm known positive associations between subjective urges and tics, with increased tic frequency and tic intensity during periods of elevated urge. Inter-individual differences in the associations between urges and tics were, however, substantial. While most participants (57-66 % depending on the specific measure) showed positive associations as expected, several participants did not, and two even had negative associations with tic occurrence and intensity being reduced at times of increased urges. Subjective urge levels and tic occurrence correlated with corresponding clinical scores, providing converging evidence. Measures of the strength of urge-tic associations did not correlate with clinical measures nor the strength of perception-action coupling. Taken together, urge-tic associations in GTS are complex and heterogenous, casting doubt on the notion that tics are primarily driven by urges.
Collapse
Affiliation(s)
- Lina Schubert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Amelie Behm
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany.
| |
Collapse
|
47
|
Weissbach A, Steinmeier A, Pauly MG, Al-Shorafat DM, Saranza G, Lang AE, Brüggemann N, Tadic V, Klein C, Lohmann K, Brown MJN, Beste C, Münchau A, Bäumer T. Multimodal Longitudinal Neurophysiological Investigations in Dopa-Responsive Dystonia. Mov Disord 2021; 36:1986-1987. [PMID: 34114668 DOI: 10.1002/mds.28679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Annika Steinmeier
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Martje G Pauly
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Duha M Al-Shorafat
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Neuroscience Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Section of Neurology, Department of Medicine, Chong Hua Hospital, Cebu City, Philippines
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Norbert Brüggemann
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Vera Tadic
- Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Matt J N Brown
- Department of Kinesiology, California State University Sacramento, Sacramento, California, USA
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| |
Collapse
|
48
|
Mainka T, Azañón E, Zeuner KE, Knutzen A, Bäumer T, Neumann WJ, Borngräber F, Kühn AA, Longo MR, Ganos C. Intact Organization of Tactile Space Perception in Isolated Focal Dystonia. Mov Disord 2021; 36:1949-1955. [PMID: 33942381 DOI: 10.1002/mds.28607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Systematic perceptual distortions of tactile space have been documented in healthy adults. In isolated focal dystonia impaired spatial somatosensory processing is suggested to be a central pathophysiological finding, but the structure of tactile space for different body parts has not been previously explored. OBJECTIVES The objective of this study was to assess tactile space organization with a novel behavioral paradigm of tactile distance perception in patients with isolated focal dystonia and controls. METHODS Three groups of isolated focal dystonia patients (cervical dystonia, blepharospasm/Meige syndrome, focal hand dystonia) and controls estimated perceived distances between 2 touches across 8 orientations on the back of both hands and the forehead. RESULTS Stimulus size judgments differed significantly across orientations in all groups replicating distortions of tactile space known for healthy individuals. There were no differences between groups in the behavioral parameters we assessed on the hands and forehead. CONCLUSIONS Tactile space organization is comparable between patients with isolated focal dystonia and healthy controls in dystonic and unaffected body parts. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Tina Mainka
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Elena Azañón
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Arne Knutzen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | - Friederike Borngräber
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany.,NeuroCure Clinical Research Centre, Charité-University Medicine Berlin, Berlin, Germany
| | - Matthew R Longo
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Christos Ganos
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité University Medicine Berlin, Berlin, Germany
| |
Collapse
|
49
|
Kleimaker A, Kleimaker M, Behm A, Weissbach A, Bäumer T, Beste C, Roessner V, Münchau A. Networks in the Field of Tourette Syndrome. Front Neurol 2021; 12:624858. [PMID: 33927678 PMCID: PMC8076536 DOI: 10.3389/fneur.2021.624858] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/10/2021] [Indexed: 12/28/2022] Open
Abstract
Gilles de la Tourette syndrome (TS) is a neuropsychiatric neurodevelopmental disorder with the cardinal clinical features of motor and phonic tics. Clinical phenomenology can be complex since, besides tics, there are other features including premonitory urges preceding tics, pali-, echo-, and coprophenomena, hypersensitivity to external stimuli, and symptom dependency on stress, attention, and other less well-defined factors. Also, the rate of comorbidities, particularly attention deficit hyperactivity disorder and obsessive-compulsive disorder, is high. Mirroring the complexities of the clinical course and phenomenology, pathophysiological findings are very diverse, and etiology is disputed. It has become clear, though, that abnormalities in the basal ganglia and their connections with cortical areas are key for the understanding of the pathophysiology and as regards etiology, genetic factors are crucial. Against this background, both adequate clinical management of TS and TS-related research require multidisciplinary preferably international cooperation in larger groups or networks to address the multiple facets of this disorder and yield valid and useful data. In particular, large numbers of patients are needed for brain imaging and genetic studies. To meet these requirements, a number of networks and groups in the field of TS have developed over the years creating an efficient, lively, and supportive international research community. In this review, we will provide an overview of these groups and networks.
Collapse
Affiliation(s)
- Alexander Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Maximilian Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Amelie Behm
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Christian Beste
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität (TU) Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität (TU) Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| |
Collapse
|
50
|
Mielke E, Takacs A, Kleimaker M, Schappert R, Conte G, Onken R, Künemund T, Verrel J, Bäumer T, Beste C, Münchau A. Tourette syndrome as a motor disorder revisited - Evidence from action coding. Neuroimage Clin 2021; 30:102611. [PMID: 33740752 PMCID: PMC7985708 DOI: 10.1016/j.nicl.2021.102611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022]
Abstract
Feature Binding/integration in the motor domain in Tourette Syndrome (TS) is examined. Motor binding processes and interleaved action are intact in TS. Binding processes are differentially modulated in the motor domain and sensori-motor processes.
Because tics are the defining clinical feature of Tourette syndrome, it is conceptualized predominantly as a motor disorder. There is some evidence though suggesting that the neural basis of Tourette syndrome is related to perception–action processing and binding between perception and action. However, binding processes have not been examined in the motor domain in these patients. If it is particularly perception–action binding but not binding processes within the motor system, this would further corroborate that Tourette syndrome it is not predominantly, or solely, a motor disorder. Here, we studied N = 22 Tourette patients and N = 24 healthy controls using an established action coding paradigm derived from the Theory of Event Coding framework and concomitant EEG-recording addressing binding between a planned but postponed, and an interleaved immediate reaction with different levels of overlap of action elements. Behavioral performance during interleaved action coding was normal in Tourette syndrome. Response locked lateralized readiness potentials reflecting processes related to motor execution were larger in Tourette syndrome, but only in simple conditions. However, pre-motor processes including response preparation and configuration reflected by stimulus-locked lateralized readiness potentials were normal. This was supported by a Bayesian data analysis providing evidence for the null hypothesis. The finding that processes integrating different action-related elements prior to motor execution are normal in Tourette syndrome suggests that Tourette it is not solely a motor disorder. Considering other recent evidence, the data show that changes in “binding” in Tourette syndrome are specific for perception–action integration but not for action coding.
Collapse
Affiliation(s)
- Emily Mielke
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Adam Takacs
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Maximilian Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Giulia Conte
- Department of Human Neuroscience, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Italy
| | - Rebecca Onken
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Till Künemund
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
| |
Collapse
|