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Paparella G, Fasano A, Hallett M, Berardelli A, Bologna M. Emerging concepts on bradykinesia in non-parkinsonian conditions. Eur J Neurol 2021; 28:2403-2422. [PMID: 33793037 DOI: 10.1111/ene.14851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Bradykinesia is one of the cardinal motor symptoms of Parkinson's disease. However, clinical and experimental studies indicate that bradykinesia may also be observed in various neurological diseases not primarily characterized by parkinsonism. These conditions include hyperkinetic movement disorders, such as dystonia, chorea, and essential tremor. Bradykinesia may also be observed in patients with neurological conditions that are not seen as "movement disorders," including those characterized by the involvement of the cerebellum and corticospinal system, dementia, multiple sclerosis, and psychiatric disorders. METHODS We reviewed clinical reports and experimental studies on bradykinesia in non-parkinsonian conditions and discussed the major findings. RESULTS Bradykinesia is a common motor abnormality in non-parkinsonian conditions. From a pathophysiological standpoint, bradykinesia in neurological conditions not primarily characterized by parkinsonism may be explained by brain network dysfunction. CONCLUSION In addition to the pathophysiological implications, the present paper highlights important terminological issues and the need for a new, more accurate, and more widely used definition of bradykinesia in the context of movement disorders and other neurological conditions.
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Affiliation(s)
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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2
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Lang C, Gries C, Lindenberg KS, Lewerenz J, Uhl S, Olsson C, Samzelius J, Landwehrmeyer GB. Monitoring the Motor Phenotype in Huntington's Disease by Analysis of Keyboard Typing During Real Life Computer Use. J Huntingtons Dis 2021; 10:259-268. [PMID: 33459656 DOI: 10.3233/jhd-200451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Besides cognitive and psychiatric abnormalities, motor symptoms are the most prominent in Huntington's disease. The manifest disease is preceded by a prodromal phase with subtle changes such as fine motor disturbances or concentration problems. OBJECTIVE Movement disorders show a high variation in their clinical manifestation depending on condition and external influences. Therefore, devices for continuous measurements, which patients use in their daily life and which can monitor motor abnormalities, in addition to the medical examination, might be useful. The aim of current scientific efforts is to find markers that reflect the prodromal phase in gene carriers. This is important for future interventional studies, as future therapies should be applied at the stage of neuronal dysfunction, i.e., before the clinical manifestation. METHODS We performed a software-supported, continuous monitoring of keyboard typing on the participants' own computer to evaluate this method as a tool to assess the motor phenotype in HD. We included 40 participants and obtained sufficient data from 25 participants, 12 of whom were manifest HD patients, 7 HD gene expansion carriers (HDGEC) and 6 healthy controls. RESULTS In a cross-sectional analysis we found statistically significant higher typing inconsistency in HD patients compared to controls. Typing inconsistency compared between HDGEC and healthy controls showed a trend to higher inconsistency levels in HDGEC. We found correlations between typing cadence and clinical scores: the UHDRS finger tapping item, the composite UHDRS and the CAP score. CONCLUSION The typing cadence inconsistency is an appropriate marker to evaluate fine motor skills of HD patients and HDGEC and is correlated to established clinical measurements.
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Affiliation(s)
- Christina Lang
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | | | | | - Jan Lewerenz
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Stefanie Uhl
- Department of Neurology, University Hospital Ulm, Ulm, Germany
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3
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Mühlbäck A, Frank W, Klempířová O, Bezdíček O, Schmitt L, Hofstetter N, Landwehrmeyer GB, Klempíř J. Validation Study of a German Cognitive Battery for Huntington's Disease: Relationship Between Cognitive Performance, Functional Decline, and Disease Burden. Arch Clin Neuropsychol 2021; 36:74-86. [PMID: 32613239 PMCID: PMC7809684 DOI: 10.1093/arclin/acaa038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Cognitive decline is a key characteristic of Huntington’s disease (HD). This study aimed to investigate the diagnostic accuracy of a cognitive battery with six tests used by most HD research centers to assess cognitive impairment in HD. Method In total, 106 HD patients in different disease stages with more (HD-CD, N = 30) and less cognitive impairments (HD-NC, N = 70) and 100 healthy controls (NC) were matched by age, sex, and education and were examined using a standardized protocol including cognitive, motor, and functional assessments. Results One-way between-groups analysis of variance showed that controls performed significantly better than HD patients and that HD-NC significantly outperformed HD-CD patients in all cognitive tests (NC > HD-NC > HD-CD), with all Games-Howell post-hoc tests p < .001. Analyses using area under the receiver-operating characteristic curve (AUC) disclosed the diagnostic accuracy of all tests included in the battery to discriminate between NC and HD patients with AUC ranging from 0.809 to 0.862 (all p < .001) and between HD-CD and HD-NC patients with AUC ranging from 0.833 to 0.899 (all p < .001). In both analysis, Stroop Color Naming Test showed the highest discriminative potential. Additional analyses showed that cognitive deficits in all domains progressed with disease duration. Moreover, cognitive performance correlated with the severity of motor and functional impairment (all p < .001) and with the Disease Burden Score regardless of disease duration and age. Conclusion Our results indicate that the cognitive battery is a suitable tool for assessing cognitive impairment in HD.
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Affiliation(s)
- Alžbeta Mühlbäck
- Department of Neuropsychiatry, Huntington Center South, kbo-Isar-Amper-Klinikum, Taufkirchen (Vils), Germany.,Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Wiebke Frank
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - Olga Klempířová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondřej Bezdíček
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lena Schmitt
- Department of Neuropsychiatry, Huntington Center South, kbo-Isar-Amper-Klinikum, Taufkirchen (Vils), Germany
| | - Nina Hofstetter
- Department of Interdisciplinary Pain Therapy, Day Clinic, Klinikum Erding, Erding, Germany
| | | | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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4
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Abstract
Huntington's disease (HD) is usually characterized by involuntary hyperkinetic movements, called chorea. The intensity of chorea exhibits a peak in middle stages of HD and then decreases as HD progresses. In contrast, Pakinsonian signs of HD are often less appreciated. They typically progress in a fairly linear pattern over time. In fact, bradykinesia is detectable early on in premanifest gene carriers up to two decades prior to the clinical manifestation of HD symptoms using quantitative motor (Q-Motor) assessments such as finger tapping (digitomotography). Other Parkinsonian symptoms besides bradykinesia are rigidity and postural instability. They typically results in falls and injuries in advanced stages of HD. A primarily Parkinsonian motor phenotype, often seen with little to no chorea, is characteristically observed in older, late manifesting patients and in pediatric HD subjects. Establishing a diagnosis of HD is difficult in these groups and patients are often misdiagnosed in early stages.
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Affiliation(s)
- Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany; Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany; Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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5
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Sherman CW, Iyer R, Abler V, Antonelli A, Carlozzi NE. Perceptions of the impact of chorea on health-related quality of life in Huntington disease (HD): A qualitative analysis of individuals across the HD spectrum, family members, and clinicians. Neuropsychol Rehabil 2019; 30:1150-1168. [PMID: 30849283 DOI: 10.1080/09602011.2018.1564675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chorea, a hallmark symptom of Huntington's disease (HD), is characterized by jerky involuntary movements affecting the whole body that can interfere with daily functioning and impact health-related quality of life (HRQOL). To characterize chorea's impact on everyday functioning and HRQOL and identify patterns of perception and experiences of chorea among patients, caregivers, and providers. Data from focus groups of individuals with manifest HD (n = 8 early-stage HD; n = 16 late-stage HD), individuals at-risk or prodromal HD (n = 16), family HD caregivers (n = 17), and HD clinicians (n = 25). Focus group recordings were transcribed verbatim and analysed via constant comparison to identify meaningful and salient themes of living with chorea. Global themes of chorea's impact identified included: watching for chorea, experiences of stigma, and constraints on independence and relationships. Themes distinct to specific respondent groups included: Vigilance (at risk, prodromal); adaptation to chorea (early-stage); loss of autonomy and social life (late-stage); monitoring engagement (family caregivers) and safety (clinical providers). Living with chorea significantly constrains daily functioning, interactions, and HRQOL across the HD disease spectrum. Addressing these impacts via appropriate management of chorea can potentially enhance functioning, HRQOL, and overall satisfaction for persons with HD and their families.
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Affiliation(s)
| | - Ravi Iyer
- Teva Pharmaceutical Industries, Frazer, PA, USA
| | | | | | - Noelle E Carlozzi
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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de Tommaso M, Ricci K, Montemurno A, Vecchio E, Invitto S. Walking-Related Dual-Task Interference in Early-to-Middle-Stage Huntington's Disease: An Auditory Event Related Potential Study. Front Psychol 2017; 8:1292. [PMID: 28824485 PMCID: PMC5535504 DOI: 10.3389/fpsyg.2017.01292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/14/2017] [Indexed: 12/19/2022] Open
Abstract
Objective: To compare interference between walking and a simple P3 auditory odd-ball paradigm in patients with Huntington's disease (HD) and age- and sex-matched controls. Methods: Twenty-four early-to-middle-stage HD patients and 14 age- and sex-matched healthy volunteers were examined. EEG—EMG recordings were obtained from 21 scalp electrodes and eight bipolar derivations from the legs. Principal component analysis was used to obtain artifact-free recordings. The stimulation paradigm consisted of 50 rare and 150 frequent stimuli and was performed in two conditions: standing and walking along a 10 by 5 m path. P3 wave amplitude and latency and EEG and EMG spectral values were compared by group and experimental condition and correlated with clinical features of HD. Results: P3 amplitude increased during walking in both HD patients and controls. This effect was inversely correlated with motor impairment in HD patients, who showed a beta-band power increase over the parieto-occipital regions in the walking condition during the P3 task. Walking speed and counting of rare stimuli were not compromised by concurrence of motor and cognitive demands. Conclusion: Our results showed that walking increased P3 amplitude in an auditory task, in both HD patients and controls. Concurrent cognitive and motor stimulation could be used for rehabilitative purposes as a means of enhancing activation of cortical compensatory reserves, counteracting potential negative interference and promoting the integration of neuronal circuits serving different functions.
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Affiliation(s)
- Marina de Tommaso
- Neurophysiopathology of Pain, Basic Medical Science, Neuroscience and Sensory System Department-SMBNOS-Bari Aldo Moro UniversityBari, Italy
| | - Katia Ricci
- Neurophysiopathology of Pain, Basic Medical Science, Neuroscience and Sensory System Department-SMBNOS-Bari Aldo Moro UniversityBari, Italy
| | - Anna Montemurno
- Neurophysiopathology of Pain, Basic Medical Science, Neuroscience and Sensory System Department-SMBNOS-Bari Aldo Moro UniversityBari, Italy
| | - Eleonora Vecchio
- Neurophysiopathology of Pain, Basic Medical Science, Neuroscience and Sensory System Department-SMBNOS-Bari Aldo Moro UniversityBari, Italy
| | - Sara Invitto
- Department of Biological and Environmental Sciences and Technologies, University of SalentoLecce, Italy
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Mirallave A, Morales M, Cabib C, Muñoz EJ, Santacruz P, Gasull X, Valls-Sole J. Sensory processing in Huntington's disease. Clin Neurophysiol 2017; 128:689-696. [PMID: 28315610 DOI: 10.1016/j.clinph.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/19/2016] [Accepted: 01/10/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE An intriguing electrophysiological feature of patients with Huntington's disease (HD) is the delayed latency and decreased amplitude of somatosensory long-latency evoked potentials (LLeps). We investigated whether such dysfunction was associated with delayed conscious perception of the sensory stimulus. METHODS Sixteen HD patients and 16 control subjects faced a computer screen showing the Libet's clock (Libet et al., 1983). In Rest trials, subjects had to memorize the position of the clock handle at perception of either electrical or thermal stimuli (AW). In React, additionally, they were asked to make a fist with their right hand, in a simple reaction time task (SRT). LLseps were recorded from Cz in both conditions. RESULTS LLeps negative peak latency (N2) and SRT were abnormally delayed in patients in all conditions. AW was only abnormally prolonged in the React condition but the time difference between AW and the negative peak of the LLeps was not different in the two groups. There was a significant negative correlation between SRT and AW or LLeps amplitude in patients but not in healthy subjects. CONCLUSION Our HD patients did not show abnormalities in conscious perception of sensory stimuli but their LLeps abnormalities were more marked when they had to react. This is compatible with failure to detect stimulus salience rather than with a cognitive defect. SIGNIFICANCE HD patients at early stages of the disease have preserved subjective perception of sensation but faulty sensorimotor integration.
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Affiliation(s)
- Ana Mirallave
- EMG Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain; Center for Neural Science (CNS), New York University (NYU), USA.
| | - Merche Morales
- EMG Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Christopher Cabib
- EMG Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Esteban J Muñoz
- Movement Disorders Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Xavier Gasull
- Neurophysiology Lab, Department of Physiological Sciences I, Medical School, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
| | - Josep Valls-Sole
- EMG Unit, Neurology Department, Hospital Clinic, Facultat de Medicina, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Spain
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Fritz NE, Hamana K, Kelson M, Rosser A, Busse M, Quinn L. Motor-cognitive dual-task deficits in individuals with early-mid stage Huntington disease. Gait Posture 2016; 49:283-289. [PMID: 27474949 DOI: 10.1016/j.gaitpost.2016.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/14/2016] [Accepted: 07/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Huntington disease (HD) results in a range of cognitive and motor impairments that progress throughout the disease stages; however, little research has evaluated specific dual-task abilities in this population, and the degree to which they may be related to functional ability. OBJECTIVES The purpose of this study was to a) examine simple and complex motor-cognitive dual-task performance in individuals with HD, b) determine relationships between dual-task walking ability and disease-specific measures of motor, cognitive and functional ability, and c) examine the relationship of dual-task measures to falls in individuals with HD. METHODS Thirty-two individuals with HD were evaluated for simple and complex dual-task ability using the Walking While Talking Test. Demographics and disease-specific measures of motor, cognitive and functional ability were also obtained. RESULTS Individuals with HD had impairments in simple and complex dual-task ability. Simple dual-task walking was correlated to disease-specific motor scores as well as cognitive performance, but complex dual-task walking was correlated with total functional capacity, as well as a range of cognitive measures. Number of prospective falls was moderately-strongly correlated to dual-task measures. CONCLUSIONS Our results suggest that individuals with HD have impairments in cognitive-motor dual-task ability that are related to disease progression and specifically functional ability. Dual-task measures appear to evaluate a unique construct in individuals with early to mid-stage HD, and may have value in improving the prediction of falls risk in this population.
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Affiliation(s)
- Nora E Fritz
- Wayne State University, Program in Physical Therapy, Detroit, MI, USA.
| | - Katy Hamana
- School of Health Care Sciences, Cardiff University, Cardiff, UK.
| | - Mark Kelson
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Anne Rosser
- Schools of Medicine and Biosciences, Cardiff University, Cardiff, UK.
| | - Monica Busse
- School of Health Care Sciences, Cardiff University, Cardiff, UK.
| | - Lori Quinn
- School of Health Care Sciences, Cardiff University, Cardiff, UK; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
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Martínez Pueyo A, García-Ruiz P, Feliz C, Garcia Caldentey J, Del Val J, Herranz A. Reaction time and rhythm of movement in Huntington's disease. J Neurol Sci 2016; 362:115-7. [DOI: 10.1016/j.jns.2015.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/29/2015] [Accepted: 12/23/2015] [Indexed: 11/17/2022]
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10
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Despard J, Ternes AM, Dimech-Betancourt B, Poudel G, Churchyard A, Georgiou-Karistianis N. Characterising Upper Limb Movements in Huntington's Disease and the Impact of Restricted Visual Cues. PLoS One 2015; 10:e0133709. [PMID: 26248012 PMCID: PMC4527591 DOI: 10.1371/journal.pone.0133709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 07/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Voluntary motor deficits are a common feature in Huntington's disease (HD), characterised by movement slowing and performance inaccuracies. This deficit may be exacerbated when visual cues are restricted. OBJECTIVE To characterize the upper limb motor profile in HD with various levels of difficulty, with and without visual targets. METHODS Nine premanifest HD (pre-HD), nine early symptomatic HD (symp-HD) and nine matched controls completed a motor task incorporating Fitts' law, a model of human movement enabling the quantification of movement timing, via the manipulation of task difficulty (i.e., target size, and distance between targets). The task required participants to make reciprocal movements under cued and blind conditions. Dwell times (time stationary between movements), speed, accuracy and variability of movements were compared between groups. RESULTS Symp-HD showed significantly prolonged and less consistent movement times, compared with controls and pre-HD. Furthermore, movement planning and online control were significantly impaired in symp-HD, compared with controls and pre-HD, evidenced by prolonged dwell times and deceleration times. Speed and accuracy were comparable across groups, suggesting that group differences observed in movement time, variability, dwell time and deceleration time were evident over and above simple performance measures. The presence of cues resulted in greater movement time variability in symp-HD, compared with pre-HD and controls, suggesting that the deficit in movement consistency manifested only in response to targeted movements. CONCLUSIONS Collectively, these findings provide evidence of a deficiency in both motor planning, particularly in relation to movement timing and online control, which became exacerbated as a function of task difficulty during symp-HD stages. These variables may provide a more sensitive measure of motor dysfunction than speed and/or accuracy alone in symp-HD.
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Affiliation(s)
- Jessica Despard
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Anne-Marie Ternes
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Bleydy Dimech-Betancourt
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Govinda Poudel
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
- Victorian Life Sciences Computation Initiative, Life Sciences Computation Centre, Melbourne, Victoria, Australia
| | - Andrew Churchyard
- Department of Neurology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- * E-mail:
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Salem L, Saleh N, Youssov K, Olivier A, Charles P, Scherer C, Verny C, Bachoud-Lévi AC, Maison P. The most appropriate primary outcomes to design clinical trials on Huntington's disease: meta-analyses of cohort studies and randomized placebo-controlled trials. Fundam Clin Pharmacol 2014; 28:700-10. [DOI: 10.1111/fcp.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/07/2014] [Accepted: 04/01/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Linda Salem
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
| | - Nadine Saleh
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Katia Youssov
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Audrey Olivier
- CHU Angers; Département de Neurologie; Angers 49000 France
| | - Perrine Charles
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | | | | | - Anne-Catherine Bachoud-Lévi
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Patrick Maison
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
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12
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Désaméricq G, Dolbeau G, Verny C, Charles P, Durr A, Youssov K, Simonin C, Azulay JP, Tranchant C, Goizet C, Damier P, Broussolle E, Demonet JF, Morgado G, de Langavant LC, Macquin-Mavier I, Bachoud-Lévi AC, Maison P. Effectiveness of anti-psychotics and related drugs in the Huntington French-speaking group cohort. PLoS One 2014; 9:e85430. [PMID: 24454865 PMCID: PMC3893200 DOI: 10.1371/journal.pone.0085430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Huntington's disease is a rare condition. Patients are commonly treated with antipsychotics and tetrabenazine. The evidence of their effect on disease progression is limited and no comparative study between these drugs has been conducted. We therefore compared the effectiveness of antipsychotics on disease progression. METHODS 956 patients from the Huntington French Speaking Group were followed for up to 8 years between 2002 and 2010. The effectiveness of treatments was assessed using Unified Huntington's Disease Rating Scale (UHDRS) scores and then compared using a mixed model adjusted on a multiple propensity score. RESULTS 63% of patients were treated with antipsychotics during the survey period. The most commonly prescribed medications were dibenzodiazepines (38%), risperidone (13%), tetrabenazine (12%) and benzamides (12%). There was no difference between treatments on the motor and behavioural declines observed, after taking the patient profiles at the start of the drug prescription into account. In contrast, the functional decline was lower in the dibenzodiazepine group than the other antipsychotic groups (Total Functional Capacity: 0.41 ± 0.17 units per year vs. risperidone and 0.54 ± 0.19 vs. tetrabenazine, both p<0.05). Benzamides were less effective than other antipsychotics on cognitive evolution (Stroop interference, Stroop color and Literal fluency: p<0.05). CONCLUSIONS Antipsychotics are widely used to treat patients with Huntington's disease. Although differences in motor or behavioural profiles between patients according to the antipsychotics used were small, there were differences in drug effectiveness on the evolution of functional and cognitive scores.
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Affiliation(s)
- Gaëlle Désaméricq
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Service de Pharmacologie Clinique, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
| | - Guillaume Dolbeau
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Unité de recherche clinique, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Christophe Verny
- Centre de référence des maladies neurogénétiques, service de neurologie, CHU d'Angers, Angers, France
- UMR CNRS 6214 - INSERM U1083, Angers, France
| | - Perrine Charles
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
- Département de génétique, Hôpital de la salpêtrière, AP-HP, Paris, France
| | - Alexandra Durr
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Katia Youssov
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Clémence Simonin
- Departement of Neurology and Movement Disorders, CHRU Lille, Lille, France
- UMR837 INSERM – JPArc Team 6, Lille, France
- University Lille 2/Law & Health, Lille, France
| | - Jean-Philippe Azulay
- Service de Neurologie et pathologie du mouvement, Hôpital de la Timone, Marseille, France
| | - Christine Tranchant
- Service de Neurologie, CHU Hautepierre, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Cyril Goizet
- Université Bordeaux Segalen, Laboratoire Maladies Rares: Génétique et Métabolisme (MRGM), EA4576, CHU Bordeaux, Service de Génétique médicale, Bordeaux, France
| | | | - Emmanuel Broussolle
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université Lyon I, Lyon, France
- Service de Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Centre de Neurosciences Cognitives, UMR5229, CNRS, Bron, France
| | - Jean-François Demonet
- Centre Leenaards de la Mémoire, Département des Neurosciences Cliniques, CHUV, Lausanne, Switzerland
| | - Graca Morgado
- Faculté de médecine, Université Paris Est, Créteil, France
- Centre d'Investigation Clinique 006, Inserm, Créteil, France
- Pôle Recherche clinique Santé Publique, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Laurent Cleret de Langavant
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Isabelle Macquin-Mavier
- Faculté de médecine, Université Paris Est, Créteil, France
- Service de Pharmacologie Clinique, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
| | - Patrick Maison
- Equipe 01, U955, Inserm, Créteil, France
- Faculté de médecine, Université Paris Est, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure, Paris, France
- Centre de référence Maladie de Huntington, Hôpital H. Mondor – A. Chenevier, AP-HP, Créteil, France
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Mickes L, Wixted JT, Peavy GM, Jacobson MW, Goldstein JL, Corey-Bloom J. Difficulty modifying a sustained motor response in prodromal Huntington's disease. J Clin Exp Neuropsychol 2013. [DOI: 10.1080/13803395.2012.742039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Organoselenium Bis Selenide Attenuates 3-Nitropropionic Acid-Induced Neurotoxicity in Rats. Neurotox Res 2012; 23:214-24. [DOI: 10.1007/s12640-012-9336-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 05/25/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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15
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Quinn L, Busse M. Physiotherapy clinical guidelines for Huntington’s disease. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.11.86] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lori Quinn
- Department of Physiotherapy, School of Healthcare Studies, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Monica Busse
- Department of Physiotherapy, School of Healthcare Studies, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
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16
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Shannon KM. Huntington's disease - clinical signs, symptoms, presymptomatic diagnosis, and diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2011; 100:3-13. [PMID: 21496568 DOI: 10.1016/b978-0-444-52014-2.00001-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
HD is a complex illness, with a broad clinical picture that begins years before clear motor onset and evolves over decades to a terminal state of extreme disability. It challenges the resources of families and communities and the skills of medical and ancillary health care providers. A broader understanding of the phenotypes, progression, and genetic basis of HD may elevate the standard of care for these deserving patients.
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Affiliation(s)
- Kathleen M Shannon
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
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17
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The Dynamic Relationship Between Voluntary and Involuntary Motor Behaviours in Patients with Basal Ganglia Disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-1-4419-0340-2_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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18
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Beste C, Konrad C, Saft C, Ukas T, Andrich J, Pfleiderer B, Hausmann M, Falkenstein M. Alterations in voluntary movement execution in Huntington's disease are related to the dominant motor system — Evidence from event-related potentials. Exp Neurol 2009; 216:148-57. [DOI: 10.1016/j.expneurol.2008.11.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 11/19/2008] [Accepted: 11/20/2008] [Indexed: 01/18/2023]
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19
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Prodoehl J, Corcos DM, Leurgans S, Comella CL, Weis-McNulty A, MacKinnon CD. Changes in the relationship between movement velocity and movement distance in primary focal hand dystonia. J Mot Behav 2008; 40:301-13. [PMID: 18628107 DOI: 10.3200/jmbr.40.4.301-314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors examined the relationship between movement velocity and distance and the associated muscle activation patterns in 18 individuals with focal hand dystonia (FHD) compared with a control group of 18 individuals with no known neuromuscular condition. Participants performed targeted voluntary wrist and elbow flexion movements as fast as possible across 5 movement distances. Individuals with FHD were slower than controls across all distances, and this difference was accentuated for longer movements. Muscle activation patterns were triphasic in the majority of individuals with FHD, and muscle activation scaled with distance in a similar manner to controls. Cocontraction did not explain movement slowing in individuals with dystonia, but there was a trend toward underactivation of the 1st agonist burst in the dystonic group. The authors concluded that slowness is a consistent feature of voluntary movement in FHD and is present even in the absence of dystonic posturing. Underactivation of the 1st agonist burst appears to be the most likely reason to explain slowing.
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Affiliation(s)
- Janey Prodoehl
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, Chicago, IL 60612, USA.
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20
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Michell AW, Goodman AOG, Silva AHD, Lazic SE, Morton AJ, Barker RA. Hand tapping: a simple, reproducible, objective marker of motor dysfunction in Huntington's disease. J Neurol 2008; 255:1145-52. [PMID: 18465109 DOI: 10.1007/s00415-008-0859-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/14/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
Abstract
Huntington's disease (HD) is a severe neurodegenerative condition in which the impairment in voluntary movement is related to functional disability. Clinical assessment of motor deficit currently relies largely on subjective rating scales without objective measurement. We have developed a quick and easy-to-use hand tapping device that enables measurement of (a) the number of taps in 30 seconds, (b) variability in tapping rhythm and (c) fatigue over the testing period. Initial cross-sectional testing of 178 consecutive HD clinic patients using an early model of the device showed that the total number of taps in 30 seconds correlated with the motor UHDRS (Spearmann's rho, r(s) = -0.81, p < 0.0001) and independence scores (r(s) = 0.78, p = 0.01). Longitudinal data from a small cohort followed over 10 years reveals a correlation between total number of taps in 30 seconds and motor UHDRS over time (rs = -0.49, p < 0.001), and suggests the technique may provide an objective measure of disease progression. Further tests on 15 HD patients and 9 controls were repeated three times in a single day using an updated device. The HD group made significantly fewer taps in 30 seconds (median HD = 79, control = 104, p = 0.009) and had greater variability of inter-tap interval (mean interdecile range HD = 148, control = 56, p = 0.016) compared to controls. Both the total number of taps and variability of inter-tap interval correlated with motor UHDRS. Of vital importance for any potential marker of disease progression is that these tapping parameters were reproducible with repeated measurement. Given that hand tapping parameters differ between HD and control populations, they correlate with motor UHDRS over time and are reproducible, we propose that assessment of hand tapping represents a useful objective adjunct to the clinical assessment of HD patients.
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Affiliation(s)
- A W Michell
- Dept. of Clinical Neurophysiology, 3rd floor Albany wing, National Hospital for Neurology, and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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21
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Fenney A, Jog MS, Duval C. Bradykinesia is not a “systematic” feature of adult-onset Huntington's disease; implications for basal ganglia pathophysiology. Brain Res 2008; 1193:67-75. [DOI: 10.1016/j.brainres.2007.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 11/29/2007] [Accepted: 12/03/2007] [Indexed: 11/26/2022]
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22
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Beste C, Saft C, Andrich J, Müller T, Gold R, Falkenstein M. Time processing in Huntington's disease: a group-control study. PLoS One 2007; 2:e1263. [PMID: 18060059 PMCID: PMC2094403 DOI: 10.1371/journal.pone.0001263] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 11/09/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND "Timing" processes are mediated via a disturbed neuronal network including the basal ganglia. Brain structures important for "timing" are also discussed to be critical for the deterioration of movements in Huntington's disease (HD). Changes in "timing processes" are found in HD, but no study has varied the degree of motor demands in timing functions in parallel in HD. It may be hypothesized that timing functions may be deteriorated to a different extent in motor and non-motor timing, because in motor timing the underlying brain structures may be more demanding than in non-motor timing. METHODOLOGY/PRINCIPLE FINDINGS WE ASSESSED TIMING IN TWO DIFFERENT EXPERIMENTS: a time-estimation (TE) and a time-discrimination (TD) task. The demand on motor functions is high in the TE-task and low in the TD-task. Furthermore, general motor ability was assessed at different complexity levels. A presymptomatic (pHD), a symptomatic (HD) and a control group were investigated. We found a decline in timing functions when demands on the motor system were high (TE-task), in HD and even in pHD, compared to controls. In non-motor timing (TD task) and in the assessment of general motor ability, performance in the pHD-group was comparable to the controls and better than in the symptomatic group. Performance in both timing tasks was related to the duration until the estimated age of onset in pHDs. CONCLUSIONS/SIGNIFICANCE The study shows a selective deterioration of time-estimation processes in symptomatic and even presymptomatic Huntington's disease. Time-discrimination processes were not affected in both patient groups. The relation of timing performance to the duration until the estimated age of onset in pHD is of clinical importance.
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Affiliation(s)
- Christian Beste
- Department of Neurology, Huntington Centre NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany.
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23
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de Tommaso M, Difruscolo O, Sciruicchio V, Specchio N, Livrea P. Abnormalities of the contingent negative variation in Huntington's disease: Correlations with clinical features. J Neurol Sci 2007; 254:84-9. [PMID: 17300807 DOI: 10.1016/j.jns.2007.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
The contingent negative variation (CNV) is a neurophysiological pattern related to planning of external - paced, voluntary movements. The aim of the study, was to examine the CNV in a cohort of mild demented and non-medicated HD patients, evaluating the CNV amplitude modifications in the light of clinical features and performing Low Resolution Brain Electromagnetic Tomography (LORETA) analysis in order to show the CNV multiple generators. Fourteen HD patients and 25 sex and age-matched controls were studied. All subjects were evaluated by the motor section of UHDRS, MMSE and WAIS. The CNV was recorded by 19 scalp electrodes, with a red light flash as visual warning stimulus (S1), followed by a blue light flash (S2) after a fixed interval of 3 s. The amplitude of early CNV was significantly reduced in HD, compared to controls: the amplitude reduction was significantly correlated with the bradikinesia score. LORETA analysis of early CNV significantly discriminated patients from controls, for a prevalent activation of the posterior part of anterior cingulate cortex in HD. An abnormal activation of the associative cortex devoted to the processing of attention preceding voluntary movement may be supposed in HD, probably mediated by the altered basal ganglia modulation.
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24
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Tang JKH, Moro E, Lozano AM, Lang AE, Hutchison WD, Mahant N, Dostrovsky JO. Firing rates of pallidal neurons are similar in Huntington's and Parkinson's disease patients. Exp Brain Res 2005; 166:230-6. [PMID: 16082534 DOI: 10.1007/s00221-005-2359-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 03/17/2005] [Indexed: 11/30/2022]
Abstract
According to the now classical basal ganglia-thalamocortical circuitry model, the chorea of Huntington's disease (HD) and the hypokinesia in Parkinson's disease (PD) are explained by a decrease in the inhibitory output (reduced firing rates) from the globus pallidus internus (GPi) in HD and increased output in PD. Differences between firing patterns might also be a factor contributing to the different symptoms, however. To test the predictions of the model we examined neuronal firing rates and patterns in two HD patients and 14 PD patients. Single-cell, microelectrode recordings were obtained from awake patients undergoing stereotactic surgery for implantation of deep brain stimulating (DBS) electrodes in the GPi. The mean neuronal firing rate in the GPi of HD patients was 81.8+/-4.3 Hz (mean+/-SEM), which was not significantly different from that in PD patients (89.9+/-3.0 Hz). Firing pattern analyses using measurements of burst index, coefficient of variation, and percentage participation of spikes in bursts revealed, however, that GPi neurons in HD patients fired in a more regular pattern (fewer "bursts") than in PD patients. These results suggest that the rate-based model does not adequately explain the motor abnormalities present in the two HD patients studied. Furthermore, the findings did reveal a difference between firing patterns in the HD and PD groups, thereby supporting the role of altered firing patterns in the pathophysiology of these diseases.
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Affiliation(s)
- Joyce K H Tang
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada, M5S 1A8
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