1
|
Tarrano C, Galléa C, Delorme C, McGovern EM, Atkinson-Clement C, Barnham IJ, Brochard V, Thobois S, Tranchant C, Grabli D, Degos B, Corvol JC, Pedespan JM, Krystkowiak P, Houeto JL, Degardin A, Defebvre L, Valabrègue R, Beranger B, Apartis E, Vidailhet M, Roze E, Worbe Y. Association of abnormal explicit sense of agency with cerebellar impairment in myoclonus-dystonia. Brain Commun 2024; 6:fcae105. [PMID: 38601915 PMCID: PMC11004927 DOI: 10.1093/braincomms/fcae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/20/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Non-motor aspects in dystonia are now well recognized. The sense of agency, which refers to the experience of controlling one's own actions, has been scarcely studied in dystonia, even though its disturbances can contribute to movement disorders. Among various brain structures, the cerebral cortex, the cerebellum, and the basal ganglia are involved in shaping the sense of agency. In myoclonus dystonia, resulting from a dysfunction of the motor network, an altered sense of agency may contribute to the clinical phenotype of the condition. In this study, we compared the explicit and implicit sense of agency in patients with myoclonus dystonia caused by a pathogenic variant of SGCE (DYT-SGCE) and control participants. We utilized behavioural tasks to assess the sense of agency and performed neuroimaging analyses, including structural, resting-state functional connectivity, and dynamic causal modelling, to explore the relevant brain regions involved in the sense of agency. Additionally, we examined the relationship between behavioural performance, symptom severity, and neuroimaging findings. We compared 19 patients with DYT-SGCE and 24 healthy volunteers. Our findings revealed that patients with myoclonus-dystonia exhibited a specific impairment in explicit sense of agency, particularly when implicit motor learning was involved. However, their implicit sense of agency remained intact. These patients also displayed grey-matter abnormalities in the motor cerebellum, as well as increased functional connectivity between the cerebellum and pre-supplementary motor area. Dynamic causal modelling analysis further identified reduced inhibitory effects of the cerebellum on the pre-supplementary motor area, decreased excitatory effects of the pre-supplementary motor area on the cerebellum, and increased self-inhibition within the pre-supplementary motor area. Importantly, both cerebellar grey-matter alterations and functional connectivity abnormalities between the cerebellum and pre-supplementary motor area were found to correlate with explicit sense of agency impairment. Increased self-inhibition within the pre-supplementary motor area was associated with less severe myoclonus symptoms. These findings highlight the disruption of higher-level cognitive processes in patients with myoclonus-dystonia, further expanding the spectrum of neurological and psychiatric dysfunction already identified in this disorder.
Collapse
Affiliation(s)
- Clément Tarrano
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Cécile Galléa
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Department of Research Neuroimaging, Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, Paris 75013, France
| | - Cécile Delorme
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Eavan M McGovern
- Department of Neurology, Beaumont Hospital, Dublin 9, D09 VY21, Ireland
- School of Medicine, Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | - Cyril Atkinson-Clement
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | | | - Vanessa Brochard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Stéphane Thobois
- Department of Neurology, Hospices Civils de Lyon, Lyon 69000, France
| | - Christine Tranchant
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg 67098, France
- INSERM-U964/CNRS-UMR7104, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg, Illkirch 67404, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000, France
| | - David Grabli
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Bertrand Degos
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, Sorbonne Paris Nord, Bobigny 93000, France
| | - Jean Christophe Corvol
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Jean-Michel Pedespan
- Department of Neuropediatry, Universitary Hospital of Pellegrin, Bordeaux 33076, France
| | - Pierre Krystkowiak
- Department of Neurology, Abu Dhabi Stem Cells Centre, Abu Dhabi, United Arab Emirates
| | - Jean-Luc Houeto
- Department of Neurology CHU Limoges, Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT—Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges 87000, France
| | - Adrian Degardin
- Department of Neurology, Tourcoing Hospital, Tourcoing 59599, France
| | - Luc Defebvre
- Department of Neurology, University of Lille, Lille 59000, France
- Department of Neurology, Lille Centre of Excellence for Neurodegenerative Diseases » (LiCEND), Lille F-59000, France
| | - Romain Valabrègue
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Department of Research Neuroimaging, Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, Paris 75013, France
| | - Benoit Beranger
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Department of Research Neuroimaging, Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, Paris 75013, France
| | - Emmanuelle Apartis
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Department of Neurophysiology, Saint-Antoine Hospital, Paris 75012, France
| | - Marie Vidailhet
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Emmanuel Roze
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Clinical Investigation Center for Neurosciences, Paris 75013, France
| | - Yulia Worbe
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute—Institut du Cerveau et de la Moelle épinière, Inserm U1127, Paris 75013, France
- Department of Neurophysiology, Saint-Antoine Hospital, Paris 75012, France
| |
Collapse
|
2
|
Lin WS. Translating Genetic Discovery into a Mechanistic Understanding of Pediatric Movement Disorders: Lessons from Genetic Dystonias and Related Disorders. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200018. [PMID: 37288166 PMCID: PMC10242408 DOI: 10.1002/ggn2.202200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Indexed: 06/09/2023]
Abstract
The era of next-generation sequencing has increased the pace of gene discovery in the field of pediatric movement disorders. Following the identification of novel disease-causing genes, several studies have aimed to link the molecular and clinical aspects of these disorders. This perspective presents the developing stories of several childhood-onset movement disorders, including paroxysmal kinesigenic dyskinesia, myoclonus-dystonia syndrome, and other monogenic dystonias. These stories illustrate how gene discovery helps focus the research efforts of scientists trying to understand the mechanisms of disease. The genetic diagnosis of these clinical syndromes also helps clarify the associated phenotypic spectra and aids the search for additional disease-causing genes. Collectively, the findings of previous studies have led to increased recognition of the role of the cerebellum in the physiology and pathophysiology of motor control-a common theme in many pediatric movement disorders. To fully exploit the genetic information garnered in the clinical and research arenas, it is crucial that corresponding multi-omics analyses and functional studies also be performed at scale. Hopefully, these integrated efforts will provide us with a more comprehensive understanding of the genetic and neurobiological bases of movement disorders in childhood.
Collapse
Affiliation(s)
- Wei-Sheng Lin
- Department of Pediatrics Taipei Veterans General Hospital Taipei 11217 Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei 112304 Taiwan
| |
Collapse
|
3
|
Marie V. What have we learned about the biology of dystonia from deep brain stimulation? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:481-491. [PMID: 37482401 DOI: 10.1016/bs.irn.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Deep brain stimulation has dramatically changed the management of patients with dystonia, therapeutic approach of dystonia with marked improvement of dystonia and functional disability. However, despite decades of experience and identification of good prognosis factors, prediction of beneficial effect at the individual level is still a challenge. There is inter-individual variability in therapeutic outcome. Genetic factors are identified but subgroups of patients still have relapse or worsening of dystonia in short or long term. Possible "biological factors" underlying such a difference among patients are discussed, including structural or functional differences including altered plasticity.
Collapse
Affiliation(s)
- Vidailhet Marie
- Sorbonne Université, Paris Brain Institute - ICM, Inserm CNRS, Paris, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France.
| |
Collapse
|
4
|
El Atiallah I, Bonsi P, Tassone A, Martella G, Biella G, Castagno AN, Pisani A, Ponterio G. Synaptic Dysfunction in Dystonia: Update From Experimental Models. Curr Neuropharmacol 2023; 21:2310-2322. [PMID: 37464831 PMCID: PMC10556390 DOI: 10.2174/1570159x21666230718100156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 07/20/2023] Open
Abstract
Dystonia, the third most common movement disorder, refers to a heterogeneous group of neurological diseases characterized by involuntary, sustained or intermittent muscle contractions resulting in repetitive twisting movements and abnormal postures. In the last few years, several studies on animal models helped expand our knowledge of the molecular mechanisms underlying dystonia. These findings have reinforced the notion that the synaptic alterations found mainly in the basal ganglia and cerebellum, including the abnormal neurotransmitters signalling, receptor trafficking and synaptic plasticity, are a common hallmark of different forms of dystonia. In this review, we focus on the major contribution provided by rodent models of DYT-TOR1A, DYT-THAP1, DYT-GNAL, DYT/ PARK-GCH1, DYT/PARK-TH and DYT-SGCE dystonia, which reveal that an abnormal motor network and synaptic dysfunction represent key elements in the pathophysiology of dystonia.
Collapse
Affiliation(s)
- Ilham El Atiallah
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Bonsi
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Annalisa Tassone
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giuseppina Martella
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Gerardo Biella
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
| | - Antonio N. Castagno
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Giulia Ponterio
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
5
|
McClelland VM, Lin JP. Dystonia in Childhood: How Insights from Paediatric Research Enrich the Network Theory of Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:1-22. [PMID: 37338693 DOI: 10.1007/978-3-031-26220-3_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Dystonia is now widely accepted as a network disorder, with multiple brain regions and their interconnections playing a potential role in the pathophysiology. This model reconciles what could previously have been viewed as conflicting findings regarding the neuroanatomical and neurophysiological characteristics of the disorder, but there are still significant gaps in scientific understanding of the underlying pathophysiology. One of the greatest unmet challenges is to understand the network model of dystonia in the context of the developing brain. This article outlines how research in childhood dystonia supports and contributes to the network theory and highlights aspects where data from paediatric studies has revealed novel and unique physiological insights, with important implications for understanding dystonia across the lifespan.
Collapse
Affiliation(s)
- Verity M McClelland
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Jean-Pierre Lin
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Women and Children's Institute, Faculty of Life Sciences and Medicine (FolSM), King's College London, London, UK
| |
Collapse
|
6
|
Imbriani P, Sciamanna G, El Atiallah I, Cerri S, Hess EJ, Pisani A. Synaptic effects of ethanol on striatal circuitry: therapeutic implications for dystonia. FEBS J 2022; 289:5834-5849. [PMID: 34217152 PMCID: PMC9786552 DOI: 10.1111/febs.16106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/21/2021] [Accepted: 07/02/2021] [Indexed: 12/30/2022]
Abstract
Alcohol consumption affects motor behavior and motor control. Both acute and chronic alcohol abuse have been extensively investigated; however, the therapeutic efficacy of alcohol on some movement disorders, such as myoclonus-dystonia or essential tremor, still does not have a plausible mechanistic explanation. Yet, there are surprisingly few systematic trials with known GABAergic drugs mimicking the effect of alcohol on neurotransmission. In this brief survey, we aim to summarize the effects of EtOH on striatal function, providing an overview of its cellular and synaptic actions in a 'circuit-centered' view. In addition, we will review both experimental and clinical evidence, in the attempt to provide a plausible mechanistic explanation for alcohol-responsive movement disorders, with particular emphasis on dystonia. Different hypotheses emerge, which may provide a rationale for the utilization of drugs that mimic alcohol effects, predicting potential drug repositioning.
Collapse
Affiliation(s)
- Paola Imbriani
- Department of Systems MedicineUniversity of Rome ‘Tor Vergata’Italy,IRCCS Fondazione Santa LuciaRomeItaly
| | - Giuseppe Sciamanna
- Department of Systems MedicineUniversity of Rome ‘Tor Vergata’Italy,IRCCS Fondazione Santa LuciaRomeItaly
| | - Ilham El Atiallah
- Department of Systems MedicineUniversity of Rome ‘Tor Vergata’Italy,IRCCS Fondazione Santa LuciaRomeItaly
| | | | - Ellen J. Hess
- Departments of Pharmacology and Chemical Biology and NeurologyEmory UniversityAtlantaGAUSA
| | - Antonio Pisani
- IRCCS Mondino FoundationPaviaItaly,Department of Brain and Behavioral SciencesUniversity of PaviaItaly
| |
Collapse
|
7
|
Chandarana M, Saraf U, Divya KP, Krishnan S, Kishore A. Myoclonus- A Review. Ann Indian Acad Neurol 2021; 24:327-338. [PMID: 34446993 PMCID: PMC8370153 DOI: 10.4103/aian.aian_1180_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Myoclonus is a hyperkinetic movement disorder characterized by a sudden, brief, involuntary jerk. Positive myoclonus is caused by abrupt muscle contractions, while negative myoclonus by sudden cessation of ongoing muscular contractions. Myoclonus can be classified in various ways according to body distribution, relation to activity, neurophysiology, and etiology. The neurophysiological classification of myoclonus by means of electrophysiological tests is helpful in guiding the best therapeutic strategy. Given the diverse etiologies of myoclonus, a thorough history and detailed physical examination are key to the evaluation of myoclonus. These along with basic laboratory testing and neurophysiological studies help in narrowing down the clinical possibilities. Though symptomatic treatment is required in the majority of cases, treatment of the underlying etiology should be the primary aim whenever possible. Symptomatic treatment is often not satisfactory, and a combination of different drugs is often required to control the myoclonus. This review addresses the etiology, classification, clinical approach, and management of myoclonus.
Collapse
Affiliation(s)
- Mitesh Chandarana
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Udit Saraf
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K P Divya
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Syam Krishnan
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Asha Kishore
- Comprehensive Care Centre for Movement Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
8
|
Myoclonic dystonia (DYT11) responsive to lacosamide: a case report. Acta Neurol Belg 2021; 122:1631-1632. [PMID: 34273089 DOI: 10.1007/s13760-021-01756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
|
9
|
Cazurro-Gutiérrez A, Marcé-Grau A, Correa-Vela M, Salazar A, Vanegas MI, Macaya A, Bayés À, Pérez-Dueñas B. ε-Sarcoglycan: Unraveling the Myoclonus-Dystonia Gene. Mol Neurobiol 2021; 58:3938-3952. [PMID: 33886091 DOI: 10.1007/s12035-021-02391-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 01/23/2023]
Abstract
Myoclonus-dystonia (MD) is a rare childhood-onset movement disorder, with an estimated prevalence of about 2 per 1,000,.000 in Europe, characterized by myoclonic jerks in combination with focal or segmental dystonia. Pathogenic variants in the gene encoding ε-sarcoglycan (SGCE), a maternally imprinted gene, are the most frequent genetic cause of MD. To date, the exact role of ε-sarcoglycan and the pathogenic mechanisms that lead to MD are still unknown. However, there are more than 40 reported isoforms of human ε-sarcoglycan, pointing to a complex biology of this protein. Additionally, some of these are brain-specific isoforms, which may suggest an important role within the central nervous system. In the present review, we aim to provide an overview of the current state of knowledge of ε-sarcoglycan. We will focus on the genetic landscape of SGCE and the presence and plausible role of ε-sarcoglycan in the brain. Finally, we discuss the importance of the brain-specific isoforms and hypothesize that SGCE may play essential roles in normal synaptic functioning and their alteration will be strongly related to MD.
Collapse
Affiliation(s)
- Ana Cazurro-Gutiérrez
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Marcé-Grau
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
| | - Marta Correa-Vela
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ainara Salazar
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
- Paediatric Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - María I Vanegas
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Alfons Macaya
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Paediatric Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Àlex Bayés
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Molecular Physiology of the Synapse Laboratory, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Belén Pérez-Dueñas
- Paediatric Neurology Research Group, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Research Institute, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
- Paediatric Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain.
| |
Collapse
|
10
|
Mure H, Toyoda N, Morigaki R, Fujita K, Takagi Y. Clinical Outcome and Intraoperative Neurophysiology of the Lance-Adams Syndrome Treated with Bilateral Deep Brain Stimulation of the Globus Pallidus Internus: A Case Report and Review of the Literature. Stereotact Funct Neurosurg 2020; 98:399-403. [PMID: 32894852 DOI: 10.1159/000509318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Lance-Adams syndrome (LAS) is a myoclonus syndrome caused by hypoxic-ischemic encephalopathy. LAS cases could be refractory to first-line medications, and the neuronal mechanism underlying LAS pathology remains unknown. OBJECTIVES To describe a patient with LAS who underwent bilateral globus pallidus internus (GPi) stimulation and discuss the pathophysiology of LAS with intraoperative electrophysiological findings. PATIENTS A 79-year-old woman presented with a history of cardiopulmonary arrest due to internal carotid artery rupture following carotid endarterectomy after successful cardiopulmonary resuscitation. However, within 1 month, the patient developed sensory stimulation-induced myoclonus in her face and extremities. Because her myoclonic symptoms were refractory to pharmacotherapy, deep brain stimulation of the GPi was performed 1 year after the hypoxic attack. RESULTS Continuous bilateral GPi stimulation with optimal parameter settings remarkably improved the patient's myoclonic symptoms. At the 2-year follow-up, her Unified Myoclonus Rating Scale score decreased from 90 to 24. In addition, we observed burst firing and interburst pause patterns on intraoperative microelectrode recordings of the bilateral GPi and stimulated this area as the therapeutic target. CONCLUSION Our results show that impairment in the basal ganglion circuitry might be involved in the pathogenesis of myoclonus in patients with LAS.
Collapse
Affiliation(s)
- Hideo Mure
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan, .,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan,
| | - Naoto Toyoda
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan.,Department of Advanced Brain Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koji Fujita
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima, Japan.,Department of Clinical Neuroscience, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Advanced Brain Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| |
Collapse
|
11
|
Atkinson-Clement C, Tarrano C, Porte CA, Wattiez N, Delorme C, McGovern EM, Brochard V, Thobois S, Tranchant C, Grabli D, Degos B, Corvol JC, Pedespan JM, Krystkoviak P, Houeto JL, Degardin A, Defebvre L, Valabregue R, Rosso C, Apartis E, Vidailhet M, Pouget P, Roze E, Worbe Y. Dissociation in reactive and proactive inhibitory control in Myoclonus dystonia. Sci Rep 2020; 10:13933. [PMID: 32811896 PMCID: PMC7434767 DOI: 10.1038/s41598-020-70926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Abstract
Myoclonus-dystonia (MD) is a syndrome characterized by myoclonus of subcortical origin and dystonia, frequently associated with psychiatric comorbidities. The motor and psychiatric phenotypes of this syndrome likely result from cortico-striato-thamalo-cerebellar-cortical pathway dysfunction. We hypothesized that reactive and proactive inhibitory control may be altered in these patients. Using the Stop Signal Task, we assessed reactive and proactive inhibitory control in MD patients with (n = 12) and without (n = 21) deep brain stimulation of the globus pallidus interna and compared their performance to matched healthy controls (n = 24). Reactive inhibition was considered as the ability to stop an already initiated action and measured using the stop signal reaction time. Proactive inhibition was assessed through the influence of several consecutive GO or STOP trials on decreased response time or inhibitory process facilitation. The proactive inhibition was solely impaired in unoperated MD patients. Patients with deep brain stimulation showed impairment in reactive inhibition, independent of presence of obsessive–compulsive disorders. This impairment in reactive inhibitory control correlated with intrinsic severity of myoclonus (i.e. pre-operative score). The results point to a dissociation in reactive and proactive inhibitory control in MD patients with and without deep brain stimulation of the globus pallidus interna.
Collapse
Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Clement Tarrano
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Department of Neurology, CHU Côte de Nacre, Université Caen Normandie, Caen, France
| | - Camille-Albane Porte
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Nicolas Wattiez
- Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne University, Paris, France
| | - Cécile Delorme
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Eavan M McGovern
- Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Department of Neurology, St Vincent's University Hospital Dublin, Dublin, Ireland
| | - Vanessa Brochard
- INSERM/APHP, Centre d'Investigation Clinique 1422, Paris, France
| | - Stéphane Thobois
- Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, University of Lyon, Bron, France.,Service de Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - David Grabli
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Bertrand Degos
- Department of Neurology, Hôpital Avicennes, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Jean-Christophe Corvol
- Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre Krystkoviak
- Department of Neurology, Amiens University Medical Center, Amiens, France
| | - Jean-Luc Houeto
- Service de Neurologie, CIC-INSERM 1402, CHU de Poitiers, Poitiers, France
| | - Adrian Degardin
- Department of Neurology, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Luc Defebvre
- INSERM, U1171-Degenerative and Vascular Cognitive Disorders, CHU Lille, Université de Lille, Lille, France.,Lille Centre of Excellence for Neurodegenerative Diseases (LiCEND), Lille, France
| | - Romain Valabregue
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, Paris, France
| | - Charlotte Rosso
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Urgences Cérébro-Vasculaires, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Emmanuelle Apartis
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Vidailhet
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Pierre Pouget
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Emmanuel Roze
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yulia Worbe
- Sorbonne University, 75005, Paris, France. .,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France. .,Movement Investigation and Therapeutics Team, Paris, France. .,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| |
Collapse
|
12
|
Fearon C, Peall KJ, Vidailhet M, Fasano A. Medical management of myoclonus-dystonia and implications for underlying pathophysiology. Parkinsonism Relat Disord 2020; 77:48-56. [PMID: 32622300 DOI: 10.1016/j.parkreldis.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022]
Abstract
Myoclonus-dystonia is an early onset genetic disorder characterised by subcortical myoclonus and less prominent dystonia. Its primary causative gene is the epsilon-sarcoglycan gene but the syndrome of "myoclonic dystonia" has been shown to be a heterogeneous group of genetic disorders. The underlying pathophysiology of myoclonus-dystonia is incompletely understood, although it may relate to dysfunction of striatal monoamine neurotransmission or disruption of cerebellothalamic networks (possibly via a GABAergic deficit of Purkinje cells). A broad range of oral medical therapies have been used in the treatment of myoclonus-dystonia with a varying response, and limited data relating to efficacy and tolerability, yet this condition responds dramatically to alcohol. Few well conducted randomized controlled trials have been undertaken leading to an empirical ad hoc approach for many patients. We review the current evidence for pharmacological therapies in myoclonus-dystonia, discuss implications for underlying pathogenesis of the condition and propose a treatment algorithm for these patients.
Collapse
Affiliation(s)
- Conor Fearon
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kathryn J Peall
- Neurosciences and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, CF24 4HQ, UK
| | - Marie Vidailhet
- AP-HP, Hôpital Salpetriere, Department of Neurology, F-75013, Paris, France; Institut du Cerveau et de la Moelle, ICM, F-75013, Paris, France; INSERM U1127, CNRS UMR 7225, Sorbonne Unversité, F-75013, Paris, France
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
| |
Collapse
|
13
|
Merchant SHI, Vial-Undurraga F, Leodori G, van Gerpen JA, Hallett M. Myoclonus: An Electrophysiological Diagnosis. Mov Disord Clin Pract 2020; 7:489-499. [PMID: 32626792 DOI: 10.1002/mdc3.12986] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/03/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background Many different movement disorders have similar "jerk-like" phenomenology and can be misconstrued as myoclonus. Different types of myoclonus also share similar phenomenological characteristics that can be difficult to distinguish solely based on clinical exam. However, they have distinctive physiologic characteristics that can help refine categorization of jerk-like movements. Objectives In this review, we briefly summarize the clinical, physiologic, and pathophysiologic characteristics of different types of myoclonus. The methodology and technical considerations for the electrophysiologic assessment of jerk-like movements are reviewed. A simplistic pragmatic approach for the classification of myoclonus and other jerk-like movements based on objective electrophysiologic characteristics is proposed. Conclusions Clinical neurophysiology is an underutilized tool in the diagnosis and treatment of movement disorders. Various jerk-like movements have distinguishing physiologic characteristics, differentiated in the milliseconds range, which is beyond human capacity. We argue that the categorization of movement disorders as myoclonus can be refined based on objective physiology that can have important prognostic and therapeutic implications.
Collapse
Affiliation(s)
| | | | | | - Jay A van Gerpen
- Department of Neurology University of Alabama Huntsville Alabama USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda Maryland USA
| |
Collapse
|
14
|
Valsky D, Blackwell KT, Tamir I, Eitan R, Bergman H, Israel Z. Real-time machine learning classification of pallidal borders during deep brain stimulation surgery. J Neural Eng 2020; 17:016021. [PMID: 31675740 DOI: 10.1088/1741-2552/ab53ac] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) in patients with Parkinson's disease and dystonia improves motor symptoms and quality of life. Traditionally, pallidal borders have been demarcated by electrophysiological microelectrode recordings (MERs) during DBS surgery. However, detection of pallidal borders can be challenging due to the variability of the firing characteristics of neurons encountered along the trajectory. MER can also be time-consuming and therefore costly. Here we show the feasibility of real-time machine learning classification of striato-pallidal borders to assist neurosurgeons during DBS surgery. APPROACH An electrophysiological dataset from 116 trajectories of 42 patients consisting of 11 774 MER segments of background spiking activity in five classes of disease was used to train the classification algorithm. The five classes included awake Parkinson's disease patients, as well as awake and lightly anesthetized genetic and non-genetic dystonia patients. A machine learning algorithm was designed to provide prediction of the striato-pallidal borders, based on hidden Markov models (HMMs) and the L1-distance measure in normalized root mean square (NRMS) and power spectra of the MER. We tested its performance prospectively against the judgment of three electrophysiologists in the operating rooms of three hospitals using newly collected data. MAIN RESULTS The awake and the light anesthesia dystonia classes could be merged. Using MER NRMS and spectra, the machine learning algorithm was on par with the performance of the three electrophysiologists across the striatum-GPe, GPe-GPi, and GPi-exit transitions for all disease classes. SIGNIFICANCE Machine learning algorithms enable real-time GPi navigation systems to potentially shorten the duration of electrophysiological mapping of pallidal borders, while ensuring correct pallidal border detection.
Collapse
Affiliation(s)
- Dan Valsky
- The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University, Jerusalem, Israel. Author to whom any correspondence should be addressed
| | | | | | | | | | | |
Collapse
|
15
|
Wang X, Yu X. Deep brain stimulation for myoclonus dystonia syndrome: a meta-analysis with individual patient data. Neurosurg Rev 2020; 44:451-462. [PMID: 31900736 DOI: 10.1007/s10143-019-01233-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/26/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022]
Abstract
Good outcomes have been reported in deep brain stimulation (DBS) for myoclonus-dystonia syndrome (M-D), a heritable disease characterized by childhood-onset myoclonic jerks and dystonia in the upper body. This meta-analysis was to evaluate the clinical outcomes consecutively, compare the stimulation targets, and identify potential prognostic factors. A systematic literature search was performed on PubMed, Web of Science, and Embase. The primary outcome was the percent improvement in Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) scores for dystonia and Unified Myoclonus Rating Scale (UMRS) scores for myoclonus at the last follow-up visit. BFMDRS-disability scores of the patients were also summarized. Pearson correlation analyses were performed to identify the myoclonus and dystonia outcome predictors. Thirty-one studies reporting 71 patients were included. There were significant improvements in BFMDRS-M and BFMDRS-disability scores in each time category and at the last follow-up visit. Mean improvement (%) in UMRS was 79.5 ± 18.2, and 94.1% of the patients showed > 50% improvement in UMRS scores at the last follow-up visit. There was a significant trend toward improved myoclonus outcome with older age at onset and shorter disease duration. Most of the adverse events were mild and transient, and pallidal stimulation seemed to be better with respect to fewer stimulation-induced events. Based on the current data, DBS is effective for even the severe M-D. Surgery at an early stage may predict a better outcome. Although targets do not serve as the outcome predictors, pallidal stimulation may be preferred due to fewer stimulation-induced events.
Collapse
Affiliation(s)
- Xin Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- School of Medicine, Nankai University, Tianjin, China.
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
16
|
Washburn S, Fremont R, Moreno-Escobar MC, Angueyra C, Khodakhah K. Acute cerebellar knockdown of Sgce reproduces salient features of myoclonus-dystonia (DYT11) in mice. eLife 2019; 8:52101. [PMID: 31868164 PMCID: PMC6959989 DOI: 10.7554/elife.52101] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Myoclonus dystonia (DYT11) is a movement disorder caused by loss-of-function mutations in SGCE and characterized by involuntary jerking and dystonia that frequently improve after drinking alcohol. Existing transgenic mouse models of DYT11 exhibit only mild motor symptoms, possibly due to rodent-specific developmental compensation mechanisms, which have limited the study of neural mechanisms underlying DYT11. To circumvent potential compensation, we used short hairpin RNA (shRNA) to acutely knock down Sgce in the adult mouse and found that this approach produced dystonia and repetitive, myoclonic-like, jerking movements in mice that improved after administration of ethanol. Acute knockdown of Sgce in the cerebellum, but not the basal ganglia, produced motor symptoms, likely due to aberrant cerebellar activity. The acute knockdown model described here reproduces the salient features of DYT11 and provides a platform to study the mechanisms underlying symptoms of the disorder, and to explore potential therapeutic options.
Collapse
Affiliation(s)
- Samantha Washburn
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Rachel Fremont
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Maria Camila Moreno-Escobar
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Chantal Angueyra
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| |
Collapse
|
17
|
Myoclonus-dystonia: Distinctive motor and non-motor phenotype from other dystonia syndromes. Parkinsonism Relat Disord 2019; 69:85-90. [DOI: 10.1016/j.parkreldis.2019.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/05/2019] [Accepted: 10/16/2019] [Indexed: 11/22/2022]
|
18
|
Tarrano C, Wattiez N, Delorme C, McGovern EM, Brochard V, Thobois S, Tranchant C, Grabli D, Degos B, Corvol J, Pedespan J, Krystkoviak P, Houeto J, Degardin A, Defebvre L, Valabrègue R, Vidailhet M, Pouget P, Roze E, Worbe Y. Visual Sensory Processing is Altered in Myoclonus Dystonia. Mov Disord 2019; 35:151-160. [DOI: 10.1002/mds.27857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/04/2019] [Accepted: 08/08/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Clément Tarrano
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
- Department of Neurology CHU Côte de Nacre, Université Caen Normandie Caen France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Cécile Delorme
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Eavan M. McGovern
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
- Department of Neurology St Vincent's University Hospital Dublin Dublin Ireland
| | | | - Stéphane Thobois
- University of Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C Bron France
| | - Christine Tranchant
- Service de Neurologie Hôpitaux Universitaires de Strasbourg, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM‐U964/CNRS‐UMR7104/Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg Strasbourg France
| | - David Grabli
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Bertrand Degos
- Assistance Publique‐Hôpitaux de Paris, Department of Neurology Hôpital Avicennes Bobigny France
| | - Jean‐Christophe Corvol
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | | | | | - Jean‐Luc Houeto
- Service de Neurologie, CIC‐INSERM 1402, CHU de Poitiers Poitiers France
| | - Adrian Degardin
- Department of Neurology Centre hospitalier de Tourcoing Tourcoing France
| | - Luc Defebvre
- Université de Lille, CHU Lille, INSERM, U1171–Degenerative & Vascular Cognitive Disorders, Lille, France; Lille Centre of Excellence for Neurodegenerative Diseases (LiCEND) Lille France
| | - Romain Valabrègue
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Centre de NeuroImagerie de Recherche (CENIR) Sorbonne Université, UMR S 975, CNRS UMR 7225, ICM Paris France
| | - Marie Vidailhet
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Pierre Pouget
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
| | - Emmanuel Roze
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Assistance Publique‐Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié‐Salpêtrière, Paris, France; Department of Neurology Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Yulia Worbe
- Sorbonne Université Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM Paris France
- Department of Neurophysiology Saint‐Antoine Hospital, Assistance Publique‐Hôpitaux de Paris Paris France
| |
Collapse
|
19
|
Menozzi E, Balint B, Latorre A, Valente EM, Rothwell JC, Bhatia KP. Twenty years on: Myoclonus-dystonia and ε-sarcoglycan - neurodevelopment, channel, and signaling dysfunction. Mov Disord 2019; 34:1588-1601. [PMID: 31449710 DOI: 10.1002/mds.27822] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/19/2019] [Accepted: 07/14/2019] [Indexed: 12/26/2022] Open
Abstract
Myoclonus-dystonia is a clinical syndrome characterized by a typical childhood onset of myoclonic jerks and dystonia involving the neck, trunk, and upper limbs. Psychiatric symptomatology, namely, alcohol dependence and phobic and obsessive-compulsive disorder, is also part of the clinical picture. Zonisamide has demonstrated effectiveness at reducing both myoclonus and dystonia, and deep brain stimulation seems to be an effective and long-lasting therapeutic option for medication-refractory cases. In a subset of patients, myoclonus-dystonia is associated with pathogenic variants in the epsilon-sarcoglycan gene, located on chromosome 7q21, and up to now, more than 100 different pathogenic variants of the epsilon-sarcoglycan gene have been described. In a few families with a clinical phenotype resembling myoclonus-dystonia associated with distinct clinical features, variants have been identified in genes involved in novel pathways such as calcium channel regulation and neurodevelopment. Because of phenotypic similarities with epsilon-sarcoglycan gene-related myoclonus-dystonia, these conditions can be collectively classified as "myoclonus-dystonia syndromes." In the present article, we present myoclonus-dystonia caused by epsilon-sarcoglycan gene mutations, with a focus on genetics and underlying disease mechanisms. Second, we review those conditions falling within the spectrum of myoclonus-dystonia syndromes, highlighting their genetic background and involved pathways. Finally, we critically discuss the normal and pathological function of the epsilon-sarcoglycan gene and its product, suggesting a role in the stabilization of the dopaminergic membrane via regulation of calcium homeostasis and in the neurodevelopmental process involving the cerebello-thalamo-pallido-cortical network. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Elisa Menozzi
- Department of Biomedical, Metabolic and Neural Sciences, University-Hospital of Modena and Reggio Emilia, Modena, Italy.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The present study will highlight recent advances in the field of myoclonus-dystonia with a focus on clinical aspects, pathogenesis, and treatment. We will also discuss genetics, classification issues, and diagnostic criteria. RECENT FINDINGS Myoclonus-dystonia is a clinical syndrome corresponding to the phenotype linked to SGCE, the main causative gene. Childhood-onset myoclonus that predominates over dystonia with prominent upper body involvement, an absence of truncal dystonia, associated anxiety or compulsivity, and a positive family history are helpful diagnostic clues. Recent studies demonstrated that zonisamide is an interesting therapeutic option in myoclonus-dystonia, and that bilateral pallidal stimulation has major and lasting therapeutic effects. Accumulating evidence suggests that an alteration in cerebello-thalamic pathway function may play a prominent role and that this is possibly related to a GABAergic deficit reflecting Purkinje cell dysfunction. Impaired striatal plasticity and disturbed serotonin homeostasis may also be implicated. Newly available cellular and rodent models may further assist in investigating the pathogenesis of this disorder. SUMMARY Comprehensive analysis of the phenotype and precise classification are important in patients with myoclonus and dystonia to identify homogeneous groups of patients. This is critical to guide tailored therapeutic strategies and promote effective research.
Collapse
|
21
|
Eltoprazine prevents levodopa-induced dyskinesias by reducing causal interactions for theta oscillations in the dorsolateral striatum and substantia nigra pars reticulate. Neuropharmacology 2019; 148:1-10. [PMID: 30612008 DOI: 10.1016/j.neuropharm.2018.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
Oscillatory activities within basal ganglia (BG) circuitry in L-DOPA induced dyskinesia (LID), a condition that occurs in patients with Parkinson disease (PD), are not well understood. The aims of this study were firstly to investigate oscillations in main BG input and output structures-the dorsolateral striatum (dStr) and substantia nigra pars reticulata (SNr), respectively- including the direction of oscillation information flow, and secondly to investigate the effects of 5-HT1A/B receptor agonism with eltoprazine on oscillatory activities and abnormal involuntary movements (AIMs) characteristic. To this end, we conducted local field potential (LFP) electrophysiology in the dStr and SNr of LID rats simultaneous with AIM scoring. The LFP data were submitted to power spectral density, coherence, and partial Granger causality analyses. AIM data were analyzed relative to simultaneous oscillatory activities, with and without eltoprazine. We obtained four major findings. 1) Theta band (5-8 Hz) oscillations were enhanced in the dStr and SNr of LID rats. 2) Theta power correlated with AIM scores in the 180-min period after the last LID-inducing L-DOPA injection, but not with daily summed AIM scores during LID development. 3) Oscillatory information flowed from the dStr to the SNr. 4) Chronic eltoprazine reduced BG theta activity in LID rats and normalized information flow directionality, relative to that in LID rats not given eltoprazine. These results indicate that dStr activity plays a determinative role in the causal interactions of theta oscillations and that serotonergic inhibition may suppress dyskinesia by reducing dStr-SNr theta activity and restoring theta network information flow.
Collapse
|
22
|
Kosutzka Z, Tisch S, Bonnet C, Ruiz M, Hainque E, Welter M, Viallet F, Karachi C, Navarro S, Jahanshahi M, Rivaud‐Pechoux S, Grabli D, Roze E, Vidailhet M. Long‐term GPi‐DBS improves motor features in myoclonus‐dystonia and enhances social adjustment. Mov Disord 2018; 34:87-94. [DOI: 10.1002/mds.27474] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/26/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Zuzana Kosutzka
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- Second Department of Neurology, Faculty of Medicine Comenius University Bratislava Slovakia
| | - Stephen Tisch
- Department of Neurology, St Vincent's Hospital University of New South Wales Sydney Australia
| | - Cecilia Bonnet
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| | - Marta Ruiz
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| | - Elodie Hainque
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| | - Marie‐Laure Welter
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- Neurophysiology Department CHU Rouen Rouen France
| | - Francois Viallet
- Laboratoire Parole et Langage, UMR 7309 Aix‐Marseille University Aix‐en‐Provence France
- Neurology Department Aix en Provence Hospital Aix‐en‐Provence France
| | - Carine Karachi
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurochirurgie Paris France
| | - Soledad Navarro
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurochirurgie Paris France
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience & Movement Disorders and the National Hospital for Neurology & Neurosurgery London UK
| | - Sophie Rivaud‐Pechoux
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
| | - David Grabli
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| | - Emmanuel Roze
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| | - Marie Vidailhet
- Sorbonne Université, Faculté de Médecine; CNRS UMR 7225, UMR S 1127 Institut du Cerveau et de la Moelle épinière Paris France
- APHP, Hôpital Salpêtrière Département de Neurologie Paris France
| |
Collapse
|
23
|
Maltese M, Martella G, Imbriani P, Schuermans J, Billion K, Sciamanna G, Farook F, Ponterio G, Tassone A, Santoro M, Bonsi P, Pisani A, Goodchild RE. Abnormal striatal plasticity in a DYT11/SGCE myoclonus dystonia mouse model is reversed by adenosine A2A receptor inhibition. Neurobiol Dis 2017; 108:128-139. [PMID: 28823931 DOI: 10.1016/j.nbd.2017.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/31/2017] [Accepted: 08/16/2017] [Indexed: 02/02/2023] Open
Abstract
Striatal dysfunction is implicated in many movement disorders. However, the precise nature of defects often remains uncharacterized, which hinders therapy development. Here we examined striatal function in a mouse model of the incurable movement disorder, myoclonus dystonia, caused by SGCE mutations. Using RNAseq we found surprisingly normal gene expression, including normal levels of neuronal subclass markers to strongly suggest that striatal microcircuitry is spared by the disease insult. We then functionally characterized Sgce mutant medium spiny projection neurons (MSNs) and cholinergic interneurons (ChIs). This revealed normal intrinsic electrophysiological properties and normal responses to basic excitatory and inhibitory neurotransmission. Nevertheless, high-frequency stimulation in Sgce mutants failed to induce normal long-term depression (LTD) at corticostriatal glutamatergic synapses. We also found that pharmacological manipulation of MSNs by inhibiting adenosine 2A receptors (A2AR) restores LTD, again pointing to structurally intact striatal circuitry. The fact that Sgce loss specifically inhibits LTD implicates this neurophysiological defect in myoclonus dystonia, and emphasizes that neurophysiological changes can occur in the absence of broad striatal dysfunction. Further, the positive effect of A2AR antagonists indicates that this drug class be tested in DYT11/SGCE dystonia.
Collapse
Affiliation(s)
- M Maltese
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - G Martella
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - P Imbriani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Jeroen Schuermans
- VIB-KU Leuven Center for Brain & Disease Research, 3000 Leuven, Belgium
| | - Karolien Billion
- VIB-KU Leuven Center for Brain & Disease Research, 3000 Leuven, Belgium; KU Leuven, Department of Neurosciences, 3000 Leuven, Belgium.
| | - G Sciamanna
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - Febin Farook
- VIB-KU Leuven Center for Brain & Disease Research, 3000 Leuven, Belgium
| | - G Ponterio
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - A Tassone
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - M Santoro
- Fondazione Don Gnocchi, Milan, Italy.
| | - P Bonsi
- Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - A Pisani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
| | - Rose E Goodchild
- VIB-KU Leuven Center for Brain & Disease Research, 3000 Leuven, Belgium; KU Leuven, Department of Neurosciences, 3000 Leuven, Belgium.
| |
Collapse
|
24
|
Ramdhani RA, Frucht SJ, Kopell BH. Improvement of Post-hypoxic Myoclonus with Bilateral Pallidal Deep Brain Stimulation: A Case Report and Review of the Literature. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:461. [PMID: 28616357 PMCID: PMC5468509 DOI: 10.7916/d8nz8dxp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/20/2017] [Indexed: 12/01/2022]
Abstract
Background Post-hypoxic myoclonus (PHM) is a syndrome that occurs when a patient has suffered hypoxic brain injury. The myoclonus is usually multifocal and generalized, often stemming from both cortical and subcortical origins. In severe cases, pharmacological treatments with antiepileptic medications may not satisfactorily control the myoclonus. Methods We present a case of a 23-year-old male with chronic medication refractory PHM following a cardiopulmonary arrest related to an asthmatic attack who improved with bilateral globus pallidus internus (GPi) deep brain stimulation (DBS). We review the clinical features of PHM, as well as the preoperative and postoperative Unified Myoclonus Rating Scale scores and DBS programming parameters in this patient and compare them with the three other published PHM-DBS cases in the literature. Results This patient experienced an alleviation of myoclonic jerks at rest and a 39% reduction in action myoclonus with improvement in both positive and negative myoclonus with bilateral GPi-DBS. High frequency stimulation (130 Hz) with amplitudes >2.5 V were needed for the therapeutic response. Discussion We demonstrate a robust improvement in a medication refractory PHM patient with bilateral GPi-DBS, and suggest that it is a viable therapeutic option for debilitating post-hypoxic myoclonus.
Collapse
Affiliation(s)
- Ritesh A Ramdhani
- Division of Movement Disorders, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven J Frucht
- Division of Movement Disorders, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian H Kopell
- Division of Movement Disorders, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
25
|
McClelland VM, Valentin A, Rey HG, Lumsden DE, Elze MC, Selway R, Alarcon G, Lin JP. Differences in globus pallidus neuronal firing rates and patterns relate to different disease biology in children with dystonia. J Neurol Neurosurg Psychiatry 2016; 87:958-67. [PMID: 26848170 PMCID: PMC5013118 DOI: 10.1136/jnnp-2015-311803] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/24/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The pathophysiology underlying different types of dystonia is not yet understood. We report microelectrode data from the globus pallidus interna (GPi) and globus pallidus externa (GPe) in children undergoing deep brain stimulation (DBS) for dystonia and investigate whether GPi and GPe firing rates differ between dystonia types. METHODS Single pass microelectrode data were obtained to guide electrode position in 44 children (3.3-18.1 years, median 10.7) with the following dystonia types: 14 primary, 22 secondary Static and 8 progressive secondary to neuronal brain iron accumulation (NBIA). Preoperative stereotactic MRI determined coordinates for the GPi target. Digitised spike trains were analysed offline, blind to clinical data. Electrode placement was confirmed by a postoperative stereotactic CT scan. FINDINGS We identified 263 GPi and 87 GPe cells. Both GPi and GPe firing frequencies differed significantly with dystonia aetiology. The median GPi firing frequency was higher in the primary group than in the secondary static group (13.5 Hz vs 9.6 Hz; p=0.002) and higher in the NBIA group than in either the primary (25 Hz vs 13.5 Hz; p=0.006) or the secondary static group (25 Hz vs 9.6 Hz; p=0.00004). The median GPe firing frequency was higher in the NBIA group than in the secondary static group (15.9 Hz vs 7 Hz; p=0.013). The NBIA group also showed a higher proportion of regularly firing GPi cells compared with the other groups (p<0.001). A higher proportion of regular GPi cells was also seen in patients with fixed/tonic dystonia compared with a phasic/dynamic dystonia phenotype (p<0.001). The GPi firing frequency showed a positive correlation with 1-year outcome from DBS measured by improvement in the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m) score (p=0.030). This association was stronger for the non-progressive patients (p=0.006). INTERPRETATION Pallidal firing rates and patterns differ significantly with dystonia aetiology and phenotype. Identification of specific firing patterns may help determine targets and patient-specific protocols for neuromodulation therapy. FUNDING National Institute of Health Research, Guy's and St. Thomas' Charity, Dystonia Society UK, Action Medical Research, German National Academic Foundation.
Collapse
Affiliation(s)
- V M McClelland
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - A Valentin
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK Department of Basic and Clinical Neuroscience, King's College London, London, UK Department of Human Physiology, Faculty of Medicine, Complutense University, Madrid, Spain
| | - H G Rey
- Centre for Systems Neuroscience, University of Leicester, Leicester, UK
| | - D E Lumsden
- Rayne Institute, King's College London, London, UK Complex Motor Disorder Service, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M C Elze
- Department of Statistics, University of Warwick, Coventry, UK
| | - R Selway
- Department of Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - G Alarcon
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK Department of Basic and Clinical Neuroscience, King's College London, London, UK Department of Human Physiology, Faculty of Medicine, Complutense University, Madrid, Spain
| | - J-P Lin
- Complex Motor Disorder Service, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
26
|
Local field potential oscillations of the globus pallidus in cervical and tardive dystonia. J Neurol Sci 2016; 366:68-73. [DOI: 10.1016/j.jns.2016.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/16/2016] [Accepted: 04/16/2016] [Indexed: 01/06/2023]
|
27
|
Ramdhani RA, Frucht SJ, Behnegar A, Kopell BH. Improvement of Isolated Myoclonus Phenotype in Myoclonus Dystonia after Pallidal Deep Brain Stimulation. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:369. [PMID: 26989574 PMCID: PMC4790205 DOI: 10.7916/d8f47p0c] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/05/2016] [Indexed: 12/01/2022]
Abstract
Background Myoclonus–dystonia is a condition that manifests predominantly as myoclonic jerks with focal dystonia. It is genetically heterogeneous with most mutations in the epsilon sarcoglycan gene (SGCE). In medically refractory cases, deep brain stimulation (DBS) has been shown to provide marked sustainable clinical improvement, especially in SGCE-positive patients. We present two patients with myoclonus–dystonia (one SGCE positive and the other SGCE negative) who have the isolated myoclonus phenotype and had DBS leads implanted in the bilateral globus pallidus internus (GPi). Methods We review their longitudinal Unified Myoclonus Rating Scale scores along with their DBS programming parameters and compare them with published cases in the literature. Results Both patients demonstrated complete amelioration of all aspects of myoclonus within 6–12 months after surgery. The patient with the SGCE-negative mutation responded just as well as the patient who was SGCE positive. High-frequency stimulation (130 Hz) with amplitudes greater than 2.5 V provided therapeutic benefit. Discussion This case series demonstrates that high frequency GPi-DBS is effective in treating isolated myoclonus in myoclonus–dystonia, regardless of the presence of SGCE mutation.
Collapse
Affiliation(s)
- Ritesh A Ramdhani
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Movement Disorders, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven J Frucht
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anousheh Behnegar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian H Kopell
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Movement Disorders, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
28
|
Delorme C, Rogers A, Lau B, Francisque H, Welter ML, Vidal SF, Yelnik J, Durr A, Grabli D, Karachi C. Deep brain stimulation of the internal pallidum in Huntington's disease patients: clinical outcome and neuronal firing patterns. J Neurol 2015; 263:290-298. [PMID: 26568561 DOI: 10.1007/s00415-015-7968-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) could treat chorea in Huntington's disease patients. The objectives of this study were to evaluate the efficacy of GPi-DBS to reduce abnormal movements of three patients with Huntington's disease and assess tolerability. Three non-demented patients with severe pharmacoresistant chorea underwent bilateral GPi-DBS and were followed for 30, 24, and 12 months, respectively. Primary outcome measure was the change of the chorea and total motor scores of the Unified Huntington's Disease Rating Scale between pre- and last postoperative assessments. Secondary outcome measures were motor changes between ventral versus dorsal and between on- and off- GPi-DBS. GPi neuronal activities were analyzed and compared to those obtained in patients with Parkinson's disease. No adverse effects occurred. Chorea decreased in all patients (13, 67 and 29%) postoperatively. Total motor score decreased in patient 2 (19.6%) and moderately increased in patients 1 and 3 (17.5 and 1.7%), due to increased bradykinesia and dysarthria. Ventral was superior to dorsal GPi-DBS to control chorea. Total motor score increased dramatically off-stimulation compared to ventral GPi-DBS (70, 63 and 19%). Cognitive and psychic functions were overall unchanged. Lower mean rate and less frequent bursting activity were found in Huntington's disease compared to Parkinson's disease patients. Ventral GPi-DBS sustainably reduced chorea, but worsened bradykinesia and dysarthria. Based on these results and previous published reports, we propose to select non-demented HD patients with severe chorea, and a short disease evolution as the best candidates for GPi-DBS.
Collapse
Affiliation(s)
- Cécile Delorme
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Alister Rogers
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France. .,Neurosurgery department, Groupe Hospitalier Pitié-Salpêtrière, Brain and Spine Institute, CHU Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France.
| | - Brian Lau
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Hélène Francisque
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Marie-Laure Welter
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Sara Fernandez Vidal
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France.,Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle épinière, 75013, Paris, France
| | - Jérôme Yelnik
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Alexandra Durr
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - David Grabli
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Carine Karachi
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France.,Neurosurgery department, Groupe Hospitalier Pitié-Salpêtrière, Brain and Spine Institute, CHU Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France
| |
Collapse
|