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Sabry HA, Zahra MM. Icariin attenuates dopaminergic neural loss in haloperidol-induced Parkinsonism in rats via GSK-3β and tyrosine hydroxylase regulation mechanism. J Chem Neuroanat 2024; 136:102385. [PMID: 38160784 DOI: 10.1016/j.jchemneu.2023.102385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/09/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
Parkinson's Disease (PD) is an age-dependent, incessant, dynamic neurodegenerative illness. In animal models, the administration of the dopaminergic D2 antagonist Haloperidol (HP) affects the nigrostriatal pathway, inducing catalepsy, a state of immobility like PD, bradykinesia, and akinesia. The present study investigated the neural effects of Icariin (ICA), a flavonoid derived from Herba Epimedii, against HP-induced PD in rats compared to a standard drug levodopa (L-DOPA). Twenty-four adult male rats were divided into 4 groups: the control group treated with vehicle, the 2nd group treated with HP intraperitoneally, the 3rd group treated with the same dose of HP+L-DOPA orally, and the 4th one, treated with the same dose of HP+ICA orally. All the groups were treated for fourteen consecutive days. Two days before the last dose, locomotor activity was assessed in open field and rotarod tasks. At the end of the experiment, the malondialdehyde, nitric oxide (NO), iron, glycogen synthase kinase-3beta (GSK-3β), and tyrosine hydroxylase (TH) contents, glutathione S-transferase, catalase, superoxide dismutase, activities were estimated in the midbrain. Also, cortex and midbrain monoamine contents (norepinephrine, dopamine, and serotonin) were determined. Moreover, the midbrain histopathology was detected in all treated groups. The results suggested that the neuroleptic effect of HP was completely improved by ICA. This improvement occurred by decreasing the neurotoxicity via lowering midbrain lipid peroxidation, NO, GSK-3β contents, increasing antioxidant biomarkers, TH, and recovering the treated groups' cortex and midbrain monoamines contents. In conclusion, this study suggests that ICA is a suitable treatment for Parkinson's induced by HP.
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Affiliation(s)
- Hend A Sabry
- Zoology Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt.
| | - Mai M Zahra
- Zoology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
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Vilanakis E, Papakonstantinou E, Paramera E, Argyri I, Drakou E, Kokkinou E, Zouvelou V, Outsika C, Pons R. Cerebrospinal Fluid Concentrations of Neurotransmitters in a Greek Pediatric Reference Population. Neuropediatrics 2023; 54:126-133. [PMID: 36442788 DOI: 10.1055/a-1988-2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Biogenic amines and pterins analysis in cerebrospinal fluid (CSF) are reliable biomarkers for the diagnosis of inherited disorders of monoamine neurotransmitters. OBJECTIVE The objectives of this study were the establishment of reference values of CSF biogenic amine metabolites in a cohort of Greek children, the detection of primary defects of biogenic amine metabolism, and the assessment of biogenic amine metabolites in children with different neurological disorders. METHODS CSF biogenic amine metabolites and pterins (biopterin and neopterin) were analyzed using high-performance liquid chromatography with electrochemical and fluorescence detection. Three hundred sixty-three samples were analyzed: 60 infants and children with no history of neurological disorder, 6 with inherited disorders of monoamine neurotransmitters, and 297 with diverse neurological disorders. RESULTS Reference values were stratified into six age groups. A strong correlation between homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5HIAA) levels with age was detected (p < 0.001). Two patients were diagnosed with a defect of the biogenic amine synthetic pathway and three with a defect of tetrahydrobiopterin cofactor production. HVA and 5HIAA abnormalities were detected within different groups of neurological disorders, but none followed a specific pattern of HVA and 5HIAA abnormalities. CONCLUSION In the current study, Greek reference values of biogenic amines and pterins in CSF are presented. Five new patients with inherited monoamine neurotransmitter disorders are described. Nonspecific secondary biogenic amine disturbances can be seen in patients with different neurological disorders.
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Affiliation(s)
- Emmanouil Vilanakis
- Pediatric Department, 401 General Military Hospital, Athens, Greece.,First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
| | | | | | - Ioanna Argyri
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Aglaia Kyriakou Hospital, Athens, Greece
| | - Eleni Drakou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
| | - Eleftheria Kokkinou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
| | - Vicky Zouvelou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
| | - Chrysa Outsika
- First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
| | - Roser Pons
- First Department of Pediatrics, National and Kapodistrian University of Athens, Agia Sofia Hospital, Athens, Greece
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3
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Pérez‐Dueñas B, Gorman K, Marcé‐Grau A, Ortigoza‐Escobar JD, Macaya A, Danti FR, Barwick K, Papandreou A, Ng J, Meyer E, Mohammad SS, Smith M, Muntoni F, Munot P, Uusimaa J, Vieira P, Sheridan E, Guerrini R, Cobben J, Yilmaz S, De Grandis E, Dale RC, Pons R, Peall KJ, Leuzzi V, Kurian MA. The Genetic Landscape of Complex Childhood-Onset Hyperkinetic Movement Disorders. Mov Disord 2022; 37:2197-2209. [PMID: 36054588 PMCID: PMC9804670 DOI: 10.1002/mds.29182] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/19/2022] [Accepted: 06/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to better delineate the genetic landscape and key clinical characteristics of complex, early-onset, monogenic hyperkinetic movement disorders. METHODS Patients were recruited from 14 international centers. Participating clinicians completed standardized proformas capturing demographic, clinical, and genetic data. Two pediatric movement disorder experts reviewed available video footage, classifying hyperkinetic movements according to published criteria. RESULTS One hundred forty patients with pathogenic variants in 17 different genes (ADCY5, ATP1A3, DDC, DHPR, FOXG1, GCH1, GNAO1, KMT2B, MICU1, NKX2.1, PDE10A, PTPS, SGCE, SLC2A1, SLC6A3, SPR, and TH) were identified. In the majority, hyperkinetic movements were generalized (77%), with most patients (69%) manifesting combined motor semiologies. Parkinsonism-dystonia was characteristic of primary neurotransmitter disorders (DDC, DHPR, PTPS, SLC6A3, SPR, TH); chorea predominated in ADCY5-, ATP1A3-, FOXG1-, NKX2.1-, SLC2A1-, GNAO1-, and PDE10A-related disorders; and stereotypies were a prominent feature in FOXG1- and GNAO1-related disease. Those with generalized hyperkinetic movements had an earlier disease onset than those with focal/segmental distribution (2.5 ± 0.3 vs. 4.7 ± 0.7 years; P = 0.007). Patients with developmental delay also presented with hyperkinetic movements earlier than those with normal neurodevelopment (1.5 ± 2.9 vs. 4.7 ± 3.8 years; P < 0.001). Effective disease-specific therapies included dopaminergic agents for neurotransmitters disorders, ketogenic diet for glucose transporter deficiency, and deep brain stimulation for SGCE-, KMT2B-, and GNAO1-related hyperkinesia. CONCLUSIONS This study highlights the complex phenotypes observed in children with genetic hyperkinetic movement disorders that can lead to diagnostic difficulty. We provide a comprehensive analysis of motor semiology to guide physicians in the genetic investigation of these patients, to facilitate early diagnosis, precision medicine treatments, and genetic counseling. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Belén Pérez‐Dueñas
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain,Department of Pediatrics, Obstetrics, Gynecology, Preventative Medicine and Public HealthUniversitat Autònoma de BarcelonaBarcelonaSpain,Center for Biomedical Network Research on Rare Diseases (CIBERER) CB06/07/0063BarcelonaSpain
| | - Kathleen Gorman
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Anna Marcé‐Grau
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain
| | | | - Alfons Macaya
- Department of Pediatric NeurologyVall d'Hebron Hospital Universitary and Vall d'Hebrón Research Institute (VHIR).BarcelonaSpain,Department of Pediatrics, Obstetrics, Gynecology, Preventative Medicine and Public HealthUniversitat Autònoma de BarcelonaBarcelonaSpain,Center for Biomedical Network Research on Rare Diseases (CIBERER) CB06/07/0063BarcelonaSpain
| | - Federica R. Danti
- Unit of Child Neurology and Psychiatry, Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Katy Barwick
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom
| | - Apostolos Papandreou
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Joanne Ng
- Gene Transfer Technology GroupInstitute for Women's Health, University College LondonLondonUnited Kingdom
| | - Esther Meyer
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom
| | - Shekeeb S. Mohammad
- Kids Neuroscience Centre and Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyWestmeadNew South WalesAustralia
| | - Martin Smith
- Department of Pediatric NeurologyJohn Radcliffe HospitalOxfordUnited Kingdom
| | - Francesco Muntoni
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Pinki Munot
- Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Johanna Uusimaa
- PEDEGO Research Unit, Department of Children and Adolescents, Medical Research Center OuluOulu University Hospital, University of OuluOuluFinland
| | - Päivi Vieira
- PEDEGO Research Unit, Department of Children and Adolescents, Medical Research Center OuluOulu University Hospital, University of OuluOuluFinland
| | - Eammon Sheridan
- School of MedicineSt James's University Hospital, University of LeedsLeedsUnited Kingdom
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience DepartmentA. Meyer Children's Hospital, University of FlorenceFlorenceItaly
| | - Jan Cobben
- North West Thames Regional Genetic ServiceNorthwick Park HospitalLondonUnited Kingdom
| | - Sanem Yilmaz
- Department of Pediatrics, Division of Child NeurologyEge University Medical FacultyİzmirTurkey
| | - Elisa De Grandis
- Child Neuropsychiatry Unit, Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children's SciencesUniversity of GenoaGenoaItaly
| | - Russell C. Dale
- Institute for Neuroscience and Muscle ResearchChildren's Hospital at Westmead, University of SydneySydneyNew South WalesAustralia
| | - Roser Pons
- First Department of PediatricsAgia Sofia Children's Hospital, National and Kapodistrian University of AthensAthensGreece
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research InstituteInstitute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff UniversityCardiffUnited Kingdom
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human NeuroscienceSapienza University of RomeRomeItaly
| | - Manju A. Kurian
- Developmental Neurosciences ProgrammeGreat Ormond Street–Institute of Child Health, University College LondonLondonUnited Kingdom,Dubowitz neuromuscular CenterGreat Ormond Street Hospital for ChildrenLondonUnited Kingdom
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Gowda VK, Vegda H, Nagarajan BB, Shivappa SK. Clinical Profile and Outcome of Indian Children with Aromatic L-Amino Acid Decarboxylase Deficiency: A primary CSF Neurotransmitter Disorder Mimicking as Dyskinetic Cerebral Palsy. J Pediatr Genet 2020; 10:85-91. [PMID: 33996177 DOI: 10.1055/s-0040-1714690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is a disorder of neurotransmitter synthesis. It presents with psychomotor delay, dystonia, oculogyric crisis, and autonomic features. There is paucity of literature on this disorder. Hence, we are reporting this series with an objective to study profile and outcome of Indian children with AADC deficiency. In this retrospective review, all case records of genetically confirmed cases of AADC deficiency at the pediatric neurology department in a tertiary care hospital, from March 2014 to March 2020, were analyzed. The data were extracted in a predesigned proforma and analyzed. Out of seven cases, five were males. Median age of onset of symptoms was 4 months but median age of diagnosis was 12 months. All of them had developmental delay, oculogyric crisis, dystonia, increased sweating, intermittent fever, feeding and sleep disturbance, irritability, failure to thrive, axial hypotonia with dyskinetic quadriparesis, and normal magnetic resonance imaging (MRI) of brain and electroencephalogram (EEG). All of them were treated with pyridoxal 5-phosphate, trihexyphenidyl and pramipexole and six cases, in addition, were given bromocriptine. One case was additionally treated with selegiline. One case showed good improvement, five showed partial improvement, and one case expired. In conclusion, AADC deficiency should be suspected in any child with dyskinetic quadriparesis, oculogyric crisis, autonomic disturbances like increased sweating, intermittent fever, and sleep disturbance with normal neuroimaging.
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Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Hemadri Vegda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Balamurugan B Nagarajan
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sanjay K Shivappa
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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5
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Hou M, Yang C, Hu J, Guo Y, Liu P, Liu Y, Song J, Wei W, Chen Z. Levodopa is effective in the treatment of three Chinese Tyrosine hydroxylase (TH) deficiency children. Int J Dev Neurosci 2019; 78:28-32. [PMID: 31419477 DOI: 10.1016/j.ijdevneu.2019.08.002] [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: 05/14/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
Tyrosine hydroxylase (TH) deficiency is a rare autosomal recessive inborn error of dopamine transmission, which the deficient gene is at the chromosome 11, also called'Segawa Syndrome'. TH converts tyrosine into L-DOPA, which is the direct precursor of catecholamine biosynthesis. TH deficiency causes a neurological disease with primary extrapyramidal signs and a variable response to L-DOPA. We report three patients in China who were diagnosed with Tyrosine hydroxylase (TH) deficiency by genetic testing and clinical manifestations. After L-DOPA treatment, their condition had sustained improvement.
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Affiliation(s)
- Mei Hou
- Pediatric Department of the Qingdao Women & Children Hospital, No. 6 Tongfu Road, Shandong, 266000, PR China
| | - Chengqing Yang
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
| | - Jingfei Hu
- Pediatric Department of the Qingdao Women & Children Hospital, No. 6 Tongfu Road, Shandong, 266000, PR China
| | - Ya Guo
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
| | - Peipei Liu
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
| | - Yedan Liu
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
| | - Jie Song
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
| | - Wei Wei
- Kangso Medical Inspection Co., Ltd, No. 65 Haidian District, Xingshikou Road Yiyuan Cultural Creative Industry Base C District No. 10, Floor 2, 201-203, Beijing, 100195, PR China
| | - Zongbo Chen
- Pediatric Department of the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shandong, 266000, PR China
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Kamate M, Detroja M. Clinico-Investigative Profile of Hereditary Spastic Paraplegia in Children. Ann Indian Acad Neurol 2019; 22:341-344. [PMID: 31359954 PMCID: PMC6613430 DOI: 10.4103/aian.aian_527_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Hereditary spastic paraplegia (HSP) is a group of neurogenetic disorders seen mainly in adults. With the advancement in genetics, more than 78 types of HSP have been identified, with increasing identification of HSP in children. However, there is scant literature on this from India. Materials and Methods Retrospective chart review of patients with HSP diagnosed in the last 6 years was done. The data were extracted and analyzed. Results A total of 11 patients had a diagnosis of HSP (genetically confirmed), with mean age of presentation at 21.7 months. The main symptom at the time of presentation was delayed walking and/or abnormal gait in the form of tip-toeing and scissoring of limbs. The mean delay in diagnosis was 5.2 years after initial presentation. MRI of the presented children showed mainly thinning of corpus callosum and white-matter changes. All of them had gradual worsening spasticity, despite physiotherapy and drugs. Except one, all children had recessive form of spastic paraplegia. Child with autosomal dominant spastic paraplegia had heterozygous mutation in SPAST gene, which is known to present in the first 2 years of life. Conclusions HSP is probably not uncommon. Recessive form of HSP is more frequently seen in children. Because of lack of awareness, there is delay in reaching the final diagnosis.
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Affiliation(s)
- Mahesh Kamate
- Division of Pediatric Neurology, Department of Pediatrics, KAHER University's J N Medical College, In-charge Child Development Centre, KLES Prabhakar Kore Hospital, Belgaum, Karnataka, India
| | - Mayank Detroja
- Department of Pediatric Neurology and Epilepsy, Child Development Centre, KLE Prabhakar Kore Hospital, Belgaum, Karnataka, India
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7
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Straniero L, Guella I, Cilia R, Parkkinen L, Rimoldi V, Young A, Asselta R, Soldà G, Sossi V, Stoessl AJ, Priori A, Nishioka K, Hattori N, Follett J, Rajput A, Blau N, Pezzoli G, Farrer MJ, Goldwurm S, Rajput AH, Duga S. DNAJC12
and dopa-responsive nonprogressive parkinsonism. Ann Neurol 2017; 82:640-646. [DOI: 10.1002/ana.25048] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Letizia Straniero
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele Milan Italy
| | - Ilaria Guella
- Centre for Applied Neurogenetics; University of British Columbia; Vancouver BC Canada
| | - Roberto Cilia
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | - Laura Parkkinen
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson's Disease Centre; University of Oxford; Oxford United Kingdom
| | - Valeria Rimoldi
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele Milan Italy
- Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Alexander Young
- Centre for Applied Neurogenetics; University of British Columbia; Vancouver BC Canada
| | - Rosanna Asselta
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele Milan Italy
- Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Giulia Soldà
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele Milan Italy
- Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Vesna Sossi
- Pacific Parkinson's Research Centre & Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver BC Canada
| | - A. Jon Stoessl
- Pacific Parkinson's Research Centre & Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver BC Canada
| | - Alberto Priori
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics; Department of Health Sciences, University of Milan & ASST Santi Paolo e Carlo; Milan Italy
| | - Kenya Nishioka
- Department of Neurology; Juntendo University School of Medicine; Tokyo Japan
| | - Nobutaka Hattori
- Department of Neurology; Juntendo University School of Medicine; Tokyo Japan
| | - Jordan Follett
- Centre for Applied Neurogenetics; University of British Columbia; Vancouver BC Canada
| | - Alex Rajput
- Division of Neurology, Saskatchewan Movement Disorders Program; University of Saskatchewan, Royal University Hospital; Saskatoon SK Canada
| | - Nenad Blau
- Dietmar-Hopp-Metabolic Center, Department of General Pediatrics; University Hospital; Heidelberg Germany
| | - Gianni Pezzoli
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | - Matthew J. Farrer
- Centre for Applied Neurogenetics; University of British Columbia; Vancouver BC Canada
| | | | - Ali H. Rajput
- Division of Neurology, Saskatchewan Movement Disorders Program; University of Saskatchewan, Royal University Hospital; Saskatoon SK Canada
| | - Stefano Duga
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele Milan Italy
- Humanitas Clinical and Research Center; Rozzano Milan Italy
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Abstract
Dystonia is one of the most frequent movement disorders in childhood. It can impede normal motor development and cause significant motor disability. The diagnostic evaluation of childhood dystonia is challenging due to the phenotypic variability and heterogeneous etiologies. Evidence to guide the diagnostic evaluation and treatment is limited. Assessment is primarily directed by clinical history and distinctive examination findings. Neuroimaging is typically necessary to evaluate for acquired or complex inherited dystonias. A trial of levodopa can be both diagnostic and therapeutic in children with dopa-responsive dystonia. However, for the majority of children with early-onset dystonia, treatment is symptomatic with varying efficacy. There is a paucity of therapeutic trials for childhood dystonia and most treatment recommendations are consensus or expert opinion driven. This review summarizes the available evidence and guidelines on the diagnostic evaluation and pharmacological treatment of childhood-onset dystonia and provides practical frameworks to approach both issues based on best evidence.
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Pons R, Kekou K, Antonellou R, Svingou M, Kanavakis E, Stefanis L. Analysis of a founder mutation in the TH
gene in a cohort of greek patients with Parkinson's disease. Mov Disord 2016; 31:1753-1754. [DOI: 10.1002/mds.26807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/11/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Roser Pons
- First Department of Pediatrics, Agia Sophia Children's Hospital; National and Kapodistrian University of Athens; Greece
| | - Kyriaki Kekou
- Department of Medical Genetics, Agia Sophia Children's Hospital; National and Kapodistrian University of Athens; Greece
| | - Roubina Antonellou
- Second Department of Neurology; Attikon University Hospital, National and Kapodistrian University of Athens; Athens Greece
| | - Maria Svingou
- Department of Medical Genetics, Agia Sophia Children's Hospital; National and Kapodistrian University of Athens; Greece
| | - Emmanouel Kanavakis
- Department of Medical Genetics, Agia Sophia Children's Hospital; National and Kapodistrian University of Athens; Greece
| | - Leonidas Stefanis
- Second Department of Neurology; Attikon University Hospital, National and Kapodistrian University of Athens; Athens Greece
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Kuiper A, Eggink H, Tijssen MAJ, de Koning TJ. Neurometabolic disorders are treatable causes of dystonia. Rev Neurol (Paris) 2016; 172:455-464. [PMID: 27561437 DOI: 10.1016/j.neurol.2016.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 01/16/2023]
Abstract
A broad range of rare inherited metabolic disorders can present with dystonia. For clinicians, it is important to recognize dystonic features, but it can be complicated by the mixed and complex clinical picture seen in many neurometabolic patients. Careful phenotyping is the first step towards the diagnosis of the underlying condition and subsequent targeted treatment, further supported by imaging, biochemical diagnostics and the availability of modern diagnostic techniques such as next generation sequencing. As several neurometabolic disorders are treatable causes of dystonia, these should have priority in the diagnostic process. In the symptomatic treatment of dystonia, several therapeutic options are available. Awareness for the occurrence and optimal treatment of dystonia and other movement disorders in neurometabolic conditions is important because these symptoms can have a substantial impact on the quality of life and daily functioning; this effect is not only exerted by the dystonia itself, but also by the frequently associated non-motor features. In this paper, the highlights and key concepts of neurometabolic forms of dystonia are discussed, with a focus on phenomenology, the diagnostic approach, the most important neurometabolic aetiologies, co-occurring non-motor features and therapeutic options.
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Affiliation(s)
- A Kuiper
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Eggink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T J de Koning
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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11
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Polymeris AA, Tessa A, Anagnostopoulou K, Rubegni A, Galatolo D, Dinopoulos A, Gika AD, Youroukos S, Skouteli E, Santorelli FM, Pons R. A series of Greek children with pure hereditary spastic paraplegia: clinical features and genetic findings. J Neurol 2016; 263:1604-11. [DOI: 10.1007/s00415-016-8179-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/08/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
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12
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Abstract
OPINION STATEMENT Dystonia is a movement disorder caused by diverse etiologies. Its treatment in children is particularly challenging due to the complexity of the development of the nervous system from birth to young adulthood. The treatment options of childhood dystonia include several oral pharmaceutical agents, botulinum toxin injections, and deep brain stimulation (DBS) therapy. The choice of drug therapy relies on the suspected etiology of the dystonia and the adverse effect profile of the drugs. Dystonic syndromes with known etiologies may require specific interventions, but most dystonias are treated by trying serially a handful of medications starting with those with the best risk/benefit profile. In conjunction to drug therapy, botulinum toxin injections may be used to target a problematic group dystonic muscles. The maximal botulinum toxin dose is limited by the weight of the child, therefore limiting the number of the muscles amenable to such treatment. When drugs and botulinum toxin injections fail to control the child's disabling dystonia, DBS therapy may be offered as a last remedy. Delivering optimal DBS therapy to children with dystonia requires a multidisciplinary team of experienced pediatric neurosurgeons, neurologists, and nurses to select adequate candidates, perform this delicate stereotactic procedure, and optimize DBS delivery. Even in the best hands, the response of childhood dystonia to DBS therapy varies greatly. Future therapy of childhood dystonia will parallel the advancement of knowledge of the pathophysiology of dystonic syndromes and the development of clinical and research tools for their study.
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Affiliation(s)
- Samer D Tabbal
- Department of Neurology, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon,
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13
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Mercimek-Mahmutoglu S, Sidky S, Hyland K, Patel J, Donner EJ, Logan W, Mendoza-Londono R, Moharir M, Raiman J, Schulze A, Siriwardena K, Yoon G, Kyriakopoulou L. Prevalence of inherited neurotransmitter disorders in patients with movement disorders and epilepsy: a retrospective cohort study. Orphanet J Rare Dis 2015; 10:12. [PMID: 25758715 PMCID: PMC4342151 DOI: 10.1186/s13023-015-0234-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/27/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inherited neurotransmitter disorders are primary defects of neurotransmitter metabolism. The main purpose of this retrospective cohort study was to identify prevalence of inherited neurotransmitter disorders. METHODS This retrospective cohort study does not have inclusion criteria; rather included all patients who underwent cerebrospinal fluid (CSF) homovanillic and 5-hydroxyindol acetic acid measurements. Patients with CSF neurotransmitter investigations suggestive of an inherited neurotransmitter disorder and patients with normal or non-diagnostic CSF neurotransmitter investigations underwent direct sequencing of single gene disorders. RESULTS There were 154 patients between October 2004 and July 2013. Four patients were excluded due to their diagnosis prior to this study dates. Two major clinical feature categories of patients who underwent lumbar puncture were movement disorders or epilepsy in our institution. Twenty out of the 150 patients (13.3%) were diagnosed with a genetic disorder including inherited neurotransmitter disorders (6 patients) (dihydropteridine reductase, 6-pyruvoyl-tetrahydropterin synthase, guanosine triphosphate cyclohydrolase I, tyrosine hydroxylase, pyridoxine dependent epilepsy due to mutations in the ALDH7A1 gene and pyridoxamine-5-phosphate oxidase deficiencies) and non-neurotransmitter disorders (14 patients). CONCLUSION Prevalence of inherited neurotransmitter disorders was 4% in our retrospective cohort study. Eight out of the 150 patients (5.3%) had one of the treatable inherited metabolic disorders with favorable short-term neurodevelopmental outcomes, highlighting the importance of an early and specific diagnosis. Whole exome or genome sequencing might shed light to unravel underlying genetic defects of new inherited neurotransmitter disorders in near future.
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Affiliation(s)
- Saadet Mercimek-Mahmutoglu
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada. .,Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, Genetic and Genome Biology, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Sarah Sidky
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | | | - Jaina Patel
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Elizabeth J Donner
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - William Logan
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Julian Raiman
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Andreas Schulze
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.
| | - Komudi Siriwardena
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Grace Yoon
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Lianna Kyriakopoulou
- Biochemical Genetics Laboratory, Department of Laboratory Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
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14
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Phenotypic features of children with neurodevelopmental diseases in relation to biogenic amines. Respir Physiol Neurobiol 2014; 209:124-32. [PMID: 25514185 DOI: 10.1016/j.resp.2014.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
Abstract
Disruption of monoamines metabolism leads to diverse manifestations, including developmental, movement and respiratory dysfunctions. We aimed to correlate clinical phenotypes of 55 children with neurodevelopmental disorders with dopamine (HVA) and serotonin (5-HIIA) metabolites in CSF. Decreased level of at least one metabolite was documented in 49.1% patients. Both metabolites were significantly lower in progressive disorder and extrapyramidal syndrome (p<0.05). HVA was significantly lower in hypokinetic and regulatory disorders (p<0.05). In univariate analysis, only progressive course, extrapyramidal syndrome and dystonia were significantly associated with decreased 5-HIAA. In multivariate regression only progressive course remained significant (p=0.005). Progressive disease, extrapyramidal syndrome, dystonia, tremor and rigidity were positively associated with low HVA. In multivariate analysis only: progressive course and rigidity remained significant. Progressive/rigid phenotype carries a high risk of monoamines deficiency, strongly implying need for their analysis. Psychomotor delay with epilepsy and hypotonia is rarely linked to low monoamines level. Irrespective of final diagnosis, different clinical presentations may be associated with impaired monoamines turnover.
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15
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Garcia-Cazorla A, Duarte ST. Parkinsonism and inborn errors of metabolism. J Inherit Metab Dis 2014; 37:627-42. [PMID: 24906253 DOI: 10.1007/s10545-014-9723-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/26/2014] [Accepted: 04/25/2014] [Indexed: 01/30/2023]
Abstract
Parkinsonism is a frequent neurological syndrome in adulthood but is very rare in childhood. Early forms of Parkinsonism have many distinctive features as compared to Parkinsonism in adults. In fact, rather than Parkinsonism, the general concept "hypokinetic-rigid syndrome" (HRS) is more accurate in children. In general, the terms "dystonia-parkinsonism", "parkinsonism-plus", or "parkinsonism-like" are preferred to designate these forms of paediatric HRS. Inborn errors of metabolism (IEM) constitute an important group amongst the genetic causes of Parkinsonism at any age. The main IEM causing Parkinsonism are metal-storage diseases, neurotransmitter defects, lysosomal storage disorders and energy metabolism defects. IEM should not be neglected as many of them represent treatable causes of Parkinsonism. Here we review IEMs causing this neurological syndrome and propose diagnostic approaches depending on the age of onset and the associated clinical and neuroimaging features.
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Affiliation(s)
- A Garcia-Cazorla
- Department of Neurology, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain,
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16
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Chen PW, Lee NC, Chien YH, Wu JY, Wang PC, Hwu WL. Diagnosis of aromatic l-amino acid decarboxylase deficiency by measuring 3-O-methyldopa concentrations in dried blood spots. Clin Chim Acta 2014; 431:19-22. [DOI: 10.1016/j.cca.2014.01.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 11/16/2022]
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17
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Fung VSC, Jinnah HA, Bhatia K, Vidailhet M. Assessment of patients with isolated or combined dystonia: an update on dystonia syndromes. Mov Disord 2014; 28:889-98. [PMID: 23893445 DOI: 10.1002/mds.25549] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/04/2013] [Accepted: 05/09/2013] [Indexed: 01/20/2023] Open
Abstract
The clinical evaluation of a patient with dystonia is a stepwise process, beginning with classification of the phenomenology of the movement disorder(s), then formulation of the dystonia syndrome, which, in turn, leads to a targeted etiological differential diagnosis. In recent years, there have been significant advances in our understanding of the etiological basis of dystonia, aided especially by discoveries in imaging and genetics. In this review, we provide an update on the assessment of a patient with dystonia, including the phenomenology of dystonia and highlighting how to integrate clinical, imaging, blood, and neurophysiological investigations in order to formulate a dystonia syndrome. Evolving or emerging dystonia syndromes are reviewed, and potential etiologies of these as well as established dystonia syndromes listed to guide diagnostic testing. © 2013 Movement Disorder Society.
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Affiliation(s)
- Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, Australia.
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18
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Abstract
We describe a disease encompassing infantile-onset movement disorder (including severe parkinsonism and nonambulation), mood disturbance, autonomic instability, and developmental delay, and we describe evidence supporting its causation by a mutation in SLC18A2 (which encodes vesicular monoamine transporter 2 [VMAT2]). VMAT2 translocates dopamine and serotonin into synaptic vesicles and is essential for motor control, stable mood, and autonomic function. Treatment with levodopa was associated with worsening, whereas treatment with direct dopamine agonists was followed by immediate ambulation, near-complete correction of the movement disorder, and resumption of development.
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19
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Pons R, Syrengelas D, Youroukos S, Orfanou I, Dinopoulos A, Cormand B, Ormazabal A, Garzía-Cazorla A, Serrano M, Artuch R. Levodopa-induced dyskinesias in tyrosine hydroxylase deficiency. Mov Disord 2013; 28:1058-63. [DOI: 10.1002/mds.25382] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/12/2012] [Accepted: 01/03/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roser Pons
- First Department of Pediatrics, Aghia Sophia Children's Hospital; University of Athens; Athens Greece
| | - Dimitris Syrengelas
- Department of Pediatric Physical Therapy; Aghia Sophia Children's Hospital; Athens Greece
| | - Sotiris Youroukos
- First Department of Pediatrics, Aghia Sophia Children's Hospital; University of Athens; Athens Greece
| | - Irene Orfanou
- First Department of Pediatrics, Aghia Sophia Children's Hospital; University of Athens; Athens Greece
| | - Arqirios Dinopoulos
- Third Department of Pediatrics; Attiko University Hospital; University of Athens; Haidari Greece
| | - Bru Cormand
- Department of Genetics; University of Barcelona, Institute of Biomedicine of the University of Barcelona, Center for Biomedical Research on Rare Diseases; Barcelona Spain
| | - Aida Ormazabal
- Department of Neuropediatrics and Department of Clinical Biochemistry; Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases; Barcelona Spain
| | - Angels Garzía-Cazorla
- Department of Neuropediatrics and Department of Clinical Biochemistry; Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases; Barcelona Spain
| | - Mercedes Serrano
- Department of Neuropediatrics and Department of Clinical Biochemistry; Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases; Barcelona Spain
| | - Rafael Artuch
- Department of Neuropediatrics and Department of Clinical Biochemistry; Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases; Barcelona Spain
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20
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Roubertie A, Mariani LL, Fernandez-Alvarez E, Doummar D, Roze E. Treatment for dystonia in childhood. Eur J Neurol 2012; 19:1292-9. [DOI: 10.1111/j.1468-1331.2011.03649.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Lee HCH, Lai CK, Yau KCE, Siu TS, Mak CM, Yuen YP, Chan KY, Tam S, Lam CW, Chan AYW. Non-invasive urinary screening for aromatic l-amino acid decarboxylase deficiency in high-prevalence areas: A pilot study. Clin Chim Acta 2012; 413:126-30. [DOI: 10.1016/j.cca.2011.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
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22
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Moran MM, Allen NM, Treacy EP, King MD. "Stiff neonate" with mitochondrial DNA depletion and secondary neurotransmitter defects. Pediatr Neurol 2011; 45:403-5. [PMID: 22115005 DOI: 10.1016/j.pediatrneurol.2011.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/24/2011] [Indexed: 10/15/2022]
Abstract
Mitochondrial disorders comprise a heterogenous group. A neonate who presented with episodes of severe truncal hypertonia and apnea progressed to a hypokinetic rigid syndrome characterized by hypokinesia, tremulousness, profound head lag, absent suck and gag reflexes, brisk deep tendon reflexes, ankle and jaw clonus, and evidence of autonomic dysfunction. Analysis of cerebrospinal fluid neurotransmitters from age 7 weeks demonstrated low levels of amine metabolites (homovanillic acid and 5-hydroxyindoleacetic acid), tetrahydrobiopterin, and pyridoxal phosphate. Mitochondrial DNA quantitative studies on muscle homogenate demonstrated a mitochondrial DNA depletion disorder. Respiratory chain enzymology demonstrated decreased complex IV activity. Screening for mitochondrial DNA rearrangement disorders and sequencing relevant mitochondrial genes produced negative results. No clinical or biochemical response to treatment with pyridoxal phosphate, tetrahydrobiopterin, or l-dopa occurred. The clinical course was progressive, and the patient died at age 19 months. Mitochondrial disorders causing secondary neurotransmitter diseases are usually severe, but are rarely reported. This diagnosis should be considered in neonates or infants who present with hypertonia, hypokinesia rigidity, and progressive neurodegeneration.
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Affiliation(s)
- Margaret M Moran
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's University Hospital, Dublin, Ireland
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23
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Abstract
BH4 (6R-L-erythro-5,6,7,8-tetrahydrobiopterin) is an essential cofactor of a set of enzymes that are of central metabolic importance, including four aromatic amino acid hydroxylases, alkylglycerol mono-oxygenase and three NOS (NO synthase) isoenzymes. Consequently, BH4 is present in probably every cell or tissue of higher organisms and plays a key role in a number of biological processes and pathological states associated with monoamine neurotransmitter formation, cardiovascular and endothelial dysfunction, the immune response and pain sensitivity. BH4 is formed de novo from GTP via a sequence of three enzymatic steps carried out by GTP cyclohydrolase I, 6-pyruvoyltetrahydropterin synthase and sepiapterin reductase. An alternative or salvage pathway involves dihydrofolate reductase and may play an essential role in peripheral tissues. Cofactor regeneration requires pterin-4a-carbinolamine dehydratase and dihydropteridine reductase, except for NOSs, in which the BH4 cofactor undergoes a one-electron redox cycle without the need for additional regeneration enzymes. With regard to the regulation of cofactor biosynthesis, the major controlling point is GTP cyclohydrolase I. BH4 biosynthesis is controlled in mammals by hormones and cytokines. BH4 deficiency due to autosomal recessive mutations in all enzymes, except for sepiapterin reductase, has been described as a cause of hyperphenylalaninaemia. A major contributor to vascular dysfunction associated with hypertension, ischaemic reperfusion injury, diabetes and others, appears to be an effect of oxidized BH4, which leads to an increased formation of oxygen-derived radicals instead of NO by decoupled NOS. Furthermore, several neurological diseases have been suggested to be a consequence of restricted cofactor availability, and oral cofactor replacement therapy to stabilize mutant phenylalanine hydroxylase in the BH4-responsive type of hyperphenylalaninaemia has an advantageous effect on pathological phenylalanine levels in patients.
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Affiliation(s)
- Ernst R Werner
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck A-6020, Austria
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24
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García-Cazorla A, Ortez C, Pérez-Dueñas B, Serrano M, Pineda M, Campistol J, Fernández-Álvarez E. Hypokinetic-rigid syndrome in children and inborn errors of metabolism. Eur J Paediatr Neurol 2011; 15:295-302. [PMID: 21612960 DOI: 10.1016/j.ejpn.2011.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/22/2011] [Indexed: 11/24/2022]
Abstract
Hypokinetic-rigid syndrome (HRS) or "parkinsonism" is rare in children. From a clinical point of view it is characterised by a group of signs in which hypokinesia (decreased number of movements), bradykinesia (slowness of movements), rigidity and rest tremor are the fundamental traits. Nervous system infections, immunomediated encephalitis, hypoxia and some drugs have been described as acquired or secondary causes of HRS in the paediatric age. Inborn errors of metabolism (IEM) comprise and important group regarding genetic causes. Main diseases causing HRS in children are neurotransmitter (biogenic amines) defects, metal storage diseases, energy metabolism disorders and lysosomal diseases. In general, in IEM, the HRS is associated to other neurological signs such as dykinesias, pyramidal signs, and psychomotor delay, is very rare in the neonatal period, tends to be more frequent in advanced stages of progressive diseases, and may respond to specific therapies. In particular, l-dopa + carbidopa can be a very effective treatment in neurotransmitter defects, whereas other disorders such as Wilson disease and some particular lysosomal disorders have different therapeutic possibilities. Furthermore, other genetic conditions in dopa-responsive and non-responsive HRS should be also considered, especially in juvenile parkinsonism. Through this review, a practical orientation for paediatric neurologists concerning clinical clues, diagnostic procedure and treatment of metabolic HRS will be provided.
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Affiliation(s)
- A García-Cazorla
- Department of Neurology, Hospital Sant Joan de Déu, Passeig Sant Joan de Deu 2, 08950 Esplugues, Barcelona, Spain
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25
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De Grandis E, Serrano M, Pérez-Dueñas B, Ormazábal A, Montero R, Veneselli E, Pineda M, González V, Sanmartí F, Fons C, Sans A, Cormand B, Puelles L, Alonso A, Campistol J, Artuch R, García-Cazorla A. Cerebrospinal fluid alterations of the serotonin product, 5-hydroxyindolacetic acid, in neurological disorders. J Inherit Metab Dis 2010; 33:803-9. [PMID: 20852934 DOI: 10.1007/s10545-010-9200-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/29/2010] [Accepted: 08/24/2010] [Indexed: 11/30/2022]
Abstract
Although patients with low cerebrospinal fluid (CSF) serotonin metabolite levels have been reported, inborn errors of the rate-limiting enzyme of serotonin synthesis (tryptophan hydroxylase, TPH) have not been described so far. In this study we aimed to evaluate CSF alterations of the serotonin metabolite 5-hydroxyindolacetic acid (5-HIAA) in patients with neurological disorders and to explore a possible TPH deficiency in some of them. A total of 606 patients (286 males, 320 females, mean age 4 years and 6 months, SD 5 years and 7 months) underwent CSF analysis of neurotransmitter metabolites by reverse phase high performance liquid chromatography. Results were compared with values established in a control population. Patients' medical records were reviewed to determine diagnosis and clinical features. A primary defect of biogenic amines was genetically investigated in indicated patients. Low 5-HIAA was seen in 19.3%. Of these, 22.2% showed inborn errors of metabolism (mitochondrial disorders being the most frequent at 10.2% of low 5-HIAA patients) and neurogenetic conditions. Other relatively frequent conditions were pontocerebellar hypoplasia (4.3%), Rett syndrome (4.3%), and among congenital nonetiologically determined conditions, epilepsy including epileptic encephalopathies (26.4%), leukodystrophies (6.8%), and neuropsychiatric disturbances (4.2%). Mutational analysis of the TPH2 gene, performed in five candidate patients, was negative. Although frequency of secondary alteration of 5-HIAA was relatively high in patients with neurological disorders, this finding was more frequently associated with some neurometabolic disorders, epileptic encephalopathies, and neuropsychiatric disturbances. No inborn errors of TPH were found. Due to serotonin's neurotrophic role and to ameliorate symptoms, a supplementary treatment with 5-hydroxytriptophan would seem advisable in these patients.
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Affiliation(s)
- Elisa De Grandis
- Neurology Department, Hospital Sant Joan de Deu, Barcelona, Spain
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26
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Blackstone C. Infantile parkinsonism-dystonia due to dopamine transporter gene mutations: another genetic twist. Lancet Neurol 2010; 10:24-5. [PMID: 21112252 DOI: 10.1016/s1474-4422(10)70280-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Craig Blackstone
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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27
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[Monogenetic dystonia: revisiting the dopaminergic hypothesis]. Rev Neurol (Paris) 2010; 166:389-99. [PMID: 19836812 DOI: 10.1016/j.neurol.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/10/2009] [Accepted: 09/16/2009] [Indexed: 11/20/2022]
Abstract
Dystonias are clinically and genetically heterogeneous neurological disorders that affect movement, and are the focus of much investigative work. The recent identification of mutations in the gene THAP1 in DYT6 dystonia reopens the very interesting question of the in fine involvement of dopamine in the different types of dystonia. In this review, we will go through the recent literature in order to evaluate the many contributions to this theory as well as to highlight the difficulties in identifying a global regulatory pathway for the different forms of this disease that we are just starting to decipher.
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28
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[Treatment of childhood dystonia]. Arch Pediatr 2010; 17:540-53. [PMID: 20362421 DOI: 10.1016/j.arcped.2010.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 10/27/2009] [Accepted: 02/21/2010] [Indexed: 12/28/2022]
Abstract
Dystonia is not uncommon in childhood, but is clinically very heterogeneous. Therefore, introduction and follow-up of the treatment of dystonia in children are often a challenge for the physicians. Progresses in functional neurosurgery have open new fields in the treatment of dystonia in children, but it should be managed by a multidisciplinary team. This paper reviews the various therapeutic options available for childhood-onset dystonia, with a specific attention to dosage and side effects of the drugs regarding pediatric population according to the data of the literature. The rational strategy for therapeutic management of the various types of childhood dystonia is discussed.
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