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Gelineau-Morel R, Dlamini N, Bruss J, Cohen AL, Robertson A, Alexopoulos D, Smyser CD, Boes AD. Network localization of pediatric lesion-induced dystonia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.06.24305421. [PMID: 38645071 PMCID: PMC11030491 DOI: 10.1101/2024.04.06.24305421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objective Dystonia is a movement disorder defined by involuntary muscle contractions leading to abnormal postures or twisting and repetitive movements. Classically dystonia has been thought of as a disorder of the basal ganglia, but newer results in idiopathic dystonia and lesion-induced dystonia in adults point to broader motor network dysfunction spanning the basal ganglia, cerebellum, premotor cortex, sensorimotor, and frontoparietal regions. It is unclear whether a similar network is shared between different etiologies of pediatric lesion-induced dystonia. Methods Three cohorts of pediatric patients with lesion-induced dystonia were identified. The lesion etiologies included hypoxia, kernicterus, and stroke versus comparison subjects with acquired lesions not associated with dystonia. Multivariate lesion-symptom mapping and lesion network mapping were used to evaluate the anatomy and networks associated with dystonia. Results Multivariate lesion-symptom mapping showed that lesions of the putamen (stroke: r = 0.50, p <0.01; hypoxia, r = 0.64, p <0.001) and globus pallidus (kernicterus, r = 0.61, p <0.01) were associated with dystonia. Lesion network mapping using normative connectome data from healthy children demonstrated that these regional findings occurred within a common brain-wide network that involves the basal ganglia, anterior and medial cerebellum, and cortical regions that overlap the cingulo-opercular and somato-cognitive-action networks. Interpretation We interpret these findings as novel evidence for a unified dystonia brain network that involves the somato-cognitive-action network, which is involved in higher order coordination of movement. Elucidation of this network gives insight into the functional origins of dystonia and provides novel targets to investigate for therapeutic intervention.
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Affiliation(s)
- Rose Gelineau-Morel
- Division of Neurology, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nomazulu Dlamini
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joel Bruss
- Department of Pediatrics, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Neurology, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alexander Li Cohen
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Robertson
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | | | - Christopher D. Smyser
- Department of Neurology, Washington University, St Louis, Missouri, USA
- Department of Pediatrics, Washington University, St Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
| | - Aaron D. Boes
- Department of Pediatrics, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Neurology, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, USA Characters in title: 57, Characters in running head: 31
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Nataraj J, MacLean JA, Davies J, Kurtz J, Salisbury A, Liker MA, Sanger TD, Olaya J. Application of deep brain stimulation for the treatment of childhood-onset dystonia in patients with MEPAN syndrome. Front Neurol 2024; 14:1307595. [PMID: 38328756 PMCID: PMC10847241 DOI: 10.3389/fneur.2023.1307595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Mitochondrial Enoyl CoA Reductase Protein-Associated Neurodegeneration (MEPAN) syndrome is a rare inherited metabolic condition caused by MECR gene mutations. This gene encodes a protein essential for fatty acid synthesis, and defects cause progressively worsening childhood-onset dystonia, optic atrophy, and basal ganglia abnormalities. Deep brain stimulation (DBS) has shown mixed improvement in other childhood-onset dystonia conditions. To the best of our knowledge, DBS has not been investigated as a treatment for dystonia in patients with MEPAN syndrome. Methods Two children with MEPAN were identified as possible DBS candidates due to severe generalized dystonia unresponsive to pharmacotherapy. Temporary depth electrodes were placed in six locations bilaterally and tested during a 6-day hospitalization to determine the best locations for permanent electrode placement. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Barry-Albright Dystonia Scale (BADS) were used for preoperative and postoperative testing to quantitatively assess dystonia severity changes. Patient 1 had permanent electrodes placed at the globus pallidus internus (GPi) and pedunculopontine nucleus (PPN). Patient 2 had permanent electrodes placed at the GPi and ventralis intermedius nucleus of the thalamus (VIM). Results Both patients successfully underwent DBS placement with no perioperative complications and significant improvement in their BFMDRS score. Patient 2 also demonstrated improvement in the BADS. Discussion We demonstrated a novel application of DBS in MEPAN syndrome patients with childhood-onset dystonia. These patients showed clinically significant improvements in dystonia following DBS, indicating that DBS can be considered for dystonia in patients with rare metabolic disorders that currently have no other proven treatment options.
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Affiliation(s)
- Jaya Nataraj
- Samueli School of Engineering, University of California Irvine, Irvine, CA, United States
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
| | - Jennifer A. MacLean
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Neurology, Children’s Hospital of Orange County, Orange, CA, United States
| | - Jordan Davies
- Division of Neurosurgery, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Neurological Surgery, School of Medicine, University of California Irvine, Irvine, CA, United States
| | - Joshua Kurtz
- School of Medicine, University of California Irvine, Irvine, CA, United States
| | - Amanda Salisbury
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
| | - Mark A. Liker
- Division of Neurosurgery, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Terence D. Sanger
- Samueli School of Engineering, University of California Irvine, Irvine, CA, United States
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Neurology, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, United States
| | - Joffre Olaya
- Division of Neurosurgery, Children’s Hospital of Orange County, Orange, CA, United States
- Department of Neurological Surgery, School of Medicine, University of California Irvine, Irvine, CA, United States
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Garofalo M, Beudel M, Dijk J, Bonouvrié L, Buizer A, Geytenbeek J, Prins R, Schuurman P, van de Pol L. Elective and Emergency Deep Brain Stimulation in Refractory Pediatric Monogenetic Movement Disorders Presenting with Dystonia: Current Practice Illustrated by Two Cases. Neuropediatrics 2022; 54:44-52. [PMID: 36223877 PMCID: PMC9842449 DOI: 10.1055/a-1959-9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dystonia is characterized by sustained or intermittent muscle contractions, leading to abnormal posturing and twisting movements. In pediatric patients, dystonia often negatively influences quality of life. Pharmacological treatment for dystonia is often inadequate and causes adverse effects. Deep brain stimulation (DBS) appears to be a valid therapeutic option for pharmacoresistant dystonia in children. METHODS To illustrate the current clinical practice, we hereby describe two pediatric cases of monogenetic movement disorders presenting with dystonia and treated with DBS. We provide a literature review of similar previously described cases and on different clinical aspects of DBS in pediatric dystonia. RESULTS The first patient, a 6-year-old girl with severe dystonia, chorea, and myoclonus due to an ADCY5 gene mutation, received DBS in an elective setting. The second patient, an 8-year-old boy with GNAO1-related dystonia and chorea, underwent emergency DBS due to a pharmacoresistant status dystonicus. A significant amelioration of motor symptoms (65% on the Burke-Fahn-Marsden Dystonia Rating Scale) was observed postoperatively in the first patient and her personal therapeutic goals were achieved. DBS was previously reported in five patients with ADCY5-related movement disorders, of which three showed objective improvement. Emergency DBS in our second patient resulted in the successful termination of his GNAO1-related status dystonicus, this being the eighth case reported in the literature. CONCLUSION DBS can be effective in monogenetic pediatric dystonia and should be considered early in the disease course. To better evaluate the effects of DBS on patients' functioning, patient-centered therapeutic goals should be discussed in a multidisciplinary approach.
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Affiliation(s)
- M. Garofalo
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M. Beudel
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J.M. Dijk
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L.A. Bonouvrié
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - A.I. Buizer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - J. Geytenbeek
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands
| | - R.H.N. Prins
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - P.R. Schuurman
- Department of Neurosurgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - L.A. van de Pol
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands,Department of Child Neurology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Address for correspondence L.A. van de Pol, MD, PhD Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije UniversiteitBoelelaan 1117, 1081 HV Amsterdamthe Netherlands
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Libdeh AA, Ibrahim A. Clinical Reasoning: A 6-Year-Old Girl With Progressive Toe Walking. Neurology 2021; 98:e769-e773. [PMID: 34880086 DOI: 10.1212/wnl.0000000000013183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amal Abu Libdeh
- University of Virginia. Department of Neurology Charlottesville. Virginia
| | - Ahmed Ibrahim
- University of Virginia. Department of Neurology Charlottesville. Virginia.
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van der Heijden ME, Kizek DJ, Perez R, Ruff EK, Ehrlich ME, Sillitoe RV. Abnormal cerebellar function and tremor in a mouse model for non-manifesting partially penetrant dystonia type 6. J Physiol 2021; 599:2037-2054. [PMID: 33369735 PMCID: PMC8559601 DOI: 10.1113/jp280978] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Loss-of-function mutations in the Thap1 gene cause partially penetrant dystonia type 6 (DYT6). Some non-manifesting DYT6 mutation carriers have tremor and abnormal cerebello-thalamo-cortical signalling. We show that Thap1 heterozygote mice have action tremor, a reduction in cerebellar neuron number, and abnormal electrophysiological signals in the remaining neurons. These results underscore the importance of Thap1 levels for cerebellar function. These results uncover how cerebellar abnormalities contribute to different dystonia-associated motor symptoms. ABSTRACT Loss-of-function mutations in the Thanatos-associated domain-containing apoptosis-associated protein 1 (THAP1) gene cause partially penetrant autosomal dominant dystonia type 6 (DYT6). However, the neural abnormalities that promote the resultant motor dysfunctions remain elusive. Studies in humans show that some non-manifesting DYT6 carriers have altered cerebello-thalamo-cortical function with subtle but reproducible tremor. Here, we uncover that Thap1 heterozygote mice have action tremor that rises above normal baseline values even though they do not exhibit overt dystonia-like twisting behaviour. At the neural circuit level, we show using in vivo recordings in awake Thap1+/- mice that Purkinje cells have abnormal firing patterns and that cerebellar nuclei neurons, which connect the cerebellum to the thalamus, fire at a lower frequency. Although the Thap1+/- mice have fewer Purkinje cells and cerebellar nuclei neurons, the number of long-range excitatory outflow projection neurons is unaltered. The preservation of interregional connectivity suggests that abnormal neural function rather than neuron loss instigates the network dysfunction and the tremor in Thap1+/- mice. Accordingly, we report an inverse correlation between the average firing rate of cerebellar nuclei neurons and tremor power. Our data show that cerebellar circuitry is vulnerable to Thap1 mutations and that cerebellar dysfunction may be a primary cause of tremor in non-manifesting DYT6 carriers and a trigger for the abnormal postures in manifesting patients.
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Affiliation(s)
- Meike E. van der Heijden
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, Texas, USA
| | - Dominic J. Kizek
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, Texas, USA
| | - Ross Perez
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, Texas, USA
| | - Elena K. Ruff
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, Texas, USA
| | - Michelle E. Ehrlich
- Department of Neurology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roy V. Sillitoe
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, Texas, USA
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, Texas, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, Texas, USA
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Knorr S, Rauschenberger L, Pasos UR, Friedrich MU, Peach RL, Grundmann-Hauser K, Ott T, O'Leary A, Reif A, Tovote P, Volkmann J, Ip CW. The evolution of dystonia-like movements in TOR1A rats after transient nerve injury is accompanied by dopaminergic dysregulation and abnormal oscillatory activity of a central motor network. Neurobiol Dis 2021; 154:105337. [PMID: 33753289 DOI: 10.1016/j.nbd.2021.105337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
TOR1A is the most common inherited form of dystonia with still unclear pathophysiology and reduced penetrance of 30-40%. ∆ETorA rats mimic the TOR1A disease by expression of the human TOR1A mutation without presenting a dystonic phenotype. We aimed to induce dystonia-like symptoms in male ∆ETorA rats by peripheral nerve injury and to identify central mechanism of dystonia development. Dystonia-like movements (DLM) were assessed using the tail suspension test and implementing a pipeline of deep learning applications. Neuron numbers of striatal parvalbumin+, nNOS+, calretinin+, ChAT+ interneurons and Nissl+ cells were estimated by unbiased stereology. Striatal dopaminergic metabolism was analyzed via in vivo microdialysis, qPCR and western blot. Local field potentials (LFP) were recorded from the central motor network. Deep brain stimulation (DBS) of the entopeduncular nucleus (EP) was performed. Nerve-injured ∆ETorA rats developed long-lasting DLM over 12 weeks. No changes in striatal structure were observed. Dystonic-like ∆ETorA rats presented a higher striatal dopaminergic turnover and stimulus-induced elevation of dopamine efflux compared to the control groups. Higher LFP theta power in the EP of dystonic-like ∆ETorA compared to wt rats was recorded. Chronic EP-DBS over 3 weeks led to improvement of DLM. Our data emphasizes the role of environmental factors in TOR1A symptomatogenesis. LFP analyses indicate that the pathologically enhanced theta power is a physiomarker of DLM. This TOR1A model replicates key features of the human TOR1A pathology on multiple biological levels and is therefore suited for further analysis of dystonia pathomechanism.
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Affiliation(s)
- Susanne Knorr
- Department of Neurology, University Hospital of Würzburg, 97080, Germany
| | | | - Uri Ramirez Pasos
- Department of Neurology, University Hospital of Würzburg, 97080, Germany
| | | | - Robert L Peach
- Department of Neurology, University Hospital of Würzburg, 97080, Germany
| | - Kathrin Grundmann-Hauser
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, 72076, Germany; Centre for Rare Diseases, University of Tübingen, 72076, Germany
| | - Thomas Ott
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, 72076, Germany; Core Facility Transgenic Animals, University Hospital of Tübingen, 72076, Germany
| | - Aet O'Leary
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, 60528, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, 60528, Germany
| | - Philip Tovote
- Systems Neurobiology, Institute of Clinical Neurobiology, University Hospital of Würzburg, Versbacher Straße 5, 97080, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, 97080, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, 97080, Germany.
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Scaratti C, Zorzi G, Guastafierro E, Leonardi M, Covelli V, Toppo C, Nardocci N. Long term perceptions of illness and self after Deep Brain Stimulation in pediatric dystonia: A narrative research. Eur J Paediatr Neurol 2020; 26:61-67. [PMID: 32147411 DOI: 10.1016/j.ejpn.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/30/2019] [Accepted: 02/18/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Deep Brain Stimulation (DBS) is increasingly used in pediatric patients affected by isolated dystonia, with excellent results. Despite well documented long-term effects on motor functioning, information on quality of life and social adaptation is almost lacking. OBJECTIVES The present study aims to explore the experience of illness and the relation with the device in adult patients suffering from dystonia who underwent DBS surgery in pediatric age. METHODS A narrative inquiry approach was used to collect patients' narratives of their experience with dystonia and DBS stimulator. A written interview was administered to 8 patients over 18 years old with generalized isolated dystonia who had undergone pallidal DBS implantation in childhood. A thematic analysis was realized to examine the narratives collected. RESULTS Five main themes emerged: "relationship with the disease", "experience related to DBS procedure", "relationship with one's own body", "fears", "thoughts about future". Despite a general satisfaction in relation to DBS intervention, some patients expressed difficulties, such as the acceptance of changes in one's own body, concerns and fears regarding the device and the future, also considering the critical phase of transition from childhood to adulthood. CONCLUSIONS These results suggest that further research is needed to understand the contribution of psychological, as much as medical, aspects to the overall outcome of the intervention. The present explorative study encourages a deeper investigations of psychological aspects of patients, in order to plan a tailored care path and to decide whether to suggest a psychological support, both before and after the intervention.
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Affiliation(s)
- Chiara Scaratti
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanna Zorzi
- Department of Paediatric Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Erika Guastafierro
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Claudia Toppo
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nardo Nardocci
- Department of Paediatric Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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