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Liu C, Lan C, Chen Y. The use of sertraline to treat an adolescent of dystonia comorbid with major depressive disorder with psychotic features. Neuropsychopharmacol Rep 2024; 44:275-279. [PMID: 37987035 PMCID: PMC10932769 DOI: 10.1002/npr2.12401] [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: 07/26/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
Dystonia is characterized by sustained or intermittent involuntary muscle contractions. Psychiatric symptoms are essential non-motor features of dystonia, and higher risks of depressive and anxiety disorders have been reported. The precedence of psychiatric to motor symptoms in some patients and the dopaminergic and serotonergic system involvement in both the motor and psychiatric aspects suggest these psychiatric disorders may be intrinsic to the neurobiology of dystonia. Nevertheless, psychiatric comorbidities are often construed as secondary reactions to motor disabilities and the negative bio-psycho-social impacts of dystonia, leading to underdiagnosis and undertreatment. Research on antidepressant use in dystonia is scarce, especially in children and adolescents. This report presents a 17-year-old female with dystonia comorbid with depression with psychotic features, whose motor symptoms improved but psychiatric symptoms persisted with dopaminergic pharmacotherapy. Sertraline was finally added 5 years after the onset and successfully managed her psychotic depression without worsening motor symptoms. Early detection, prompt diagnosis, and timely holistic treatment with dopaminergic agents, antidepressants, and psychosocial interventions are critical for the mental health of dystonia patients.
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Affiliation(s)
- Chia‐Chien Liu
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Chen‐Chia Lan
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Ying‐Sheue Chen
- Department of PsychiatryTaipei Veterans General HospitalTaipeiTaiwan
- Department of PsychiatryChina Medical University HospitalTaichungTaiwan
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Zhu L, Meng H, Zhang W, Xie W, Sun H, Hou S. The pathogenesis of blepharospasm. Front Neurol 2024; 14:1336348. [PMID: 38274886 PMCID: PMC10808626 DOI: 10.3389/fneur.2023.1336348] [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: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Blepharospasm is a focal dystonia characterized by involuntary tetanic contractions of the orbicularis oculi muscle, which can lead to functional blindness and loss of independent living ability in severe cases. It usually occurs in adults, with a higher incidence rate in women than in men. The etiology and pathogenesis of this disease have not been elucidated to date, but it is traditionally believed to be related to the basal ganglia. Studies have also shown that this is related to the decreased activity of inhibitory neurons in the cerebral cortex caused by environmental factors and genetic predisposition. Increasingly, studies have focused on the imbalance in the regulation of neurotransmitters, including dopamine, serotonin, and acetylcholine, in blepharospasm. The onset of the disease is insidious, and the misdiagnosis rate is high based on history and clinical manifestations. This article reviews the etiology, epidemiological features, and pathogenesis of blepharospasm, to improve understanding of the disease by neurologists and ophthalmologists.
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Affiliation(s)
- Lixia Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Xie
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Huaiyu Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shuai Hou
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Rissardo JP, Medeiros Araujo de Matos U, Fornari Caprara AL. Gabapentin-Associated Movement Disorders: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:52. [PMID: 37755242 PMCID: PMC10536490 DOI: 10.3390/medicines10090052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Gabapentin (GBP)-induced movement disorders (MDs) are under-recognized adverse drug reactions. They are commonly not discussed with patients, and their sudden occurrence can lead to misdiagnosis. This literature review aims to evaluate the clinical-epidemiological profile, pathological mechanisms, and management of GBP-associated MD. METHODS Two reviewers identified and assessed relevant reports in six databases without language restriction between 1990 and 2023. RESULTS A total of 99 reports of 204 individuals who developed a MD associated with GBP were identified. The MDs encountered were 135 myoclonus, 22 dyskinesias, 7 dystonia, 3 akathisia, 3 stutterings, 1 myokymia, and 1 parkinsonism. The mean and median ages were 54.54 (SD: 17.79) and 57 years (age range: 10-89), respectively. Subjects were predominantly male (53.57%). The mean and median doses of GBP when the MD occurred were 1324.66 (SD: 1117.66) and 1033 mg/daily (GBP dose range: 100-9600), respectively. The mean time from GBP-onset to GBP-associated MD was 4.58 weeks (SD: 8.08). The mean recovery time after MD treatment was 4.17 days (SD: 4.87). The MD management involved GBP discontinuation. A total of 82.5% of the individuals had a full recovery in the follow-up period. CONCLUSIONS Myoclonus (GRADE A) and dyskinesia (GRADE C) were the most common movement disorders associated with GBP.
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Gut Microbiome Composition in Dystonia Patients. Int J Mol Sci 2023; 24:ijms24032383. [PMID: 36768705 PMCID: PMC9916458 DOI: 10.3390/ijms24032383] [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: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Dystonia is a movement disorder in which patients have involuntary abnormal movements or postures. Non-motor symptoms, such as psychiatric symptoms, sleep problems and fatigue, are common. We hypothesise that the gut microbiome might play a role in the pathophysiology of the (non-)motor symptoms in dystonia via the gut-brain axis. This exploratory study investigates the composition of the gut microbiome in dystonia patients compared to healthy controls. Furthermore, the abundance of neuro-active metabolic pathways, which might be implicated in the (non-)motor symptoms, was investigated. We performed both metagenomic and 16S rRNA sequencing on the stool samples of three subtypes of dystonia (27 cervical dystonia, 20 dopa-responsive dystonia and 24 myoclonus-dystonia patients) and 25 controls. While microbiome alpha and beta diversity was not different between dystonia patients and controls, dystonia patients had higher abundances of Ruminococcus torques and Dorea formicigenerans, and a lower abundance of Butyrivibrio crossotus compared to controls. For those with dystonia, non-motor symptoms and the levels of neurotransmitters in plasma explained the variance in the gut microbiome composition. Several neuro-active metabolic pathways, especially tryptophan degradation, were less abundant in the dystonia patients compared to controls. This suggest that the gut-brain axis might be involved in the pathophysiology of dystonia. Further studies are necessary to confirm our preliminary findings.
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Timmers ER, Plösch T, Smit M, Hof IH, Verkaik-Schakel RN, Tijssen MAJ, de Koning TJ, Niezen-Koning KE. Methylation of the serotonin reuptake transporter gene and non-motor symptoms in dystonia patients. Clin Epigenetics 2022; 14:170. [PMID: 36503539 PMCID: PMC9743677 DOI: 10.1186/s13148-022-01384-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dystonia is a rare movement disorder, in which patients suffer from involuntary twisting movements or abnormal posturing. Next to these motor symptoms, patients have a high prevalence of psychiatric comorbidity, suggesting a role for serotonin in its pathophysiology. This study investigates the percentage of DNA methylation of the gene encoding for the serotonin reuptake transporter (SLC6A4) in dystonia patients and the associations between methylation levels and presence and severity of psychiatric symptoms. METHODS Patients with cervical dystonia (n = 49), myoclonus dystonia (n = 41) and dopa-responsive dystonia (DRD) (n = 27) and a group of healthy controls (n = 56) were included. Psychiatric comorbidity was evaluated with validated questionnaires. Methylation levels of 20 CpG sites situated 69 to 213 base pairs upstream of the start codon of SLC6A4 were investigated. Methylation in dystonia patients was compared to healthy controls, correcting for age, and correlated with psychiatric comorbidity. RESULTS Bootstrapped quantile regression analysis showed that being a dystonia patient compared to a healthy control significantly explains the methylation level at two CpG sites (CpG 24: pseudo-R2 = 0.05, p = 0.04, CpG 32: pseudo-R2 = 0.14, p = 0.03). Subgroup analysis revealed that being a DRD patient significantly explained a part of the variance of methylation levels at two CpG sites (CpG 21: pseudo-R2 = 0.03, p = 0.00, CpG 24: pseudo-R2 = 0.06, p = 0.03). Regression analysis showed that methylation level at CpG 38 significantly explained a small proportion of the variance of severity score for anxiety (R2 = 0.07, p = 0.04) and having a diagnosis of depression (Nagelkerke R2: 0.11, p = 0.00). Genotype of the 5-HTTLPR polymorphism had no additional effect on these associations. CONCLUSIONS This study showed an association between percentage of methylation at several specific sites of the promoter region of SLCA64 and (dopa-responsive) dystonia patients compared to healthy controls. Furthermore, methylation levels were associated with severity of anxiety and presence of a depressive disorder in the dystonia group. This study suggests alterations in the serotonergic metabolism in dystonia patients, and its relation with the non-motor symptoms.
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Affiliation(s)
- Elze R. Timmers
- grid.4830.f0000 0004 0407 1981Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Torsten Plösch
- grid.4830.f0000 0004 0407 1981Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marenka Smit
- grid.4830.f0000 0004 0407 1981Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Ingrid H. Hof
- grid.4494.d0000 0000 9558 4598Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rikst Nynke Verkaik-Schakel
- grid.4830.f0000 0004 0407 1981Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marina A. J. Tijssen
- grid.4830.f0000 0004 0407 1981Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Tom J. de Koning
- grid.4494.d0000 0000 9558 4598Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4514.40000 0001 0930 2361Pediatrics, Department of Clinical Sciences, Lund University, Box 117, 221 00 Lund, Sweden
| | - Klary E. Niezen-Koning
- grid.4494.d0000 0000 9558 4598Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Abu-hadid O, Jimenez-Shahed J. An overview of the pharmacotherapeutics for dystonia: advances over the past decade. Expert Opin Pharmacother 2022; 23:1927-1940. [DOI: 10.1080/14656566.2022.2147823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- O. Abu-hadid
- Icahn School of Medicine at Mount Sinai, New York City, NY
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Serotonergic system in vivo with [ 11C]DASB PET scans in GTP-cyclohydrolase deficient dopa-responsive dystonia patients. Sci Rep 2022; 12:6292. [PMID: 35428769 PMCID: PMC9012759 DOI: 10.1038/s41598-022-10067-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
GTP-cyclohydrolase deficiency in dopa-responsive dystonia (DRD) patients impairs the biosynthesis of dopamine, but also of serotonin. The high prevalence of non-motor symptoms suggests involvement of the serotonergic pathway. Our study aimed to investigate the serotonergic system in vivo in the brain of`DRD patients and correlate this to (non-)motor symptoms. Dynamic [11C]DASB PET scans, a marker of serotonin transporter availability, were performed. Ten DRD, 14 cervical dystonia patients and 12 controls were included. Univariate- and network-analysis did not show differences in binding between DRD patients compared to controls. Sleep disturbances were correlated with binding in the dorsal raphe nucleus (all participants: rs = 0.45, p = 0.04; patients: rs = 0.64, p = 0.05) and participants with a psychiatric disorder had a lower binding in the hippocampus (all participants: p = 0.00; patients: p = 0.06). Post-hoc analysis with correction for psychiatric co-morbidity showed a significant difference in binding in the hippocampus between DRD patients and controls (p = 0.00). This suggests that psychiatric symptoms might mask the altered serotonergic metabolism in DRD patients, but definite conclusions are difficult as psychiatry is considered part of the phenotype. We hypothesize that an imbalance between different neurotransmitter systems is responsible for the non-motor symptoms, and further research investigating multiple neurotransmitters and psychiatry in DRD is necessary.
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Dopaminergic and serotonergic alterations in plasma in three groups of dystonia patients. Parkinsonism Relat Disord 2021; 91:48-54. [PMID: 34482194 DOI: 10.1016/j.parkreldis.2021.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/13/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In dystonia, dopaminergic alterations are considered to be responsible for the motor symptoms. Recent attention for the highly prevalent non-motor symptoms suggest also a role for serotonin in the pathophysiology. In this study we investigated the dopaminergic, serotonergic and noradrenergic metabolism in blood samples of dystonia patients and its relation with (non-)motor manifestations. METHODS Concentrations of metabolites of dopaminergic, serotonergic and noradrenergic pathways were measured in platelet-rich plasma in 41 myoclonus-dystonia (M-D), 25 dopa-responsive dystonia (DRD), 50 cervical dystonia (CD) patients and 55 healthy individuals. (Non-)motor symptoms were assessed using validated instruments, and correlated with concentrations of metabolites. RESULTS A significantly higher concentration of 3-methoxytyramine (0.03 vs. 0.02 nmol/L, p < 0.01), a metabolite of dopamine, and a reduced concentration of tryptophan (50 vs. 53 μmol/L, p = 0.03), the precursor of serotonin was found in dystonia patients compared to controls. The dopamine/levodopa ratio was higher in CD patients compared to other dystonia groups (p < 0.01). Surprisingly, relatively high concentrations of levodopa were found in the untreated DRD patients. Low concentrations of levodopa were associated with severity of dystonia (rs = -0.3, p < 0.01), depression (rs = -0.3, p < 0.01) and fatigue (rs = -0.2, p = 0.04). CONCLUSION This study shows alterations in the dopaminergic and serotonergic metabolism of patients with dystonia, with dystonia subtype specific changes. Low concentrations of levodopa, but not of serotonergic metabolites, were associated with both motor and non-motor symptoms. Further insight into the dopaminergic and serotonergic systems in dystonia with a special attention to the kinetics of enzymes involved in these pathways, might lead to better treatment options.
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Abstract
Dystonia is a complex neurological movement disorder characterized by involuntary muscle contractions. Increasing studies implicate the microbiome as a possible key susceptibility factor for neurological disorders, but the relationship between the gut microbiota and dystonia remains poorly explored. Here, the gut microbiota of 57 patients with isolated dystonia and 27 age- and environment-matched healthy controls was analyzed by 16S rRNA gene amplicon sequencing. Further, integrative analysis of the gut microbiome and serum metabolome measured by high-performance liquid chromatography-mass spectrometry was performed. No difference in α-diversity was found, while β-diversity was significantly different, with a more heterogeneous community structure among dystonia patients than among controls. The most significant changes in dystonia highlighted an increase in Clostridiales, including Blautia obeum, Dorea longicatena, and Eubacterium hallii, and a reduction in Bacteroides vulgatus and Bacteroides plebeius. The functional analysis revealed that genes related to tryptophan and purine biosynthesis were more abundant in gut microbiota from patients with dystonia, while genes linked to citrate cycle, vitamin B6, and glycan metabolism were less abundant. The evaluation of serum metabolites revealed altered levels of l-glutamic acid, taurine, and d-tyrosine, suggesting changes in neurotransmitter metabolism. The most modified metabolites strongly inversely correlated with the abundance of members belonging to the Clostridiales, revealing the effect of the gut microbiota on neurometabolic activity. This study is the first to reveal gut microbial dysbiosis in patients with isolated dystonia and identified potential links between gut microbiota and serum neurotransmitters, providing new insight into the pathogenesis of isolated dystonia. IMPORTANCE Dystonia is the third most common movement disorder after essential tremor and Parkinson’s disease. However, the cause for the majority of cases is not known. This is the first study so far that reveals significant alterations of gut microbiome and correlates the alteration of serum metabolites with gut dysbiosis in patients with isolated dystonia. We demonstrated a general overrepresentation of Clostridiales and underrepresentation of Bacteroidetes in patients with dystonia in comparison with healthy controls. The functional analysis found that genes related to the biosynthesis of tryptophan, which is the precursor of the neurotransmitter serotonin, were more active in isolated dystonia patients. Altered levels of several serum metabolites were found to be associated with microbial changes, such as d-tyrosine, taurine, and glutamate, indicating differences in neurotransmitter metabolism in isolated dystonia. Integrative analysis suggests that neurotransmitter system dysfunction may be a possible pathway by which the gut microbiome participates in the development of dystonia. The gut microbiome changes provide new insight into the pathogenesis of dystonia, suggesting new potential therapeutic directions.
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Smit M, Albanese A, Benson M, Edwards MJ, Graessner H, Hutchinson M, Jech R, Krauss JK, Morgante F, Pérez Dueñas B, Reilly RB, Tinazzi M, Contarino MF, Tijssen MAJ. Dystonia Management: What to Expect From the Future? The Perspectives of Patients and Clinicians Within DystoniaNet Europe. Front Neurol 2021; 12:646841. [PMID: 34149592 PMCID: PMC8211212 DOI: 10.3389/fneur.2021.646841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Improved care for people with dystonia presents a number of challenges. Major gaps in knowledge exist with regard to how to optimize the diagnostic process, how to leverage discoveries in pathophysiology into biomarkers, and how to develop an evidence base for current and novel treatments. These challenges are made greater by the realization of the wide spectrum of symptoms and difficulties faced by people with dystonia, which go well-beyond motor symptoms. A network of clinicians, scientists, and patients could provide resources to facilitate information exchange at different levels, share mutual experiences, and support each other's innovative projects. In the past, collaborative initiatives have been launched, including the American Dystonia Coalition, the European Cooperation in Science and Technology (COST-which however only existed for a limited time), and the Dutch DystonieNet project. The European Reference Network on Rare Neurological Diseases includes dystonia among other rare conditions affecting the central nervous system in a dedicated stream. Currently, we aim to broaden the scope of these initiatives to a comprehensive European level by further expanding the DystoniaNet network, in close collaboration with the ERN-RND. In line with the ERN-RND, the mission of DystoniaNet Europe is to improve care and quality of life for people with dystonia by, among other endeavors, facilitating access to specialized care, overcoming the disparity in education of medical professionals, and serving as a solid platform to foster international clinical and research collaborations. In this review, both professionals within the dystonia field and patients and caregivers representing Dystonia Europe highlight important unsolved issues and promising new strategies and the role that a European network can play in activating them.
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Affiliation(s)
- Marenka Smit
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Alberto Albanese
- Department of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Milan, Italy
| | | | - Mark J. Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Holm Graessner
- Institute of Medical Genetics and Applied Genomics and Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Michael Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Joachim K. Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hanover, Germany
| | - Francesca Morgante
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Belen Pérez Dueñas
- Pediatric Neurology Research Group, Hospital Vall d'Hebron–Institut de Recerca (VHIR), Barcelona, Spain
| | - Richard B. Reilly
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands
| | - Marina A. J. Tijssen
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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Bajenaru OL, Popescu-Olaru I, Dumitrescu L, Serban E, Cozma L, Raicu F, Cocos R, Popescu OB. Non-Motor Manifestations in Idiopathic Dystonia with Focal Onset - A Pilot Study. J Med Life 2020; 13:170-174. [PMID: 32742509 PMCID: PMC7378344 DOI: 10.25122/jml-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients' quality of life. This study represents a component of an ongoing research project - GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 <5, for the depression group and the control group, respectively. The cut-off for MoCA was 26 points. 22 IDFO patients (46%) had depression; 54.5% of IDFO patients with depression had cognitive impairment, indicating a slight trend of increased cognitive impairment in those with depression compared to those without; the perception of the severity of disease was the greatest in patients with depression. Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.
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Affiliation(s)
- Ovidiu-Lucian Bajenaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Ana Aslan" National Institute of Geriatrics and Gerontology, Bucharest, Romania
| | - Iulia Popescu-Olaru
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Laura Dumitrescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Elena Serban
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liviu Cozma
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania
| | - Florina Raicu
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Relu Cocos
- Department of Medical Genetics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Bogdan Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, clinical Hospital Colentina, Bucharest, Romania.,Laboratory of Molecular Biology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
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The Effect of Escitalopram on Central Serotonergic and Dopaminergic Systems in Patients with Cervical Dystonia, and Its Relationship with Clinical Treatment Effects: A Double-Blind Placebo-Controlled Trial. Biomolecules 2020; 10:biom10060880. [PMID: 32521736 PMCID: PMC7355711 DOI: 10.3390/biom10060880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: The pathophysiology of cervical dystonia (CD) is thought to be related to changes in dopamine and serotonin levels in the brain. We performed a double-blind trial with escitalopram (selective serotonin reuptake inhibitor; SSRI) in patients with CD. Here, we report on changes in dopamine D2/3 receptor (D2/3R), dopamine transporter (DAT) and serotonin transporter (SERT) binding potential (BPND) after a six-week treatment course with escitalopram or placebo. Methods: CD patients had [123I]FP-CIT SPECT (I-123 fluoropropyl carbomethoxy-3 beta-(4-iodophenyltropane) single-photon emission computed tomography) scans, to quantify extrastriatal SERT and striatal DAT, and [123I]IBZM SPECT (I-123 iodobenzamide SPECT) scans to quantify striatal D2/3R BPND before and after six weeks of treatment with either escitalopram or placebo. Treatment effect was evaluated with the Clinical Global Impression scale for dystonia, jerks and psychiatric symptoms, both by physicians and patients. Results: In both patients treated with escitalopram and placebo there were no significant differences after treatment in SERT, DAT or D2/3R BPND. Comparing scans after treatment with escitalopram (n = 8) to placebo (n = 8) showed a trend (p = 0.13) towards lower extrastriatal SERT BPND in the SSRI group (median SERT occupancy of 64.6%). After treatment with escitalopram, patients who reported a positive effect on dystonia or psychiatric symptoms had significantly higher SERT occupancy compared to patients who did not experience an effect. Conclusion: Higher extrastriatal SERT occupancy after treatment with escitalopram is associated with a trend towards a positive subjective effect on dystonia and psychiatric symptoms in CD patients.
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Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update. II. Hyperkinetic disorders. J Neural Transm (Vienna) 2019; 126:997-1027. [DOI: 10.1007/s00702-019-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
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Lizarraga KJ, Al-Shorafat D, Fox S. Update on current and emerging therapies for dystonia. Neurodegener Dis Manag 2019; 9:135-147. [PMID: 31117876 DOI: 10.2217/nmt-2018-0047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Treatment strategies for dystonia depend on the focal, segmental or generalized distribution of symptoms. Chemodenervation with botulinum toxin remains the treatment of choice for focal- or select-body regions in generalized and segmental dystonia. A potentially longer acting formulation of botulinum toxin is being investigated besides the currently available formulations. Electromyography increases toxin injection accuracy and may reduce injection number, frequency, side effects and costs by identifying dystonic muscle activity. Oral anticholinergics, baclofen and clonazepam are used off-label, but novel drugs in development include sodium oxybate, zonisamide and perampanel. Characterizing dystonia as a sensorimotor circuit disorder has prompted the use of noninvasive neuromodulation procedures. These techniques need further study but simultaneous rehabilitation techniques appear to also improve outcomes. Pallidal deep-brain stimulation is beneficial for medication-refractory primary generalized and possibly focal dystonia such as cervical dystonia. Certain genetic conditions are amenable to specific therapies and future gene-targeted therapies could benefit selected dystonia patients.
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Affiliation(s)
- Karlo J Lizarraga
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
| | - Duha Al-Shorafat
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
| | - Susan Fox
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
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15
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Zoons E, Booij J, Delnooz CCS, Dijk JM, Dreissen YEM, Koelman JHTM, van der Salm SMA, Skorvanek M, Smit M, Aramideh M, Bienfait H, Boon AJW, Brans JWM, Hoogerwaard E, Hovestadt A, Kamphuis DJ, Munts AG, Speelman JD, Tijssen MAJ. Randomised controlled trial of escitalopram for cervical dystonia with dystonic jerks/tremor. J Neurol Neurosurg Psychiatry 2018; 89:579-585. [PMID: 29326295 DOI: 10.1136/jnnp-2017-317352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/24/2017] [Accepted: 12/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Trials for additional or alternative treatments for cervical dystonia (CD) are scarce since the introduction of botulinum neurotoxin (BoNT). We performed the first trial to investigate whether dystonic jerks/tremor in patients with CD respond to the selective serotonin reuptake inhibitor (SSRI) escitalopram. METHODS In a randomised, double-blind, crossover trial, patients with CD received escitalopram and placebo for 6 weeks. Treatment with BoNT was continued, and scores on rating scales regarding dystonia, psychiatric symptoms and quality of life (QoL) were compared. Primary endpoint was the proportion of patients that improved at least one point on the Clinical Global Impression Scale for jerks/tremor scored by independent physicians with experience in movement disorders. RESULTS Fifty-threepatients were included. In the escitalopram period, 14/49 patients (29%) improved on severity of jerks/tremor versus 11/48 patients (23%) in the placebo period (P=0.77). There were no significant differences between baseline and after treatment with escitalopram or placebo on severity of dystonia or jerks/tremor. Psychiatric symptoms and QoL improved significantly in both periods compared with baseline. There were no significant differences between treatment with escitalopram and placebo for dystonia, psychiatric or QoL rating scales. During treatment with escitalopram, patients experienced slightly more adverse events, but no serious adverse events occurred. CONCLUSION In this innovative trial, no add-on effect of escitalopram for treatment of CD with jerks was found on motor or psychiatric symptoms. However, we also did not find a reason to withhold patients treatment with SSRIs for depression and anxiety, which are common in dystonia. TRIAL REGISTRATION NUMBER NTR2178.
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Affiliation(s)
- Evelien Zoons
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Joke M Dijk
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Sandra M A van der Salm
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - Matej Skorvanek
- Department of Neurology, Safarik University, Kosice, Slovakia.,Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Marenka Smit
- Department of Neurology, University Medical Center, Groningen, The Netherlands
| | - Majid Aramideh
- Department of Neurology, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | | | - Agnita J W Boon
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen W M Brans
- Department of Neurology, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Edo Hoogerwaard
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ad Hovestadt
- Department of Neurology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Daan J Kamphuis
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Johannes D Speelman
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center, Groningen, The Netherlands
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16
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Smit M, Vállez García D, de Jong BM, Zoons E, Booij J, Dierckx RA, Willemsen AT, de Vries EF, Bartels AL, Tijssen MA. Relationships between Serotonin Transporter Binding in the Raphe Nuclei, Basal Ganglia, and Hippocampus with Clinical Symptoms in Cervical Dystonia: A [ 11C]DASB Positron Emission Tomography Study. Front Neurol 2018. [PMID: 29541052 PMCID: PMC5835525 DOI: 10.3389/fneur.2018.00088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Alterations of the central serotonergic system have been implicated in the pathophysiology of dystonia. In this molecular imaging study, we assessed whether altered presynaptic serotonin transporter (SERT) binding contributes to the pathophysiology of cervical dystonia (CD), concerning both motor and non-motor symptoms (NMS). Methods We assessed the non-displaceable binding potential (BPND) using the selective SERT tracer [11C]DASB and positron emission tomography (PET) in 14 CD patients and 12 age- and gender-matched controls. Severity of motor symptoms was scored using the Toronto Western Spasmodic Torticollis Rating Scale and Clinical Global Impression jerks/tremor scale. NMS for depressive symptoms, anxiety, fatigue, and sleep disturbances were assessed with quantitative rating scales. The relationship between SERT binding and clinical patient characteristics was analyzed with the Spearman’s rho test and multiple regression. Results When comparing the CD patients with controls, no significant differences in BPND were found. Higher BPND in the dorsal raphe nucleus was statistically significantly correlated (p < 0.001) with motor symptom severity (rs = 0.65), pain (rs = 0.73), and sleep disturbances (rs = 0.73), with motor symptom severity being the most important predictor of SERT binding. Furthermore, fatigue was negatively associated with the BPND in the medial raphe nucleus (rs = −0.61, p = 0.045), and sleep disorders were positively associated with the BPND in the caudate nucleus (rs = 0.58, p = 0.03) and the hippocampus (rs = 0.56, p = 0.02). Conclusion Motor symptoms, as well as pain, sleep disturbances, and fatigue in CD showed a significant relationship with SERT binding in the raphe nuclei. Moreover, fatigue showed a significant relationship with the medial raphe nucleus and sleep disorders with the caudate nucleus and hippocampus. These findings suggest that an altered serotonergic signaling in different brain areas in CD is related to different motor as well as NMS, which will further stimulate research on the role of serotonin in the pathogenesis of dystonia.
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Affiliation(s)
- Marenka Smit
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Evelien Zoons
- Department of Neurology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Jan Booij
- Department of Nuclear Medicine and Molecular Imaging, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Rudi A Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Antoon T Willemsen
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Erik F de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Anna L Bartels
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands.,Department of Neurology, Ommelander Hospital Group, Groningen, Netherlands
| | - Marina A Tijssen
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
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17
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Timmers E, Kuiper A, Smit M, Bartels A, Kamphuis D, Wolf N, Poll-The B, Wassenberg T, Peeters E, de Koning T, Tijssen M. Non-motor symptoms and quality of life in dopa-responsive dystonia patients. Parkinsonism Relat Disord 2017; 45:57-62. [DOI: 10.1016/j.parkreldis.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/13/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
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18
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Smit M, Kamphuis ASJ, Bartels AL, Han V, Stewart RE, Zijdewind I, Tijssen MA. Fatigue, Sleep Disturbances, and Their Influence on Quality of Life in Cervical Dystonia Patients. Mov Disord Clin Pract 2016; 4:517-523. [PMID: 30363425 DOI: 10.1002/mdc3.12459] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 11/11/2022] Open
Abstract
Background Nonmotor symptoms (NMS) are highly prevalent in cervical dystonia (CD). In general, fatigue and sleep are important NMS that determine a decreased health-related quality of life (HR-QoL), but their influence in CD is unknown. The authors systematically investigated fatigue, excessive daytime sleepiness (EDS), and sleep quality in patients with CD and controls and assessed the influence of psychiatric comorbidity, pain, and dystonia motor severity. They also examined the predictors of HR-QoL. Methods The study included 44 patients with CD and 43 matched controls. Fatigue, EDS, and sleep quality were assessed with quantitative questionnaires and corrected for depression and anxiety using analysis of covariance. The Toronto Western Spasmodic Torticollis Rating Scale and the Clinical Global Impression Scale-jerks/tremor subscale were used to score motor severity and to assess whether motor characteristics could explain an additional part of the variation in fatigue and sleep-related measures. HR-QoL was determined with the RAND-36 item Health Survey, and predictors of HR-QoL were assessed using multiple regression. Results Fatigue scores were increased independently from psychiatric comorbidity (4.0 vs. 2.7; P < 0.01), whereas EDS (7.3 vs. 7.4; P = 0.95) and sleep quality (6.5 vs. 6.1; P = 0.73) were highly associated with depression and anxiety. In patients with CD, motor severity did not explain the variations in fatigue (change in the correlation coefficient [ΔR2] = 0.06; P = 0.15), EDS (ΔR2 = 0.00; P = 0.96), or sleep quality (ΔR2 = 0.04; P = 0.38) scores. Fatigue, EDS, psychiatric comorbidity, and pain predicted a decreased QoL. Conclusion Independent from psychiatric comorbidity and motor severity, fatigue appeared to be a primary NMS. Sleep-related measures were highly associated with psychiatric comorbidity, but not with motor severity. Only NMS predicted HR-QoL, which emphasizes the importance of attention to NMS in patients with CD.
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Affiliation(s)
- Marenka Smit
- Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - Arwen S J Kamphuis
- Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - Anna L Bartels
- Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands.,Department of Neurology Ommelander Hospital Group Delfzijl the Netherlands
| | - Vladimir Han
- Department of Neurology Safarik University Kosice Slovakia.,Department of Neurology University Hospital L. Pasteur Kosice Slovakia
| | - Roy E Stewart
- Department of Health Sciences Community and Occupational Medicine University Medical Center Groningen Groningen the Netherlands
| | - Inge Zijdewind
- Department of Neuroscience University Medical Center Groningen Groningen the Netherlands
| | - Marina A Tijssen
- Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands
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