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Mahajan A, Stoub T, Gonzalez DA, Stebbins G, Gray G, Warner‐Rosen T, Sugar D, Pylypyuk C, Yu M, Comella C. Understanding Anxiety in Cervical Dystonia: An Imaging Study. Mov Disord Clin Pract 2024; 11:1008-1012. [PMID: 38747154 PMCID: PMC11329561 DOI: 10.1002/mdc3.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/03/2024] [Accepted: 04/29/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Anxiety may precede motor symptoms in cervical dystonia (CD) and is associated with an earlier onset of dystonia. Our understanding of anxiety in CD is inadequate. OBJECTIVE To investigate brain networks associated with anxiety in CD. METHODS Twenty-six subjects with idiopathic CD underwent MRI Brain without contrast. Correlational tractography was derived using Diffusion MRI connectometry. Quantitative Anisotropy (QA) was used in deterministic diffusion fiber tracking. Correlational tractography was then used to correlate QA with State-Trait Anxiety Inventory (STAI) state (STAI-S) and trait (STAI-T) subscales. RESULTS Connectometry analysis showed direct correlation between state anxiety and QA in tracts from amygdala to thalamus/ pulvinar bilaterally, and trait anxiety and QA in tracts from amygdala to motor cortex, sensorimotor cortex and parietal association area bilaterally (FDR ≤0.05). CONCLUSION Our efforts to map anxiety to brain networks in CD highlight the role of the amygdala in the pathophysiology of anxiety in CD.
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Affiliation(s)
- Abhimanyu Mahajan
- Gardner Family Center For Parkinson's Disease and Movement DisordersUniversity of CincinnatiCincinnatiOhioUSA
| | - Travis Stoub
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - David A. Gonzalez
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Glenn Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Gabrielle Gray
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Tila Warner‐Rosen
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Dana Sugar
- Division of Movement disorders, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Caroline Pylypyuk
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Mandy Yu
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Cynthia Comella
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
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2
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Tomić A, Sarasso E, Basaia S, Dragašević-Misković N, Svetel M, Kostić VS, Filippi M, Agosta F. Structural brain heterogeneity underlying symptomatic and asymptomatic genetic dystonia: a multimodal MRI study. J Neurol 2024; 271:1767-1775. [PMID: 38019294 DOI: 10.1007/s00415-023-12098-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Most of DYT genotypes follow an autosomal dominant inheritance pattern with reduced penetrance; the mechanisms underlying the disease development remain unclear. The objective of the study was to investigate cortical thickness, grey matter (GM) volumes and white matter (WM) alterations in asymptomatic (DYT-A) and symptomatic dystonia (DYT-S) mutation carriers. METHODS Eight DYT-A (four DYT-TOR1A and four DYT-THAP1), 14 DYT-S (seven DYT-TOR1A, and seven DYT-THAP1), and 37 matched healthy controls underwent 3D T1-weighted and diffusion tensor (DT) MRI to study cortical thickness, cerebellar and basal ganglia GM volumes and WM microstructural changes. RESULTS DYT-S showed thinning of the frontal and motor cortical regions related to sensorimotor and cognitive processing, together with putaminal atrophy and subcortical microstructural WM damage of both motor and extra-motor tracts such as cerebral peduncle, corona radiata, internal and external capsule, temporal and orbitofrontal WM, and corpus callosum. DYT-A had cortical thickening of middle frontal areas and WM damage of the corona radiata. CONCLUSIONS DYT genes phenotypic expression is associated with alterations of both motor and extra-motor WM and GM regions. Asymptomatic genetic status is characterized by a very subtle affection of the WM motor pathway, together with an increased cortical thickness of higher-order frontal regions that might interfere with phenotypic presentation and disease manifestation.
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Affiliation(s)
- Aleksandra Tomić
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Marina Svetel
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir S Kostić
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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3
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Fan Y, Si Z, Wang L, Zhang L. DYT- TOR1A dystonia: an update on pathogenesis and treatment. Front Neurosci 2023; 17:1216929. [PMID: 37638318 PMCID: PMC10448058 DOI: 10.3389/fnins.2023.1216929] [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: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
DYT-TOR1A dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal movements. It is a severe genetic form of dystonia caused by mutations in the TOR1A gene. TorsinA is a member of the AAA + family of adenosine triphosphatases (ATPases) involved in a variety of cellular functions, including protein folding, lipid metabolism, cytoskeletal organization, and nucleocytoskeletal coupling. Almost all patients with TOR1A-related dystonia harbor the same mutation, an in-frame GAG deletion (ΔGAG) in the last of its 5 exons. This recurrent variant results in the deletion of one of two tandem glutamic acid residues (i.e., E302/303) in a protein named torsinA [torsinA(△E)]. Although the mutation is hereditary, not all carriers will develop DYT-TOR1A dystonia, indicating the involvement of other factors in the disease process. The current understanding of the pathophysiology of DYT-TOR1A dystonia involves multiple factors, including abnormal protein folding, signaling between neurons and glial cells, and dysfunction of the protein quality control system. As there are currently no curative treatments for DYT-TOR1A dystonia, progress in research provides insight into its pathogenesis, leading to potential therapeutic and preventative strategies. This review summarizes the latest research advances in the pathogenesis, diagnosis, and treatment of DYT-TOR1A dystonia.
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Affiliation(s)
- Yuhang Fan
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
| | - Zhibo Si
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, China
| | - Linlin Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lei Zhang
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
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4
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Del Vecchio Del Vecchio J, Hanafi I, Pozzi NG, Capetian P, Isaias IU, Haufe S, Palmisano C. Pallidal Recordings in Chronically Implanted Dystonic Patients: Mitigation of Tremor-Related Artifacts. Bioengineering (Basel) 2023; 10:476. [PMID: 37106663 PMCID: PMC10135680 DOI: 10.3390/bioengineering10040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
Low-frequency oscillatory patterns of pallidal local field potentials (LFPs) have been proposed as a physiomarker for dystonia and hold the promise for personalized adaptive deep brain stimulation. Head tremor, a low-frequency involuntary rhythmic movement typical of cervical dystonia, may cause movement artifacts in LFP signals, compromising the reliability of low-frequency oscillations as biomarkers for adaptive neurostimulation. We investigated chronic pallidal LFPs with the PerceptTM PC (Medtronic PLC) device in eight subjects with dystonia (five with head tremors). We applied a multiple regression approach to pallidal LFPs in patients with head tremors using kinematic information measured with an inertial measurement unit (IMU) and an electromyographic signal (EMG). With IMU regression, we found tremor contamination in all subjects, whereas EMG regression identified it in only three out of five. IMU regression was also superior to EMG regression in removing tremor-related artifacts and resulted in a significant power reduction, especially in the theta-alpha band. Pallido-muscular coherence was affected by a head tremor and disappeared after IMU regression. Our results show that the Percept PC can record low-frequency oscillations but also reveal spectral contamination due to movement artifacts. IMU regression can identify such artifact contamination and be a suitable tool for its removal.
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Affiliation(s)
- Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
| | - Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
| | - Philipp Capetian
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20122 Milano, Italy
| | - Stefan Haufe
- Uncertainty, Inverse Modeling and Machine Learning Group, Technische Universität Berlin, 10623 Berlin, Germany;
- Physikalisch-Technische Bundesanstalt Braunschweig und Berlin, 10587 Berlin, Germany
- Berlin Center for Advanced Neuroimaging, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany; (I.H.); (N.G.P.); (P.C.); (I.U.I.); (C.P.)
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5
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Whitlow CT, Atcheson KM, Snively BM, Cook JF, Kim J, Haq IU, Sweadner KJ, Ozelius LJ, Brashear A. Rapid-onset dystonia-parkinsonism is associated with reduced cerebral blood flow without gray matter changes. Front Neurol 2023; 14:1116723. [PMID: 36779071 PMCID: PMC9909223 DOI: 10.3389/fneur.2023.1116723] [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: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose Previous research showed discrete neuropathological changes associated with rapid-onset dystonia-parkinsonism (RDP) in brains from patients with an ATP1A3 variant, specifically in areas that mediate motor function. The purpose of this study was to determine if magnetic resonance imaging methodologies could identify differences between RDP patients and variant-negative controls in areas of the brain that mediate motor function in order to provide biomarkers for future treatment or prevention trials. Methods Magnetic resonance imaging voxel-based morphometry and arterial spin labeling were used to measure gray matter volume and cerebral blood flow, respectively, in cortical motor areas, basal ganglia, thalamus, and cerebellum, in RDP patients with ATP1A3 variants (n = 19; mean age = 37 ± 14 years; 47% female) and variant-negative healthy controls (n = 11; mean age = 34 ± 19 years; 36% female). Results We report age and sex-adjusted between group differences, with decreased cerebral blood flow among patients with ATP1A3 variants compared to variant-negative controls in the thalamus (p = 0.005, Bonferroni alpha level < 0.007 adjusted for regions). There were no statistically significant between-group differences for measures of gray matter volume. Conclusions There is reduced cerebral blood flow within brain regions in patients with ATP1A3 variants within the thalamus. Additionally, the lack of corresponding gray matter volume differences may suggest an underlying functional etiology rather than structural abnormality.
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Affiliation(s)
- Christopher T. Whitlow
- Section of Neuroradiology, Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States,Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, United States,Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States,Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States,*Correspondence: Christopher T. Whitlow ✉
| | - Kyle M. Atcheson
- Section of Neuroradiology, Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Beverly M. Snively
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States,Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jared F. Cook
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jeongchul Kim
- Section of Neuroradiology, Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Ihtsham U. Haq
- Department of Neurology, University of Miami, Miami, FL, United States
| | - Kathleen J. Sweadner
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Laurie J. Ozelius
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Allison Brashear
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
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6
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El Atiallah I, Bonsi P, Tassone A, Martella G, Biella G, Castagno AN, Pisani A, Ponterio G. Synaptic Dysfunction in Dystonia: Update From Experimental Models. Curr Neuropharmacol 2023; 21:2310-2322. [PMID: 37464831 PMCID: PMC10556390 DOI: 10.2174/1570159x21666230718100156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 07/20/2023] Open
Abstract
Dystonia, the third most common movement disorder, refers to a heterogeneous group of neurological diseases characterized by involuntary, sustained or intermittent muscle contractions resulting in repetitive twisting movements and abnormal postures. In the last few years, several studies on animal models helped expand our knowledge of the molecular mechanisms underlying dystonia. These findings have reinforced the notion that the synaptic alterations found mainly in the basal ganglia and cerebellum, including the abnormal neurotransmitters signalling, receptor trafficking and synaptic plasticity, are a common hallmark of different forms of dystonia. In this review, we focus on the major contribution provided by rodent models of DYT-TOR1A, DYT-THAP1, DYT-GNAL, DYT/ PARK-GCH1, DYT/PARK-TH and DYT-SGCE dystonia, which reveal that an abnormal motor network and synaptic dysfunction represent key elements in the pathophysiology of dystonia.
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Affiliation(s)
- Ilham El Atiallah
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Bonsi
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Annalisa Tassone
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giuseppina Martella
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Gerardo Biella
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, Pavia, Italy
| | - Antonio N. Castagno
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Giulia Ponterio
- Laboratory of Neurophysiology and Plasticity, IRCCS Fondazione Santa Lucia, Rome, Italy
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7
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Optimal deep brain stimulation sites and networks for cervical vs. generalized dystonia. Proc Natl Acad Sci U S A 2022; 119:e2114985119. [PMID: 35357970 PMCID: PMC9168456 DOI: 10.1073/pnas.2114985119] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We studied deep brain stimulation effects in two types of dystonia and conclude that different specific connections between the pallidum and thalamus are responsible for optimal treatment effects. Since alternative treatment options for dystonia beyond deep brain stimulation are scarce, our results will be crucial to maximize treatment outcome in this population of patients. Dystonia is a debilitating disease with few treatment options. One effective option is deep brain stimulation (DBS) to the internal pallidum. While cervical and generalized forms of isolated dystonia have been targeted with a common approach to the posterior third of the nucleus, large-scale investigations regarding optimal stimulation sites and potential network effects have not been carried out. Here, we retrospectively studied clinical results following DBS for cervical and generalized dystonia in a multicenter cohort of 80 patients. We model DBS electrode placement based on pre- and postoperative imaging and introduce an approach to map optimal stimulation sites to anatomical space. Second, we investigate which tracts account for optimal clinical improvements, when modulated. Third, we investigate distributed stimulation effects on a whole-brain functional connectome level. Our results show marked differences of optimal stimulation sites that map to the somatotopic structure of the internal pallidum. While modulation of the striatopallidofugal axis of the basal ganglia accounted for optimal treatment of cervical dystonia, modulation of pallidothalamic bundles did so in generalized dystonia. Finally, we show a common multisynaptic network substrate for both phenotypes in the form of connectivity to the cerebellum and somatomotor cortex. Our results suggest a brief divergence of optimal stimulation networks for cervical vs. generalized dystonia within the pallidothalamic loop that merge again on a thalamo-cortical level and share a common whole-brain network.
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8
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Caffall ZF, Wilkes BJ, Hernández-Martinez R, Rittiner JE, Fox JT, Wan KK, Shipman MK, Titus SA, Zhang YQ, Patnaik S, Hall MD, Boxer MB, Shen M, Li Z, Vaillancourt DE, Calakos N. The HIV protease inhibitor, ritonavir, corrects diverse brain phenotypes across development in mouse model of DYT-TOR1A dystonia. Sci Transl Med 2021; 13:13/607/eabd3904. [PMID: 34408078 DOI: 10.1126/scitranslmed.abd3904] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/14/2020] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
Dystonias are a group of chronic movement-disabling disorders for which highly effective oral medications or disease-modifying therapies are lacking. The most effective treatments require invasive procedures such as deep brain stimulation. In this study, we used a high-throughput assay based on a monogenic form of dystonia, DYT1 (DYT-TOR1A), to screen a library of compounds approved for use in humans, the NCATS Pharmaceutical Collection (NPC; 2816 compounds), and identify drugs able to correct mislocalization of the disease-causing protein variant, ∆E302/3 hTorsinA. The HIV protease inhibitor, ritonavir, was among 18 compounds found to normalize hTorsinA mislocalization. Using a DYT1 knock-in mouse model to test efficacy on brain pathologies, we found that ritonavir restored multiple brain abnormalities across development. Ritonavir acutely corrected striatal cholinergic interneuron physiology in the mature brain and yielded sustained correction of diffusion tensor magnetic resonance imaging signals when delivered during a discrete early developmental window. Mechanistically, we found that, across the family of HIV protease inhibitors, efficacy correlated with integrated stress response activation. These preclinical results identify ritonavir as a drug candidate for dystonia with disease-modifying potential.
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Affiliation(s)
- Zachary F Caffall
- Department of Neurology, Duke University Medical Center, Durham, NC 27715, USA
| | - Bradley J Wilkes
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | | | - Joseph E Rittiner
- Department of Neurology, Duke University Medical Center, Durham, NC 27715, USA
| | - Jennifer T Fox
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Kanny K Wan
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Miranda K Shipman
- Department of Neurology, Duke University Medical Center, Durham, NC 27715, USA
| | - Steven A Titus
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Ya-Qin Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Samarjit Patnaik
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Matthew D Hall
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Matthew B Boxer
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Min Shen
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Zhuyin Li
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA.,Department of Neurology, Fixel Institute for Neurological Diseases, McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA
| | - Nicole Calakos
- Department of Neurology, Duke University Medical Center, Durham, NC 27715, USA. .,Department of Neurobiology, Duke University Medical Center, Durham, NC 27715, USA.,Department of Cell Biology, Duke University Medical Center, Durham, NC 27715, USA.,Duke Institute for Brain Sciences, Duke University, Durham, NC 27715, USA
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9
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Mazere J, Dilharreguy B, Catheline G, Vidailhet M, Deffains M, Vimont D, Ribot B, Barse E, Cif L, Mazoyer B, Langbour N, Pisani A, Allard M, Lamare F, Guehl D, Fernandez P, Burbaud P. Striatal and cerebellar vesicular acetylcholine transporter expression is disrupted in human DYT1 dystonia. Brain 2021; 144:909-923. [PMID: 33638639 DOI: 10.1093/brain/awaa465] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/03/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022] Open
Abstract
Early-onset torsion dystonia (TOR1A/DYT1) is a devastating hereditary motor disorder whose pathophysiology remains unclear. Studies in transgenic mice suggested abnormal cholinergic transmission in the putamen, but this has not yet been demonstrated in humans. The role of the cerebellum in the pathophysiology of the disease has also been highlighted but the involvement of the intrinsic cerebellar cholinergic system is unknown. In this study, cholinergic neurons were imaged using PET with 18F-fluoroethoxybenzovesamicol, a radioligand of the vesicular acetylcholine transporter (VAChT). Here, we found an age-related decrease in VAChT expression in the posterior putamen and caudate nucleus of DYT1 patients versus matched controls, with low expression in young but not in older patients. In the cerebellar vermis, VAChT expression was also significantly decreased in patients versus controls, but independently of age. Functional connectivity within the motor network studied in MRI and the interregional correlation of VAChT expression studied in PET were also altered in patients. These results show that the cholinergic system is disrupted in the brain of DYT1 patients and is modulated over time through plasticity or compensatory mechanisms.
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Affiliation(s)
- Joachim Mazere
- Department of Nuclear Medicine, CHU de Bordeaux, France.,Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Bixente Dilharreguy
- Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Gwenaëlle Catheline
- Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Marie Vidailhet
- Institut du Cerveau et de la Moelle épinière (ICM) UMR 1127, hôpital de la Pitié-Salpétrière, Department of Neurology, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Marc Deffains
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, 33076, Bordeaux, France
| | - Delphine Vimont
- Department of Nuclear Medicine, CHU de Bordeaux, France.,Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Bastien Ribot
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, 33076, Bordeaux, France
| | - Elodie Barse
- Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Laura Cif
- Department of Neurosurgery, CHU de Montpellier, 34000, France
| | - Bernard Mazoyer
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, 33076, Bordeaux, France
| | - Nicolas Langbour
- Centre de Recherche en Psychiatrie, CH de la Milétrie, 86000, Poitiers, France
| | - Antonio Pisani
- Department of Brain and Behavioural Sciences, University of Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Michèle Allard
- Department of Nuclear Medicine, CHU de Bordeaux, France.,Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Frédéric Lamare
- Department of Nuclear Medicine, CHU de Bordeaux, France.,Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Dominique Guehl
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, 33076, Bordeaux, France.,Service de Neurophysiologie Clinique, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Philippe Fernandez
- Department of Nuclear Medicine, CHU de Bordeaux, France.,Institute of Cognitive and Integrative Neurosciences, CNRS UMR 5287, Bordeaux University, F33000, Bordeaux, France
| | - Pierre Burbaud
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, 33076, Bordeaux, France.,Service de Neurophysiologie Clinique, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
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10
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Wu J, Tang H, Chen S, Cao L. Mechanisms and Pharmacotherapy for Ethanol-Responsive Movement Disorders. Front Neurol 2020; 11:892. [PMID: 32982923 PMCID: PMC7477383 DOI: 10.3389/fneur.2020.00892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
Ethanol-responsive movement disorders are a group of movement disorders of which clinical manifestation could receive significant improvement after ethanol intake, including essential tremor, myoclonus-dystonia, and some other hyperkinesia. Emerging evidence supports that the sensitivity of these conditions to ethanol might be attributed to similar anatomical targets and pathophysiologic mechanisms. Cerebellum and cerebellum-related networks play a critical role in these diseases. Suppression of inhibitory neurotransmission and hyper-excitability of these regions are the key points for pathogenesis. GABA pathways, the main inhibitory system involved in these regions, were firstly linked to the pathogenesis of these diseases, and GABAA receptors and GABAB receptors play critical roles in ethanol responsiveness. Moreover, impairment of low-voltage-activated calcium channels, which were considered as a contributor to oscillation activity of the nervous system, also participates in the sensitivity of ethanol in relevant disease. Glutamate transporters and receptors that are closely associated with GABA pathways are the action sites for ethanol as well. Accordingly, alternative medicines aiming at these shared mechanisms appeared subsequently to mimic ethanol-like effects with less liability, and some of them have achieved positive effects on different diseases with well-tolerance. However, more clinical trials with a large sample and long-term follow-ups are needed for pragmatic use of these medicines, and further investigations on mechanisms will continue to deepen the understanding of these diseases and also accelerate the discovery of ideal treatment.
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Affiliation(s)
| | | | | | - Li Cao
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Gonzalez-Alegre P. Advances in molecular and cell biology of dystonia: Focus on torsinA. Neurobiol Dis 2019; 127:233-241. [DOI: 10.1016/j.nbd.2019.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/20/2019] [Accepted: 03/09/2019] [Indexed: 12/15/2022] Open
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12
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Frederick NM, Shah PV, Didonna A, Langley MR, Kanthasamy AG, Opal P. Loss of the dystonia gene Thap1 leads to transcriptional deficits that converge on common pathogenic pathways in dystonic syndromes. Hum Mol Genet 2019; 28:1343-1356. [PMID: 30590536 DOI: 10.1093/hmg/ddy433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Dystonia is a movement disorder characterized by involuntary and repetitive co-contractions of agonist and antagonist muscles. Dystonia 6 (DYT6) is an autosomal dominant dystonia caused by loss-of-function mutations in the zinc finger transcription factor THAP1. We have generated Thap1 knock-out mice with a view to understanding its transcriptional role. While germ-line deletion of Thap1 is embryonic lethal, mice lacking one Thap1 allele-which in principle should recapitulate the haploinsufficiency of the human syndrome-do not show a discernable phenotype. This is because mice show autoregulation of Thap1 mRNA levels with upregulation at the non-affected locus. We then deleted Thap1 in glial and neuronal precursors using a nestin-conditional approach. Although these mice do not exhibit dystonia, they show pronounced locomotor deficits reflecting derangements in the cerebellar and basal ganglia circuitry. These behavioral features are associated with alterations in the expression of genes involved in nervous system development, synaptic transmission, cytoskeleton, gliosis and dopamine signaling that link DYT6 to other primary and secondary dystonic syndromes.
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Affiliation(s)
| | | | - Alessandro Didonna
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Monica R Langley
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Anumantha G Kanthasamy
- Parkinson Disorders Research Program, Iowa Center for Advanced Neurotoxicology, Department of Biomedical Sciences, Iowa State University, Ames, IA, USA
| | - Puneet Opal
- Davee Department of Neurology.,Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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The role of pallidum in the neural integrator model of cervical dystonia. Neurobiol Dis 2019; 125:45-54. [PMID: 30677494 DOI: 10.1016/j.nbd.2019.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 01/17/2023] Open
Abstract
Dystonia is the third most common movement disorder affecting three million people worldwide. Cervical dystonia is the most common form of dystonia. Despite common prevalence the pathophysiology of cervical dystonia is unclear. Traditional view is that basal ganglia is involved in pathophysiology of cervical dystonia, while contemporary theories suggested the role of cerebellum and proprioception in the pathophysiology of cervical dystonia. It was recently proposed that the cervical dystonia is due to malfunctioning of the head neural integrator - the neuron network that normally converts head velocity to position. Most importantly the neural integrator model was inclusive of traditional proposal emphasizing the role of basal ganglia while also accommodating the contemporary view suggesting the involvement of cerebellum and proprioception. It was hypothesized that the head neural integrator malfunction is the result of impairment in cerebellar, basal ganglia, or proprioceptive feedback that converge onto the integrator. The concept of converging input from the basal ganglia, cerebellum, and proprioception to the network participating in head neural integrator explains that abnormality originating anywhere in the network can lead to the identical motor deficits - drifts followed by rapid corrective movements - a signature of neural integrator dysfunction. We tested this hypothesis in an experiment examining simultaneously recorded globus pallidal single-unit activity, synchronized neural activity (local field potential), and electromyography (EMG) measured from the neck muscles during the standard-of-care deep brain stimulation surgery in 12 cervical dystonia patients (24 hemispheres). Physiological data were collected spontaneously or during voluntary shoulder shrug activating the contralateral trapezius muscle. The activity of pallidal neurons during shoulder shrug exponentially decayed with time constants that were comparable to one measured from the pretectal neural integrator and the trapezius electromyography. These results show that evidence of abnormal neural integration is also seen in globus pallidum, and that latter is connected with the neural integrator. Pretectal single neuron responses consistently preceded the muscle activity; while the globus pallidum internus response always lagged behind the muscle activity. Globus pallidum externa had equal proportion of lag and lead neurons. These results suggest globus pallidum receive feedback from the muscles or the efference copy from the integrator or the other source of the feedback. There was bi-hemispheric asymmetry in the pallidal single-unit activity and local field potentials. The asymmetry correlated with degree of lateral head turning in cervical dystonia patients. These results suggest that bihemispheric asymmetry in the feedback leads to asymmetric dysfunction in the neural integrator causing head turning.
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14
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Cervical Dystonia and Executive Function: A Pilot Magnetoencephalography Study. Brain Sci 2018; 8:brainsci8090159. [PMID: 30135369 PMCID: PMC6162734 DOI: 10.3390/brainsci8090159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cervical dystonia (CD) patients have impaired working memory, processing speed and visual-motor integration ability. We used magnetoencephalography (MEG) to investigate changes in cerebral oscillations in CD patients during an executive function test, before and after administration of botulinum toxin. METHODS MEG data were collected from five CD patients while they performed a visual continuous performance task (CPT), before and after they received a botulinum toxin injection. MEG data was also collected on five controls matched for age and gender. Coherence source imaging was performed to quantify network connectivity of subjects. RESULTS Controls demonstrated two errors with visual CPT; CD patients demonstrated six and three errors pre- and post-botulinum toxin respectively. After botulinum toxin, mean time from cue to correct response was 0.337 s in controls, 0.390 s in patients before botulinum toxin injection, and 0.366 s after the injection. Differences in coherence between controls and patients were found in the following brain regions: Fronto-frontal, fronto-parietal, fronto-striatal, fronto-occipital, parieto-parietal and temporo-parietal. Intrahemispheric and interhemispheric networks were affected. Post injection, there was minimal change in coherence in the above-mentioned networks. DISCUSSION Neuropsychological testing suggests difference in coherence in frontal circuits between CD cases and controls during the visual CPT, which may reflect subjects' increased difficulty with the task. Botulinum toxin is associated with minimal improvement with executive function in CD.
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15
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Caverzasio S, Amato N, Manconi M, Prosperetti C, Kaelin-Lang A, Hutchison WD, Galati S. Brain plasticity and sleep: Implication for movement disorders. Neurosci Biobehav Rev 2018; 86:21-35. [DOI: 10.1016/j.neubiorev.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/31/2022]
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16
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Abstract
Dystonia can be seen in a number of different phenotypes that may arise from different etiologies. The pathophysiological substrate of dystonia is related to three lines of research. The first postulate a loss of inhibition which may account for the excess of movement and for the overflow phenomena. A second abnormality is sensory dysfunction which is related to the mild sensory complaints in patients with focal dystonias and may be responsible for some of the motor dysfunction. Finally, there are strong pieces of evidence from animal and human studies suggesting that alterations of synaptic plasticity characterized by a disruption of homeostatic plasticity, with a prevailing facilitation of synaptic potentiation may play a pivotal role in primary dystonia. These working hypotheses have been generalized in all form of dystonia. On the other hand, several pieces of evidence now suggest that the pathophysiology may be slightly different in the different types of dystonia. Therefore, in the present review, we would like to discuss the neural mechanisms underlying the different forms of dystonia to disentangle the different weight and role of environmental and predisposing factors.
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Affiliation(s)
- Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Diane Ruge
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
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17
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Fan X, Donsante Y, Jinnah HA, Hess EJ. Dopamine Receptor Agonist Treatment of Idiopathic Dystonia: A Reappraisal in Humans and Mice. J Pharmacol Exp Ther 2018; 365:20-26. [PMID: 29348266 DOI: 10.1124/jpet.117.246348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/17/2018] [Indexed: 01/21/2023] Open
Abstract
Although dystonia is often associated with abnormal dopamine neurotransmission, dopaminergic drugs are not currently used to treat dystonia because there is a general view that dopaminergic drugs are ineffective. However, there is little conclusive evidence to support or refute this assumption. Therefore, to assess the therapeutic potential of these compounds, we analyzed results from multiple trials of dopamine receptor agonists in patients with idiopathic dystonias and also tested the efficacy of dopamine receptor agonists in a mouse model of generalized dystonia. Our results suggest that dopamine receptor agonists were effective in some, but not all, patients tested. Further, the mixed D1/D2 dopamine receptor agonist apomorphine was apparently more effective than subtype selective D2 dopamine receptor agonists. However, rigorously controlled trials are still needed. In a mouse model of dystonia, a selective D1 dopamine receptor agonist was not effective while a selective D2 dopamine receptor had modest efficacy. However, when combined, these receptor-selective agonists acted synergistically to ameliorate the dystonia. Coactivation of D1 and D2 dopamine receptors using apomorphine or by increasing extracellular concentrations of dopamine was also effective. Thus, results from both clinical trials and tests in mice suggest that coactivation of D1 and D2 dopamine receptors may be an effective therapeutic strategy in some patients. These results support a reconsideration of dopamine receptors as targets for the treatment of dystonia, particularly because recent genetic and diagnostic advances may facilitate the identification of the subtypes of dystonia patients who respond and those who do not.
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Affiliation(s)
- Xueliang Fan
- Department of Pharmacology (X.F., Y.D., E.J.H.), Department of Neurology (H.A.J., E.J.H.), and Department of Human Genetics (H.A.J.), School of Medicine, Emory University, Atlanta, Georgia
| | - Yuping Donsante
- Department of Pharmacology (X.F., Y.D., E.J.H.), Department of Neurology (H.A.J., E.J.H.), and Department of Human Genetics (H.A.J.), School of Medicine, Emory University, Atlanta, Georgia
| | - H A Jinnah
- Department of Pharmacology (X.F., Y.D., E.J.H.), Department of Neurology (H.A.J., E.J.H.), and Department of Human Genetics (H.A.J.), School of Medicine, Emory University, Atlanta, Georgia
| | - Ellen J Hess
- Department of Pharmacology (X.F., Y.D., E.J.H.), Department of Neurology (H.A.J., E.J.H.), and Department of Human Genetics (H.A.J.), School of Medicine, Emory University, Atlanta, Georgia
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18
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Weisheit CE, Pappas SS, Dauer WT. Inherited dystonias: clinical features and molecular pathways. HANDBOOK OF CLINICAL NEUROLOGY 2018; 147:241-254. [PMID: 29325615 DOI: 10.1016/b978-0-444-63233-3.00016-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent decades have witnessed dramatic increases in understanding of the genetics of dystonia - a movement disorder characterized by involuntary twisting and abnormal posture. Hampered by a lack of overt neuropathology, researchers are investigating isolated monogenic causes to pinpoint common molecular mechanisms in this heterogeneous disease. Evidence from imaging, cellular, and murine work implicates deficiencies in dopamine neurotransmission, transcriptional dysregulation, and selective vulnerability of distinct neuronal populations to disease mutations. Studies of genetic forms of dystonia are also illuminating the developmental dependence of disease symptoms that is typical of many forms of the disease. As understanding of monogenic forms of dystonia grows, a clearer picture will develop of the abnormal motor circuitry behind this relatively common phenomenology. This chapter focuses on the current data covering the etiology and epidemiology, clinical presentation, and pathogenesis of four monogenic forms of isolated dystonia: DYT-TOR1A, DYT-THAP1, DYT-GCH1, and DYT-GNAL.
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Affiliation(s)
- Corinne E Weisheit
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samuel S Pappas
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - William T Dauer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States.
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19
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Yoo HS, Lee H, Chung SJ, Lee JS, Hong SK, Lee PH, Kim YJ, Sohn YH, Shin HW. A Novel Heterozygous ANO3 Mutation with Basal Ganglia Dysfunction in a Patient with Adult-Onset Isolated Segmental Dystonia. J Clin Neurol 2018; 14:596-597. [PMID: 30284773 PMCID: PMC6172499 DOI: 10.3988/jcn.2018.14.4.596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyoon Hong
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Joong Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, Korea.,Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,ILSONG Institute of Life Science, Hallym University, Anyang, Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea.
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20
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Abstract
Dystonia is a heterogeneous disorder characterized by involuntary muscle contractions, twisting movements, and abnormal postures in various body regions. It is widely accepted that the basal ganglia are involved in the pathogenesis of dystonia. A growing body of evidence, however, is challenging the traditional view and suggest that the cerebellum may also play a role in dystonia. Studies on animals indicate that experimental manipulations of the cerebellum lead to dystonic-like movements. Several clinical observations, including those from secondary dystonia cases as well as neurophysiologic and neuroimaging studies in human patients, provide further evidence in humans of a possible relationship between cerebellar abnormalities and dystonia. Claryfing the role of the cerebellum in dystonia is an important step towards providing alternative treatments based on noninvasive brain stimulation techniques.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli, Italy.
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21
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Mahajan A, Alshammaa A, Zillgitt A, Bowyer SM, LeWitt P, Kaminski P, Sidiropoulos C. The Effect of Botulinum Toxin on Network Connectivity in Cervical Dystonia: Lessons from Magnetoencephalography. Tremor Other Hyperkinet Mov (N Y) 2017; 7:502. [PMID: 29204314 PMCID: PMC5712677 DOI: 10.7916/d84m9h4w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Pharmacological management of cervical dystonia (CD) is considered to be symptomatic in effect, rather than targeting the underlying pathophysiology of the disease. Magnetoencephalography (MEG), a direct measure of neuronal activity, while accepted as a modality for pre-surgical mapping in epilepsy, has never been used to explore the effect of pharmacotherapy in movement disorders. METHODS Resting state MEG data were collected from patients with CD, pre- and post-botulinum toxin injections. All of these patients exhibited good clinical benefit with botulinum toxin. Resting state MEG data from four age- and gender-matched healthy controls with no neurological disorders were also collected. RESULTS Our exploratory study reveals a difference in coherence between controls and patients in the following regions: fronto-striatal, occipito-striatal, parieto-striatal, and striato-temporal networks. In these regions there is an increase after botulinum toxin. Specifically, increased coherence in the left putamen and right superior parietal gyrus was noticeable. Both intrahemispheric and interhemispheric networks were affected. DISCUSSION This is the first attempt to directly assess changes in functional connectivity with pharmacotherapy using MEG. Botulinum toxin might affect sensorimotor integration, leading to clinical benefit. The presence of increased interhemispheric coherence and intrahemispheric coherence points to the importance of global and local networks in the pathophysiology of dystonia.
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Affiliation(s)
| | | | - Andrew Zillgitt
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Susan M. Bowyer
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Peter LeWitt
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Christos Sidiropoulos
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA
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22
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Paracka L, Wegner F, Blahak C, Abdallat M, Saryyeva A, Dressler D, Karst M, Krauss JK. Sensory Alterations in Patients with Isolated Idiopathic Dystonia: An Exploratory Quantitative Sensory Testing Analysis. Front Neurol 2017; 8:553. [PMID: 29089923 PMCID: PMC5650962 DOI: 10.3389/fneur.2017.00553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/28/2017] [Indexed: 02/04/2023] Open
Abstract
Abnormalities in the somatosensory system are increasingly being recognized in patients with dystonia. The aim of this study was to investigate whether sensory abnormalities are confined to the dystonic body segments or whether there is a wider involvement in patients with idiopathic dystonia. For this purpose, we recruited 20 patients, 8 had generalized, 5 had segmental dystonia with upper extremity involvement, and 7 had cervical dystonia. In total, there were 13 patients with upper extremity involvement. We used Quantitative Sensory Testing (QST) at the back of the hand in all patients and at the shoulder in patients with cervical dystonia. The main finding on the hand QST was impaired cold detection threshold (CDT), dynamic mechanical allodynia (DMA), and thermal sensory limen (TSL). The alterations were present on both hands, but more pronounced on the side more affected with dystonia. Patients with cervical dystonia showed a reduced CDT and hot detection threshold (HDT), enhanced TSL and DMA at the back of the hand, whereas the shoulder QST only revealed increased cold pain threshold and DMA. In summary, QST clearly shows distinct sensory abnormalities in patients with idiopathic dystonia, which may also manifest in body regions without evident dystonia. Further studies with larger groups of dystonia patients are needed to prove the consistency of these findings.
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Affiliation(s)
- Lejla Paracka
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Christian Blahak
- Faculty of Medicine Mannheim, Department of Neurology, University of Heidelberg, Mannheim, Germany
| | - Mahmoud Abdallat
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Dirk Dressler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Matthias Karst
- Department of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Center for Systems Neuroscience, Hannover, Germany.,Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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23
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Fremont R, Tewari A, Angueyra C, Khodakhah K. A role for cerebellum in the hereditary dystonia DYT1. eLife 2017; 6. [PMID: 28198698 PMCID: PMC5340526 DOI: 10.7554/elife.22775] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
DYT1 is a debilitating movement disorder caused by loss-of-function mutations in torsinA. How these mutations cause dystonia remains unknown. Mouse models which have embryonically targeted torsinA have failed to recapitulate the dystonia seen in patients, possibly due to differential developmental compensation between rodents and humans. To address this issue, torsinA was acutely knocked down in select brain regions of adult mice using shRNAs. TorsinA knockdown in the cerebellum, but not in the basal ganglia, was sufficient to induce dystonia. In agreement with a potential developmental compensation for loss of torsinA in rodents, torsinA knockdown in the immature cerebellum failed to produce dystonia. Abnormal motor symptoms in knockdown animals were associated with irregular cerebellar output caused by changes in the intrinsic activity of both Purkinje cells and neurons of the deep cerebellar nuclei. These data identify the cerebellum as the main site of dysfunction in DYT1, and offer new therapeutic targets. DOI:http://dx.doi.org/10.7554/eLife.22775.001 Dystonia is the third most common type of movement disorder after Parkinson’s disease and tremor. Patients with dystonia experience prolonged involuntary contractions of their muscles, often causing uncontrollable postures or repetitive movements. Almost thirty years ago, genetic studies revealed that a mutation in the gene that encodes a protein called torsinA causes the most common type of dystonia, called DYT1. Exactly how mutations that affect the torsinA protein give rise to DYT1 remains unclear, and there are still no effective treatments for the disorder. Part of the problem is that we do not fully understand how torsinA works, or which of its many proposed functions is relevant to dystonia. Moreover, attempts to study DYT1 using genetically modified mice have proved largely unsuccessful. This is because mice that simply express the same genetic mutations that cause dystonia in humans do not show the overt symptoms of dystonia. Fremont, Tewari et al. have now generated a mouse ‘model’ that does show symptoms of dystonia, and used these model mice to investigate the role of torsinA in the disorder. Acutely reducing the amount of torsinA protein in a region of the brain called the cerebellum induced the symptoms of dystonia in the mice. Conversely, reducing the amount of torsinA in a different brain area known as the basal ganglia had no such effect, even though both the cerebellum and the basal ganglia contribute to movement. Furthermore, neither manipulation had any effect in juvenile mice, which suggests that, in contrast to humans, young mice can compensate for the loss of torsinA. Fremont, Tewari et al. also found that the loss of torsinA causes the cerebellum to generate incorrect output signals, which in turn trigger the abnormal movements seen in dystonia. In the future, further studies of the model mice could identify the exact changes that occur in neurons following the loss of torsinA from the cerebellum. Understanding these changes could potentially pave the way for developing effective treatments for DYT1 and other dystonias. DOI:http://dx.doi.org/10.7554/eLife.22775.002
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Affiliation(s)
- Rachel Fremont
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Chantal Angueyra
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
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Lozeron P, Poujois A, Richard A, Masmoudi S, Meppiel E, Woimant F, Kubis N. Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia. Front Neural Circuits 2016; 10:90. [PMID: 27891079 PMCID: PMC5102895 DOI: 10.3389/fncir.2016.00090] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/24/2016] [Indexed: 11/13/2022] Open
Abstract
Dystonias represent a heterogeneous group of movement disorders responsible for sustained muscle contraction, abnormal postures, and muscle twists. It can affect focal or segmental body parts or be generalized. Primary dystonia is the most common form of dystonia but it can also be secondary to metabolic or structural dysfunction, the consequence of a drug's side-effect or of genetic origin. The pathophysiology is still not elucidated. Based on lesion studies, dystonia has been regarded as a pure motor dysfunction of the basal ganglia loop. However, basal ganglia lesions do not consistently produce dystonia and lesions outside basal ganglia can lead to dystonia; mild sensory abnormalities have been reported in the dystonic limb and imaging studies have shown involvement of multiple other brain regions including the cerebellum and the cerebral motor, premotor and sensorimotor cortices. Transcranial magnetic stimulation (TMS) is a non-invasive technique of brain stimulation with a magnetic field applied over the cortex allowing investigation of cortical excitability. Hyperexcitability of contralateral motor cortex has been suggested to be the trigger of focal dystonia. High or low frequency repetitive TMS (rTMS) can induce excitatory or inhibitory lasting effects beyond the time of stimulation and protocols have been developed having either a positive or a negative effect on cortical excitability and associated with prevention of cell death, γ-aminobutyric acid (GABA) interneurons mediated inhibition and brain-derived neurotrophic factor modulation. rTMS studies as a therapeutic strategy of dystonia have been conducted to modulate the cerebral areas involved in the disease. Especially, when applied on the contralateral (pre)-motor cortex or supplementary motor area of brains of small cohorts of dystonic patients, rTMS has shown a beneficial transient clinical effect in association with restrained motor cortex excitability. TMS is currently a valuable tool to improve our understanding of the pathophysiology of dystonia but large controlled studies using sham stimulation are still necessary to delineate the place of rTMS in the therapeutic strategy of dystonia. In this review, we will focus successively on the use of TMS as a tool to better understand pathophysiology, and the use of rTMS as a therapeutic strategy.
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Affiliation(s)
- Pierre Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital LariboisièreParis, France; INSERM UMR965Paris, France; Sorbonne Paris Cité - Université Paris DiderotParis, France
| | - Aurélia Poujois
- Service de Neurologie, AP-HP, Hôpital LariboisièreParis, France; Centre de Référence National de la Maladie de Wilson, Hôpital LariboisièreParis, France
| | - Alexandra Richard
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital LariboisièreParis, France; Sorbonne Paris Cité - Université Paris DiderotParis, France
| | - Sana Masmoudi
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière Paris, France
| | - Elodie Meppiel
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital LariboisièreParis, France; Sorbonne Paris Cité - Université Paris DiderotParis, France
| | - France Woimant
- Service de Neurologie, AP-HP, Hôpital LariboisièreParis, France; Centre de Référence National de la Maladie de Wilson, Hôpital LariboisièreParis, France
| | - Nathalie Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital LariboisièreParis, France; INSERM UMR965Paris, France; Sorbonne Paris Cité - Université Paris DiderotParis, France
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Ren WQ, Yin F, Zhang JN, Lu WS, Liang YK, Adlerberth J, Tian ZM. Neural stem cell transplantation for the treatment of primary torsion dystonia: A case report. Exp Ther Med 2016; 12:661-666. [PMID: 27446258 PMCID: PMC4950735 DOI: 10.3892/etm.2016.3392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
Primary torsion dystonia (PTD) occurs due to a genetic mutation and often advances gradually. Currently, there is no therapy available that is able to inhibit progression. Neural stem cells (NSCs) are being investigated as potential therapies for neurodegenerative diseases, such as stroke and trauma. The present study evaluated the clinical effectiveness of NSC transplantation in an 18-year-old male patient with PTD, to assess the ability of this therapy to inhibit PTD progression. Genetic testing of the patient revealed a mutation in the torsion dystonia-1 (DYT1) gene (907–909 delGAG). NSCs were bilaterally implanted in the globus pallidus of the patient through stereotactic surgery. Prior to surgery, the patient's Burke-Fahn-Marsden dystonia movement score (BFMDMS) was 21, which progressively decreased after surgery to 18, 17, 15 and 13 at 1, 2, 3 and 4 postoperative years, respectively. BFMDMS was improved by 38.1% over the 4 postoperative years. Although computed tomography and magnetic resonance imaging examinations showed no significant changes prior to and following surgery, postoperative brain positron emission tomography scans revealed increased glucose metabolism in the transplanted region. The clinical efficacy of NSC transplantation in this patient suggests its potential for the treatment of DYT1-positive patients with PTD.
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Affiliation(s)
- Wen-Qing Ren
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Feng Yin
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Jian-Ning Zhang
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Wang-Sheng Lu
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Ying-Kui Liang
- PET Center, The PLA Navy General Hospital, Beijing 100048, P.R. China
| | - Josefin Adlerberth
- Department of Pure and Applied Biochemistry, Lund University, Lund, 22100 Scania, Sweden
| | - Zeng-Min Tian
- Institute of Neurosurgery, The PLA Navy General Hospital, Beijing 100048, P.R. China
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Role of ¹⁸F-FDG PET imaging in paediatric primary dystonia and dystonia arising from neurodegeneration with brain iron accumulation. Nucl Med Commun 2015; 36:469-76. [PMID: 25646707 DOI: 10.1097/mnm.0000000000000273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE No current neuroimaging modality offers mechanistic or prognostic information to guide management in paediatric dystonia. We assessed F-fluorodeoxyglucose (¹⁸F-FDG) PET/computed tomography (CT) brain imaging in childhood primary dystonia (PDS) and neurodegeneration with brain iron accumulation (NBIA) to determine whether it would identify altered metabolism and hence constitute a potentially useful 'biomarker' indicating functional disturbances associated with dystonia and severity of the disease. MATERIALS AND METHODS A total of 27 children (15 PDS and 12 NBIA) underwent brain ¹⁸F-FDG PET/CT imaging under anaesthesia during acquisition. The images were assessed visually and the two groups were compared quantitatively with statistical parametric mapping. PET/CT images were spatially transformed to Montreal Neurological Institute standard space. Voxelwise ¹⁸F-FDG uptake was normalized to whole-brain uptake. Data of both groups were correlated separately with duration and severity of dystonia as assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). RESULTS Visual inspection did not identify any abnormalities in ¹⁸F-FDG uptake within the cerebral cortex, basal ganglia, or thalami in either group. Quantitative analysis identified higher uptake in the posterior cingulate and bilateral posterior putamina but decreased uptake in the occipital cortex and cerebellum in NBIA compared with PDS. The NBIA group had more severe dystonia scores compared with the PDS group. BFMDRS was negatively correlated with age but not with duration of dystonia. CONCLUSION Compared with PDS, NBIA is dominated by relative overactivity in the putamen and by cerebellar underactivity, patterns that may reflect the increased severity of dystonia in NBIA cases. Hence, there is a potential role for ¹⁸F-FDG PET/CT imaging in paediatric dystonia, particularly in the NBIA group.
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Stoeter P, Roa-Sanchez P, Speckter H, Perez-Then E, Foerster B, Vilchez C, Oviedo J, Rodriguez-Raecke R. Changes of cerebral white matter in patients suffering from Pantothenate Kinase-Associated Neurodegeneration (PKAN): A diffusion tensor imaging (DTI) study. Parkinsonism Relat Disord 2015; 21:577-81. [PMID: 25819806 DOI: 10.1016/j.parkreldis.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/24/2015] [Accepted: 03/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND To look for microstructural white matter alterations in patients with dystonia due to Pantothenate Kinase-Associated Neurodegeneration. MATERIAL AND METHODS We examined 21 genetically confirmed patients and an age-matched group of 21 healthy controls by diffusion tensor imaging. Evaluation of data was performed by tract-based spatial statistics analysis and a voxel-wise comparison of calculated maps of fractional anisotropy. Findings were compared between groups and correlated to the dystonia score of the Burke-Fahn-Marsden Scale (p ≤ 0.05). RESULTS Patients showed reductions of fractional anisotropy mainly in the periventricular substance surrounding the third ventricle, in the medial part of both putamina and in the frontal white matter including the anterior limbs of the internal capsules and the corpus callosum. Infratentorially, the cerebellar white matter and dorsal parts of the pons and medulla were affected. CONCLUSION In addition to cortical grey matter changes, we now have a second structural finding pointing to a more widespread affection of cerebral tissue in PKAN dystonia than just the lesion and iron accumulation in the globus pallidus.
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Affiliation(s)
- P Stoeter
- Dep. of Radiology, Santo Domingo, Dominican Republic.
| | - P Roa-Sanchez
- Dep. of Neurology, Santo Domingo, Dominican Republic
| | - H Speckter
- Dep. of Radiology, Santo Domingo, Dominican Republic
| | - E Perez-Then
- Dep. of Medical Science, CEDIMAT, Santo Domingo, Dominican Republic
| | - B Foerster
- Philips Medical Systems LatAm, Sao Paulo, Brazil
| | - C Vilchez
- Dep. of Radiology, Santo Domingo, Dominican Republic
| | - J Oviedo
- Dep. of Radiology, Santo Domingo, Dominican Republic
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Watchko JF, Painter MJ, Panigrahy A. Are the neuromotor disabilities of bilirubin-induced neurologic dysfunction disorders related to the cerebellum and its connections? Semin Fetal Neonatal Med 2015; 20:47-51. [PMID: 25547431 DOI: 10.1016/j.siny.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Investigators have hypothesized a range of subcortical neuropathology in the genesis of bilirubin-induced neurologic dysfunction (BIND). The current review builds on this speculation with a specific focus on the cerebellum and its connections in the development of the subtle neuromotor disabilities of BIND. The focus on the cerebellum derives from the following observations: (i) the cerebellum is vulnerable to bilirubin-induced injury; perhaps the most vulnerable region within the central nervous system; (ii) infants with cerebellar injury exhibit a neuromotor phenotype similar to BIND; and (iii) the cerebellum has extensive bidirectional circuitry projections to motor and non-motor regions of the brainstem and cerebral cortex that impact a variety of neurobehaviors. Future study using advanced magnetic resonance neuroimaging techniques have the potential to shed new insights into bilirubin's effect on neural network topology via both structural and functional brain connectivity measurements.
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Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Michael J Painter
- Division of Pediatric Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Alongi P, Iaccarino L, Perani D. PET Neuroimaging: Insights on Dystonia and Tourette Syndrome and Potential Applications. Front Neurol 2014; 5:183. [PMID: 25295029 PMCID: PMC4171987 DOI: 10.3389/fneur.2014.00183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/09/2014] [Indexed: 11/13/2022] Open
Abstract
Primary dystonia (pD) is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric developmental disorder characterized by motor and phonic tics, which could progress to behavioral changes. GTS and obsessive-compulsive disorders are often seen in comorbidity, also suggesting that a possible overlap in the pathophysiological bases of these two conditions. PET techniques are of considerable value in detecting functional and molecular abnormalities in vivo, according to the adopted radioligands. For example, PET is the unique technique that allows in vivo investigation of neurotransmitter systems, providing evidence of changes in GTS or pD. For example, presynaptic and post-synaptic dopaminergic studies with PET have shown alterations compatible with dysfunction or loss of D2-receptors bearing neurons, increased synaptic dopamine levels, or both. Measures of cerebral glucose metabolism with (18)F-fluorodeoxyglucose PET ((18)F-FDG PET) are very sensitive in showing brain functional alterations as well. (18)F-FDG PET data have shown metabolic changes within the cortico-striato-pallido-thalamo-cortical and cerebello-thalamo-cortical networks, revealing possible involvement of brain circuits not limited to basal ganglia in pD and GTS. The aim of this work is to overview PET consistent neuroimaging literature on pD and GTS that has provided functional and molecular knowledge of the underlying neural dysfunction. Furthermore, we suggest potential applications of these techniques in monitoring treatments.
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Affiliation(s)
- Pierpaolo Alongi
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Bicocca University , Milan , Italy
| | - Leonardo Iaccarino
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Vita-Salute San Raffaele University , Milan , Italy
| | - Daniela Perani
- Department of Nuclear Medicine, San Raffaele Hospital , Milan , Italy ; Vita-Salute San Raffaele University , Milan , Italy
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Capetian P, Pauly MG, Azmitia LM, Klein C. Striatal cholinergic interneurons in isolated generalized dystonia-rationale and perspectives for stem cell-derived cellular models. Front Cell Neurosci 2014; 8:205. [PMID: 25120431 PMCID: PMC4112996 DOI: 10.3389/fncel.2014.00205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/07/2014] [Indexed: 12/28/2022] Open
Abstract
Interneurons comprise a minority of the striatal neuronal population of roughly 5%. However, this heterogeneous population is of particular interest as it fulfills an important relay function in modulating the output of the only type of striatal projection neurons, i.e., the medium spiny neuron (MSN).One subtype of this heterogenous group, the cholinergic interneuron, is of particular scientific interest as there is a relevant body of evidence from animal models supporting its special significance in the disease process. The development of protocols for directed differentiation of human pluripotent stem cells (PSC) into striatal interneurons provides a unique opportunity to derive in vitro those cell types that are most severely affected in dystonia.In this review we first aim to give a concise overview about the normal function of striatal interneurons and their dysfunction in dystonia in order to identify the most relevant interneuronal subtype for the pathogenesis of dystonia. Secondly we demonstrate how knowledge about the embryonic development of striatal interneurons is of particular help for the development of differentiation protocols from PSC and by this depict potential ways of deriving in vitro disease models of dystonia. We furthermore address the question as to whether cell replacement therapies might represent a beneficial approach for the treatment of dystonia.
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Affiliation(s)
- Philipp Capetian
- Institute of Neurogenetics, University of Lübeck Lübeck, Germany
| | | | - Luis Manuel Azmitia
- Laboratory of Stereotaxy and Interventional Neuroscience, Department of Stereotactic and Functional Neuroscience, University Medical Center, Freiburg Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck Lübeck, Germany
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Genetic animal models of dystonia: common features and diversities. Prog Neurobiol 2014; 121:91-113. [PMID: 25034123 DOI: 10.1016/j.pneurobio.2014.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 01/13/2023]
Abstract
Animal models are pivotal for studies of pathogenesis and treatment of disorders of the central nervous system which in its complexity cannot yet be modeled in vitro or using computer simulations. The choice of a specific model to test novel therapeutic strategies for a human disease should be based on validity of the model for the approach: does the model reflect symptoms, pathogenesis and treatment response present in human patients? In the movement disorder dystonia, prior to the availability of genetically engineered mice, spontaneous mutants were chosen based on expression of dystonic features, including abnormal muscle contraction, movements and postures. Recent discovery of a number of genes and gene products involved in dystonia initiated research on pathogenesis of the disorder, and the creation of novel models based on gene mutations. Here we present a review of current models of dystonia, with a focus on genetic rodent models, which will likely be first choice in the future either for pathophysiological or for preclinical drug testing or both. In order to help selection of a model depending on expression of a specific feature of dystonia, this review is organized by symptoms and current knowledge of pathogenesis of dystonia. We conclude that albeit there is increasing need for research on pathogenesis of the disease and development of improved models, current models do replicate features of dystonia and are useful tools to develop urgently demanded treatment for this debilitating disorder.
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Koch G, Porcacchia P, Ponzo V, Carrillo F, Cáceres-Redondo MT, Brusa L, Desiato MT, Arciprete F, Di Lorenzo F, Pisani A, Caltagirone C, Palomar FJ, Mir P. Effects of Two Weeks of Cerebellar Theta Burst Stimulation in Cervical Dystonia Patients. Brain Stimul 2014; 7:564-72. [DOI: 10.1016/j.brs.2014.05.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/27/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022] Open
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Ledoux MS, Dauer WT, Warner TT. Emerging common molecular pathways for primary dystonia. Mov Disord 2014; 28:968-81. [PMID: 23893453 DOI: 10.1002/mds.25547] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 12/23/2022] Open
Abstract
The dystonias are a group of hyperkinetic movement disorders whose principal cause is neuron dysfunction at 1 or more interconnected nodes of the motor system. The study of genes and proteins that cause familial dystonia provides critical information about the cellular pathways involved in this dysfunction, which disrupts the motor pathways at the systems level. In recent years study of the increasing number of DYT genes has implicated a number of cell functions that appear to be involved in the pathogenesis of dystonia. A review of the literature published in English-language publications available on PubMed relating to the genetics and cellular pathology of dystonia was performed. Numerous potential pathogenetic mechanisms have been identified. We describe those that fall into 3 emerging thematic groups: cell-cycle and transcriptional regulation in the nucleus, endoplasmic reticulum and nuclear envelope function, and control of synaptic function. © 2013 Movement Disorder Society.
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Affiliation(s)
- Mark S Ledoux
- Department of Neurology, University of Tennessee Health Science Center Memphis, Tennessee 38163, USA
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Song CH, Bernhard D, Bolarinwa C, Hess EJ, Smith Y, Jinnah HA. Subtle microstructural changes of the striatum in a DYT1 knock-in mouse model of dystonia. Neurobiol Dis 2013; 54:362-71. [PMID: 23336980 PMCID: PMC3628999 DOI: 10.1016/j.nbd.2013.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 11/21/2022] Open
Abstract
The dystonias are comprised of a group of disorders that share common neurological abnormalities of involuntary twisting or repetitive movements and postures. The most common inherited primary dystonia is DYT1 dystonia, which is due to loss of a GAG codon in the TOR1A gene that encodes torsinA. Autopsy studies of brains from patients with DYT1 dystonia have revealed few abnormalities, although recent neuroimaging studies have implied the existence of microstructural defects that might not be detectable with traditional histopathological methods. The current studies took advantage of a knock-in mouse model for DYT1 dystonia to search for subtle anatomical abnormalities in the striatum, a region often implicated in studies of dystonia. Multiple abnormalities were identified using a combination of quantitative stereological measures of immunohistochemical stains for specific neuronal populations, morphometric studies of Golgi-stained neurons, and immuno-electron microscopy of synaptic connectivity. In keeping with other studies, there was no obvious loss of striatal neurons in the DYT1 mutant mice. However, interneurons immunoreactive for choline acetyltransferase or parvalbumin were larger in the mutants than in control mice. In contrast, interneurons immunoreactive for neuronal nitric oxide synthase were smaller in the mutants than in controls. Golgi histochemical studies of medium spiny projection neurons in the mutant mice revealed slightly fewer and thinner dendrites, and a corresponding loss of dendritic spines. Electron microscopic studies showed a reduction in the ratio of axo-spinous to axo-dendritic synaptic inputs from glutamatergic and dopaminergic sources in mutant mice compared with controls. These results suggest specific anatomical substrates for altered signaling in the striatum and potential correlates of the abnormalities implied by human imaging studies of DYT1 dystonia.
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Affiliation(s)
- Chang-Hyun Song
- Department of Neurology, Emory University, Atlanta GA, 30322
| | | | - Caroline Bolarinwa
- Yerkes National Primate Research Center and Department of Neurology, Emory University, Atlanta GA, 30329
| | - Ellen J. Hess
- Department of Neurology, Emory University, Atlanta GA, 30322
- Department of Pharmacology, Emory University, Atlanta GA, 30322
| | - Yoland Smith
- Yerkes National Primate Research Center and Department of Neurology, Emory University, Atlanta GA, 30329
| | - H. A. Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta GA 30322
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Bostan AC, Dum RP, Strick PL. Cerebellar networks with the cerebral cortex and basal ganglia. Trends Cogn Sci 2013; 17:241-54. [PMID: 23579055 PMCID: PMC3645327 DOI: 10.1016/j.tics.2013.03.003] [Citation(s) in RCA: 497] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 01/18/2023]
Abstract
The dominant view of cerebellar function has been that it is exclusively concerned with motor control and coordination. Recent findings from neuroanatomical, behavioral, and imaging studies have profoundly changed this view. Neuroanatomical studies using virus transneuronal tracers have demonstrated that cerebellar output reaches vast areas of the neocortex, including regions of prefrontal and posterior parietal cortex. Furthermore, it has recently become clear that the cerebellum is reciprocally connected with the basal ganglia, which suggests that the two subcortical structures are part of a densely interconnected network. Taken together, these findings elucidate the neuroanatomical substrate for cerebellar involvement in non-motor functions mediated by the prefrontal and posterior parietal cortex, as well as in processes traditionally associated with the basal ganglia.
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Affiliation(s)
- Andreea C. Bostan
- Center for the Neural Basis of Cognition, Systems Neuroscience Institute and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
| | - Richard P. Dum
- Center for the Neural Basis of Cognition, Systems Neuroscience Institute and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
| | - Peter L. Strick
- Pittsburgh Veterans Affairs Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
- Center for the Neural Basis of Cognition, Systems Neuroscience Institute and Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
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Hersheson J, Mencacci NE, Davis M, MacDonald N, Trabzuni D, Ryten M, Pittman A, Paudel R, Kara E, Fawcett K, Plagnol V, Bhatia KP, Medlar AJ, Stanescu HC, Hardy J, Kleta R, Wood NW, Houlden H. Mutations in the autoregulatory domain of β-tubulin 4a cause hereditary dystonia. Ann Neurol 2013; 73:546-53. [PMID: 23424103 PMCID: PMC3698699 DOI: 10.1002/ana.23832] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 10/23/2012] [Accepted: 11/05/2012] [Indexed: 12/24/2022]
Abstract
Dystonia type 4 (DYT4) was first described in a large family from Heacham in Norfolk with an autosomal dominantly inherited whispering dysphonia, generalized dystonia, and a characteristic hobby horse ataxic gait. We carried out a genetic linkage analysis in the extended DYT4 family that spanned 7 generations from England and Australia, revealing a single LOD score peak of 6.33 on chromosome 19p13.12-13. Exome sequencing in 2 cousins identified a single cosegregating mutation (p.R2G) in the β-tubulin 4a (TUBB4a) gene that was absent in a large number of controls. The mutation is highly conserved in the β-tubulin autoregulatory MREI (methionine-arginine-glutamic acid-isoleucine) domain, highly expressed in the central nervous system, and extensive in vitro work has previously demonstrated that substitutions at residue 2, specifically R2G, disrupt the autoregulatory capability of the wild-type β-tubulin peptide, affirming the role of the cytoskeleton in dystonia pathogenesis.
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Affiliation(s)
- Joshua Hersheson
- Department of Molecular Neuroscience, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Deik AF, O'Riordan S, Luciano MS, Shanker VL, Raymond D, Bressman SB, Saunders-Pullman R. Spatial Discrimination Threshold Abnormalities are not Detected in a Pilot Study of DYT6 Dystonia Mutation Carriers. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 2. [PMID: 23439738 PMCID: PMC3570067 DOI: 10.7916/d8pr7tpc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/26/2012] [Indexed: 12/01/2022]
Abstract
Background Spatial discrimination thresholds (SDTs) assess somatosensory integration, and provide a window into better understanding the pathophysiology of dystonia. They are abnormal in some focal dystonias, but normal in DYT1 dystonia. It is unknown whether SDTs are altered in DYT6 gene mutation carriers (C). Methods SDTs were assessed in 17 DYT6 C (including eight manifesting carriers), 15 DYT1 C (including seven manifesting carriers) and 34 controls, using a standardized grating orientation task. Subjects were asked to recognize the orientation of Johnson–Van Boven–Philips (JVP) dome gratings on either index fingertip until 40% or more answers were incorrect. SDTs between indexes were calculated and averaged, with a final SDT assigned to each subject, and tertiles for control SDTs were constructed. Results SDTs of DYT6 C or DYT1 C were comparable to those of controls, and not more likely to be in the worst tertile (p = 0.8 for DYT6 C vs. controls and p = 1.0 for DYT1 C vs. controls). This was independent of gene expression. Discussion DYT6 carriers do not have impaired SDTs with the JVP dome paradigm. The normal SDT pattern thus suggests shared sensory physiologic patterns with DYT1 dystonia.
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Affiliation(s)
- Andres F Deik
- Department of Neurology, Beth Israel Medical Center, New York, New York, United States of America
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Lozano A, Lipsman N. Probing and Regulating Dysfunctional Circuits Using Deep Brain Stimulation. Neuron 2013; 77:406-24. [DOI: 10.1016/j.neuron.2013.01.020] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 01/04/2023]
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Abstract
PURPOSE OF REVIEW This review considers the recent literature pertaining to the clinical features, genetics, neuropathology and treatment of dystonia syndromes. RECENT FINDINGS The term dystonia indicates at the same time a clinical phenotype and a collection of neurological syndromes mainly of genetic origin. The physical signs contributing to the phenomenology of dystonia have been recently assembled into a coherent set. The molecular genetics of primary dystonia syndromes (DYT1 and DYT6) have been the object of extensive analysis, providing converging views on their causative mechanisms. The relationship between genotype, phenotype, and endophenotypes has been explored for hereditary and sporadic dystonia syndromes. Neurophysiological studies on DYT1 and DYT6 patients, as well as on nonmanifesting carriers, have demonstrated the presence of altered synaptic plasticity. Several recent data indicate a role of dopamine and acetylcholine (ACh) transmission in the pathophysiology of primary dystonia. SUMMARY Recent findings have led to novel, testable hypotheses on cellular mechanisms and physiopathological abnormalities underlying dystonia. Neurophysiological studies, imaging data and animal models support the view that corticostriatal, cerebellar, and dopaminergic dysfunctions converge to produce the pathophysiological abnormalities of dystonia.
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McCarthy DM, Gioioso V, Zhang X, Sharma N, Bhide PG. Neurogenesis and neuronal migration in the forebrain of the TorsinA knockout mouse embryo. Dev Neurosci 2012; 34:366-78. [PMID: 23018676 DOI: 10.1159/000342260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/26/2012] [Indexed: 01/07/2023] Open
Abstract
Early-onset generalized torsion dystonia, also known as DYT1 dystonia, is a childhood onset heritable neurological movement disorder involving painful, involuntary muscle contractions, sustained abnormal postures, and repetitive movements. It is caused by a GAG deletion in the Tor1A gene located on chromosome 9. TorsinA, the product of the Tor1A gene, is expressed throughout the brain beginning early in embryonic development. It plays a role in the regulation of nuclear envelope-cytoskeletal interactions, and presumably nuclear translocation. Since nuclear translocation, powered by cytoskeletal traction, is critical for cell proliferation and migration, we examined whether neurogenesis and neuronal migration are affected in Tor1A-/- mouse brain. Our data show that interkinetic nuclear migration and the pattern of migration of newly generated neurons are impaired in the dorsal forebrain of the Tor1A-/- embryo. However, neurogenesis is not altered significantly. The rate of migration of cells from explants of the medial ganglionic eminence is also impaired in the Tor1A-/- embryo. Thus, loss of torsinA results in subtle but significant alterations in cell proliferation and migration in the embryonic forebrain. These subtle developmental changes are consistent with a lack of significant changes in neuronal numbers, neuronal positioning or size of brain regions in DYT1 dystonia patients.
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Affiliation(s)
- Deirdre M McCarthy
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
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Vo A, Argyelan M, Eidelberg D, Uluǧ AM. Early registration of diffusion tensor images for group tractography of dystonia patients. J Magn Reson Imaging 2012; 37:67-75. [PMID: 22987473 DOI: 10.1002/jmri.23806] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 08/06/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To make a group comparison of diffusion tensor imaging (DTI) results of dystonia patients and controls to reveal occult pathology. We propose using an early registration method that produces sharper group images and enables us to do group tractography. MATERIALS AND METHODS Twelve dystonia patients manifesting the disease, seven nonmanifesting dystonia mutation carriers (DYT1 and DYT6 gene mutations), and eight age-matched normal control subjects were imaged for a previous study. Early and late registration methods for DTI were compared. An early registration technique for a super set was proposed, in which the diffusion-weighted images were registered to a template, gradient vectors were reoriented for each subject, and they were combined into a super set before tensor calculation. The super set included images from all subjects and was useful for group comparisons. We used results obtained from the early registration of a super set for group analysis of tracts using the deterministic fiber-tracking technique. RESULTS In dystonia mutation carriers, we detected fewer fibers in the cerebello-thalamo-cortical pathways. This result agrees well with the findings of a previous study that utilized a probabilistic tractography method and demonstrated that gene carriers have less fiber tracts in the disease-involved pathway. CONCLUSION This analysis visualized group level white matter fractional anisotropy and tract differences between dystonia patients and controls, and can be useful in understanding the pathophysiology of other nonfocal white matter diseases.
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Affiliation(s)
- An Vo
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York 11030, USA
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Deik A, Saunders-Pullman R, Luciano MS. Substance of abuse and movement disorders: complex interactions and comorbidities. CURRENT DRUG ABUSE REVIEWS 2012; 5:243-53. [PMID: 23030352 PMCID: PMC3966544 DOI: 10.2174/1874473711205030243] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/24/2012] [Accepted: 09/28/2012] [Indexed: 11/22/2022]
Abstract
The relationship between movement disorders and substance abuse, which we previously reviewed, is updated. We examine these relationships bidirectionally with focus on drugs of abuse that are known to cause movement disorders, as well as primary movement disorders that are associated with use and abuse of alcohol and dopaminergic medications. First, we review the movement disorders that may develop from the acute use or withdrawal of frequent drugs of abuse, including alcohol, cocaine, heroin, amphetamine and methcathinone. We then comment on the interaction between alcoholism and alcohol-responsive movement disorders, such as essential tremor and myoclonus-dystonia. Lastly, we discuss the potential for abuse of antiparkinsonian dopaminergic agents in patients with Parkinson's disease (PD).
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Blood AJ, Kuster JK, Woodman SC, Kirlic N, Makhlouf ML, Multhaupt-Buell TJ, Makris N, Parent M, Sudarsky LR, Sjalander G, Breiter H, Breiter HC, Sharma N. Evidence for altered basal ganglia-brainstem connections in cervical dystonia. PLoS One 2012; 7:e31654. [PMID: 22384048 PMCID: PMC3285161 DOI: 10.1371/journal.pone.0031654] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
Background There has been increasing interest in the interaction of the basal ganglia with the cerebellum and the brainstem in motor control and movement disorders. In addition, it has been suggested that these subcortical connections with the basal ganglia may help to coordinate a network of regions involved in mediating posture and stabilization. While studies in animal models support a role for this circuitry in the pathophysiology of the movement disorder dystonia, thus far, there is only indirect evidence for this in humans with dystonia. Methodology/Principal Findings In the current study we investigated probabilistic diffusion tractography in DYT1-negative patients with cervical dystonia and matched healthy control subjects, with the goal of showing that patients exhibit altered microstructure in the connectivity between the pallidum and brainstem. The brainstem regions investigated included nuclei that are known to exhibit strong connections with the cerebellum. We observed large clusters of tractography differences in patients relative to healthy controls, between the pallidum and the brainstem. Tractography was decreased in the left hemisphere and increased in the right hemisphere in patients, suggesting a potential basis for the left/right white matter asymmetry we previously observed in focal dystonia patients. Conclusions/Significance These findings support the hypothesis that connections between the basal ganglia and brainstem play a role in the pathophysiology of dystonia.
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Affiliation(s)
- Anne J Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America.
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Schapira AHV, Hillbom M. Publishing changes and information delivery in the clinical neurosciences. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.2011.03594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sadnicka A, Hoffland BS, Bhatia KP, van de Warrenburg BP, Edwards MJ. The cerebellum in dystonia - help or hindrance? Clin Neurophysiol 2011; 123:65-70. [PMID: 22078259 DOI: 10.1016/j.clinph.2011.04.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 03/21/2011] [Accepted: 04/05/2011] [Indexed: 10/15/2022]
Abstract
Dystonia has historically been considered a disorder of the basal ganglia. This review aims to critically examine the evidence for a role of the cerebellum in the pathophysiology of dystonia. We compare and attempt to link the information available from both clinical and experimental studies; work detailing cerebellar connectivity in primates; data that suggests a role for the cerebellum in the genesis of dystonia in murine models; clinical observation in humans with structural lesions and heredodegenerative disorders of the cerebellum; and imaging studies of patients with dystonia. The typical electrophysiological findings in dystonia are the converse to those found in cerebellar lesions. However, certain subtypes of dystonia mirror cerebellar patterns of increased cortical inhibition. Furthermore, altered cerebellar function can be demonstrated in adult onset focal dystonia with impaired cerebellar inhibition of motor cortex and abnormal eyeblink classical conditioning. We propose that abnormal, likely compensatory activity of the cerebellum is an important factor within pathophysiological models of dystonia. Work in this exciting area has only just begun but it is likely that the cerebellum will have a key place within future models of dystonia.
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Affiliation(s)
- A Sadnicka
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute for Neurology, Queen Square, London WC1N 3BG, UK
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Wakabayashi-Ito N, Doherty OM, Moriyama H, Breakefield XO, Gusella JF, O'Donnell JM, Ito N. Dtorsin, the Drosophila ortholog of the early-onset dystonia TOR1A (DYT1), plays a novel role in dopamine metabolism. PLoS One 2011; 6:e26183. [PMID: 22022556 PMCID: PMC3192163 DOI: 10.1371/journal.pone.0026183] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 09/22/2011] [Indexed: 12/14/2022] Open
Abstract
Dystonia represents the third most common movement disorder in humans. At least 15 genetic loci (DYT1-15) have been identified and some of these genes have been cloned. TOR1A (formally DYT1), the gene responsible for the most common primary hereditary dystonia, encodes torsinA, an AAA ATPase family protein. However, the function of torsinA has yet to be fully understood. Here, we have generated and characterized a complete loss-of-function mutant for dtorsin, the only Drosophila ortholog of TOR1A. Null mutation of the X-linked dtorsin was semi-lethal with most male flies dying by the pre-pupal stage and the few surviving adults being sterile and slow moving, with reduced cuticle pigmentation and thin, short bristles. Third instar male larvae exhibited locomotion defects that were rescued by feeding dopamine. Moreover, biochemical analysis revealed that the brains of third instar larvae and adults heterozygous for the loss-of-function dtorsin mutation had significantly reduced dopamine levels. The dtorsin mutant showed a very strong genetic interaction with Pu (Punch: GTP cyclohydrolase), the ortholog of the human gene underlying DYT14 dystonia. Biochemical analyses revealed a severe reduction of GTP cyclohydrolase protein and activity, suggesting that dtorsin plays a novel role in dopamine metabolism as a positive-regulator of GTP cyclohydrolase protein. This dtorsin mutant line will be valuable for understanding this relationship and potentially other novel torsin functions that could play a role in human dystonia.
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Affiliation(s)
- Noriko Wakabayashi-Ito
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Olugbenga M. Doherty
- Department of Biological Sciences, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Hideaki Moriyama
- School of Biological Science, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Xandra O. Breakefield
- Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
| | - James F. Gusella
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Janis M. O'Donnell
- Department of Biological Sciences, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Naoto Ito
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Zoons E, Booij J, Nederveen AJ, Dijk JM, Tijssen MAJ. Structural, functional and molecular imaging of the brain in primary focal dystonia--a review. Neuroimage 2011; 56:1011-20. [PMID: 21349339 DOI: 10.1016/j.neuroimage.2011.02.045] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 12/31/2022] Open
Abstract
Primary focal dystonias form a group of neurological disorders characterized by involuntary, sustained muscle contractions causing twisting movements and abnormal postures. The estimated incidence is 12-25 per 100,000. The pathophysiology is largely unclear but genetic and environmental influences are suspected. Over the last decade neuroimaging techniques have been applied in patients with focal dystonia. Using structural, functional and molecular imaging techniques, abnormalities have been detected mainly in the sensorimotor cortex, basal ganglia and cerebellum. The shared anatomical localisations in different forms of focal dystonia support the hypothesis of a common causative mechanism. The primary defect in focal dystonia is hypothesised in the motor circuit connecting the cortex, basal ganglia, and cerebellum. Imaging techniques have clearly enhanced current knowledge on the pathophysiology of primary focal dystonia and will continue to do so in the future.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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Bragg DC, Armata IA, Nery FC, Breakefield XO, Sharma N. Molecular pathways in dystonia. Neurobiol Dis 2010; 42:136-47. [PMID: 21134457 DOI: 10.1016/j.nbd.2010.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 11/08/2010] [Accepted: 11/26/2010] [Indexed: 11/27/2022] Open
Abstract
The hereditary dystonias comprise a set of diseases defined by a common constellation of motor deficits. These disorders are most likely associated with different molecular etiologies, many of which have yet to be elucidated. Here we discuss recent advances in three forms of hereditary dystonia, DYT1, DYT6 and DYT16, which share a similar clinical picture: onset in childhood or adolescence, progressive spread of symptoms with generalized involvement of body regions and a steady state affliction without treatment. Unlike DYT1, the genes responsible for DYT6 and DYT16 have only recently been identified, with relatively little information about the function of the encoded proteins. Nevertheless, recent data suggest that these proteins may fit together within interacting pathways involved in dopaminergic signaling, transcriptional regulation, and cellular stress responses. This review focuses on these molecular pathways, highlighting potential common themes among these dystonias which may serve as areas for future research. This article is part of a Special Issue entitled "Advances in dystonia".
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Affiliation(s)
- D Cristopher Bragg
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA.
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