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Nigro P, Chiappiniello A, Simoni S, Paolini Paoletti F, Cappelletti G, Chiarini P, Filidei M, Eusebi P, Guercini G, Santangelo V, Tarducci R, Calabresi P, Parnetti L, Tambasco N. Changes of olfactory tract in Parkinson's disease: a DTI tractography study. Neuroradiology 2020; 63:235-242. [PMID: 32918150 DOI: 10.1007/s00234-020-02551-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Impaired olfactory function is one of the main features of Parkinson's disease. However, how peripheral olfactory structures are involved remains unclear. Using diffusion tensor imaging fiber tracking, we investigated for MRI microstructural changes in the parkinsonian peripheral olfactory system and particularly the olfactory tract, in order to seek a better understanding of the structural alternations underlying hyposmia in Parkinson's disease. METHODS All patients were assessed utilizing by the Italian Olfactory Identification Test for olfactory function and the Unified Parkinson's Disease Rating Scale-III part as well as Hoehn and Yahr rating scale for motor disability. Imaging was performed on a 3 T Clinical MR scanner. MRI data pre-processing was carried out by DTIPrep, diffusion tensor imaging reconstruction, and fiber tracking using Diffusion Toolkit and tractography analysis by TrackVis. The following parameters were used for groupwise comparison: fractional anisotropy, mean diffusivity, radial diffusivity, axial diffusivity, and tract volume. RESULTS Overall 23 patients with Parkinson's disease (mean age 63.6 ± 9.3 years, UPDRS-III 24.5 ± 12.3, H&Y 1.9 ± 0.5) and 18 controls (mean age 56.3 ± 13.7 years) were recruited. All patients had been diagnosed hyposmic. Diffusion tensor imaging analysis of the olfactory tract showed significant fractional anisotropy, and tract volume decreases for the Parkinson's disease group compared with controls (P < 0.05). Fractional anisotropy and age, in the control group, were significant for multiple correlations (r = - 0.36, P < 0.05, Spearman's rank correlation). CONCLUSIONS Fiber tracking diffusion tensor imaging analysis of olfactory tract was feasible, and it could be helpful for characterizing hyposmia in Parkinson's disease.
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Affiliation(s)
- Pasquale Nigro
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Simone Simoni
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Federico Paolini Paoletti
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giulia Cappelletti
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Pietro Chiarini
- Neuroradiology Unit, Perugia General Hospital, Perugia, Italy
| | - Marta Filidei
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Eusebi
- Neurology Department, Perugia General Hospital and University of Perugia, Perugia, Italy
| | | | - Valerio Santangelo
- Department of Philosophy, Social Sciences & Education, University of Perugia, Perugia, Italy.,Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Roberto Tarducci
- Department of Medical Physics, Perugia General Hospital, Perugia, Italy
| | - Paolo Calabresi
- Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucilla Parnetti
- Neurology Department, Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Nicola Tambasco
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy. .,Neurology Department, Perugia General Hospital and University of Perugia, Perugia, Italy.
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Marcián V, Filip P, Bareš M, Brázdil M. Cerebellar Dysfunction and Ataxia in Patients with Epilepsy: Coincidence, Consequence, or Cause? TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:376. [PMID: 27375960 PMCID: PMC4925921 DOI: 10.7916/d8kh0nbt] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/05/2016] [Indexed: 12/15/2022]
Abstract
Basic epilepsy teachings assert that seizures arise from the cerebral cortex, glossing over infratentorial structures such as the cerebellum that are believed to modulate rather than generate seizures. Nonetheless, ataxia and other clinical findings in epileptic patients are slowly but inevitably drawing attention to this neural node. Tracing the evolution of this line of inquiry from the observed coincidence of cerebellar atrophy and cerebellar dysfunction (most apparently manifested as ataxia) in epilepsy to their close association, this review considers converging clinical, physiological, histological, and neuroimaging evidence that support incorporating the cerebellum into epilepsy pathology. We examine reports of still controversial cerebellar epilepsy, studies of cerebellar stimulation alleviating paroxysmal epileptic activity, studies and case reports of cerebellar lesions directly associated with seizures, and conditions in which ataxia is accompanied by epileptic seizures. Finally, the review substantiates the role of this complex brain structure in epilepsy whether by coincidence, as a consequence of deleterious cortical epileptic activity or antiepileptic drugs, or the very cause of the disease.
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Affiliation(s)
- Václav Marcián
- First Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic.,First Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic; Behavioral and Social Neuroscience Research Group, CEITEC (Central European Institute of Technology), Masaryk University, Brno, Czech Republic; Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Pavel Filip
- First Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic; Behavioral and Social Neuroscience Research Group, CEITEC (Central European Institute of Technology), Masaryk University, Brno, Czech Republic; Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Milan Brázdil
- First Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Medical Faculty of Masaryk University, Brno, Czech Republic; Behavioral and Social Neuroscience Research Group, CEITEC (Central European Institute of Technology), Masaryk University, Brno, Czech Republic
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Park JH, Yoon BR, Kim HJ, Lee PH, Choi BO, Chung KW. Compound mitochondrial DNA mutations in a neurological patient with ataxia, myoclonus and deafness. J Genet 2014; 93:173-7. [PMID: 24840835 DOI: 10.1007/s12041-014-0317-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ji Hoon Park
- Department of Biological Science, Kongju National University, 182 sinkwan-dong, Gongju, Chungnam 314-701, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Myoclonus remains a challenging movement phenotype to characterize, evaluate, and treat. A systematic assessment of the temporal sequence, phenomenology, and distribution of movements can assist in the rational approach to diagnosis and management. RECENT FINDINGS Cortical forms of myoclonus are increasingly recognized as primarily cerebellar disorders. A syndrome of orthostatic myoclonus has been recognized by electrophysiology in patients with neurodegenerative disorders, mainly in Alzheimer disease, accounting for impairments in gait and balance previously mischaracterized as normal pressure hydrocephalus or orthostatic tremor. Tyrosine hydroxylase deficiency and Silver-Russell syndrome (uniparental disomy of chromosome 7) have been established as two novel causes of the myoclonus-dystonia syndrome. Mutations in the glycine receptor (GlyR) α1-subunit gene (GLRA1) explain the major expression of hyperekplexia, an inherited excessive startle disorder, butnewly identified mutations in GlyR β-subunit (GLRB) and glycine transporter 2 (GlyT2) genes (SLC6A5) account for "minor" forms of this disorder manifested as excessive startle and hypnic jerks. The entity previously known as palatal myoclonus has been reclassified as palatal tremor in recognition of its clinical and electromyographic features and no longer enters the differential diagnosis of myoclonic disorders. Increasing documentation of psychogenic features in patients previously characterized as having propriospinal myoclonus has cast doubts on the existence of this distinctive disorder. SUMMARY Myoclonus can be a prominent manifestation of a wide range of disorders. Electrophysiologic testing aids in distinguishing myoclonus from other mimics and classifying them according to cortical, subcortical, or spinal origin, which assists the choice of treatment. Despite the lack of randomized clinical trials, levetiracetam appears most effective in patients with cortical myoclonus, whereas clonazepam remains the only first-line therapeutic option in subcortical and spinal myoclonus.
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Berkovic SF, Cochius J, Andermann E, Andermann F. Progressive myoclonus epilepsies: clinical and genetic aspects. Epilepsia 2010; 34 Suppl 3:S19-30. [PMID: 8500430 DOI: 10.1111/j.1528-1167.1993.tb06256.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The progressive myoclonus epilepsies (PMEs) are a group of rare genetic disorders previously shrouded in nosological confusion. Recent advances have clarified the features of these disorders and provided a rational approach to diagnosis. The major causes of PME are now known to be Unverricht-Lundborg disease, myoclonus epilepsy ragged-red fiber (MERRF) syndrome, Lafora disease, neuronal ceroid lipofuscinoses, and sialidoses. Over the past 3 years, a series of molecular genetic findings have further refined the understanding of the PMEs. The specific mutation responsible for many cases of MERRF has been identified, and the genes for Unverricht-Lundborg disease and for juvenile neuronal ceroid lipofuscinosis have been linked to chromosomes 21 and 16, respectively. Although the PMEs are among the rarest of the inherited epilepsies, because of molecular genetic discoveries they may soon be the best understood at the neurobiologic level.
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Affiliation(s)
- S F Berkovic
- Department of Neurology, Austin Hospital, Melbourne, Australia
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Alegre M, Urriza J, Valencia M, Muruzábal J, Iriarte J, Artieda J. High-Frequency Oscillations in the Somatosensory Evoked Potentials of Patients With Cortical Myoclonus: Pathophysiologic Implications. J Clin Neurophysiol 2006; 23:265-72. [PMID: 16751728 DOI: 10.1097/01.wnp.0000201075.31438.fb] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY A small series of high-frequency wavelets overlapping the earliest part of the N20 wave (high-frequency oscillations, HFOs) can be observed in the somatosensory evoked potentials (SSEPs) of normal subjects after filtering then with a high-pass filter (>500 Hz). These HFOs have been related to interneuronal activity in the primary somatosensory cortex. In patients with cortical myoclonus there is a sensorimotor cortical hyperexcitability, expressed neurophysiologically as high-amplitude waves in the SSEPs (giant SSEPs). There have been contradicting reports in the literature on the changes in the HFOs in these patients. The authors studied HFOs in a group of 20 patients with cortical myoclonus of different origins and in a control group by means of time-frequency transforms, comparing the results obtained with the amplitude and latency of the classical SSEP waves. All controls had normal HFOs, with two components. Nine patients had no HFOs, nine patients had low-amplitude and/or delayed HFOs, and the remaining two patients, the only without ataxia, had high-amplitude HFOs with a long latency. These results suggest heterogeneity in the pathophysiology of cortical myoclonus, which might be related to the different systems affected.
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Affiliation(s)
- Manuel Alegre
- Clinical Neurophysiology Section, Department of Neurology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain
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Abstract
We studied 6 patients with myoclonus elicited by flash stimulation (1-15 Hz). Multichannel electromyographic recording showed a rostrocaudal recruitment order for the generalized myoclonic jerk. In all patients, each flash induced a large (36.9 +/- 5.7 microV) frontal biphasic wave with an onset latency of 42 msec that preceded the earliest muscle response in the face by at least 4 msec (range, 4-7 msec), the activity in the biceps by 11 to 14 msec, and the activity in tibialis anterior by 26 to 34 msec. Occipital potentials evoked by the same flash stimulation had a latency of 33.7 msec and were of normal amplitude (2.1 +/- 1.2 microV). Brain-mapping analysis indicated that the frontal activity correlated with the myoclonus originated in the premotor and motor cortices. These findings provide evidence for a cortical origin of this form of stimulus-sensitive myoclonus in humans. Administration of apomorphine and lisuride (intravenously) and levodopa-carbidopa (orally) abolished the photic myoclonus. Intravenous 5-hydroxytryptophan plus carbidopa (orally) and piracetam (orally) were also effective against photic myoclonus. The wide range of drugs active against photic cortical myoclonus suggests the participation of several biochemical mechanisms in its origin.
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Affiliation(s)
- J Artieda
- Department of Neurology, Clinica Universitaria, University of Navarra Medical School, Pamplona, Spain
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