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Raslan IR, de Assis Pereira Matos PCA, Boaratti Ciarlariello V, Daghastanli KH, Rosa ABR, Arita JH, Aranda CS, Barsottini OGP, Pedroso JL. Beyond Typical Ataxia Telangiectasia: How to Identify the Ataxia Telangiectasia-Like Disorders. Mov Disord Clin Pract 2021; 8:118-125. [PMID: 33426167 PMCID: PMC7780949 DOI: 10.1002/mdc3.13110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/31/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ataxia telangiectasia is one of the most common causes of autosomal recessive cerebellar ataxias. However, absence of telangiectasia, normal levels of alpha-fetoprotein and negative genetic test may direct to alternative diagnosis with similar phenotypes such as ataxia telangiectasia-like disorders (ATLD). CASES We report two instructive cases of ATLD: the first case with ataxia telangiectasia-like disorder type 1 related to MRE11A gene, and the second case with ataxia telangiectasia-like disorder type 2 related to PCNA gene. LITERATURE REVIEW ATLD is an unusual group of autosomal recessive diseases that share some clinical features and pathophysiological mechanisms with ataxia telangiectasia (AT). ATLD may be associated with mutations in the MRE11A (ATLD type 1) and PCNA (ATLD type 2) genes. ATLD belongs to the group of chromosomal instability syndromes. The reason for the term ATLD is related to the similar pathophysiological mechanisms observed in AT, which is characterized by chromosomal instability and radiosensitivity. CONCLUSIONS In this review, the main clinical features, biomarkers, brain imaging and genetics of ATLD are discussed. Mutations in the MRE11A and PCNA genes should be included in the differential diagnosis for early onset cerebellar ataxia with absence of telangiectasia and normal levels of alpha-fetoprotein.
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Affiliation(s)
- Ivana Rocha Raslan
- Department of Neurology, Ataxia UnitUniversidade Federal de São PauloSão PauloBrazil
| | | | | | | | | | | | | | | | - José Luiz Pedroso
- Department of Neurology, Ataxia UnitUniversidade Federal de São PauloSão PauloBrazil
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Megna M, Marvulli R, Farì G, Gallo G, Dicuonzo F, Fiore P, Ianieri G. Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment. Endocr Metab Immune Disord Drug Targets 2020; 19:1127-1133. [PMID: 30843498 DOI: 10.2174/1871530319666190306101322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients' to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke. METHODS We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness). RESULTS Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only. CONCLUSION Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke.
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Affiliation(s)
- Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Riccardo Marvulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giacomo Farì
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia Gallo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Franca Dicuonzo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Pietro Fiore
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Boonstra FMC, Evans A, Noffs G, Perera T, Jokubaitis V, Stankovich J, Vogel AP, Moffat BA, Butzkueven H, Kolbe SC, van der Walt A. OnabotulinumtoxinA treatment for MS-tremor modifies fMRI tremor response in central sensory-motor integration areas. Mult Scler Relat Disord 2020; 40:101984. [PMID: 32062446 DOI: 10.1016/j.msard.2020.101984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/21/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment of tremor in MS is an unmet need. OnabotulinumtoxinA (BoNT-A) has shown promising results; however, little is known regarding its effects on the brain. The clinical presentation of tremor MS is shown to depend on subcortical neural damage and cortical neural plasticity. This study aimed to identify effects of onabotulinumtoxinA (BoNT-A) on brain activation in MS and upper-limb tremor using functional MRI. METHODS Forty-three MS participants with tremor were randomized to receive intramuscular injections of placebo (n = 22) or BoNT-A (n = 21). Tremor was quantified using the Bain score (0-10) for severity, handwriting and Archimedes drawing at baseline, 6 weeks and 12 weeks. Functional MRI activation within two previously identified clusters, ipsilateral inferior parietal cortex (IPL) and premotor/supplementary motor cortex (SMC) of compensatory activity, was measured at baseline and 6 weeks. RESULTS Treatment with BoNT-A resulted in improved handwriting tremor at 6 weeks (p = 0.049) and 12 weeks (p = 0.014), and tremor severity -0.79 (p = 0.007) at 12 weeks. Furthermore, the patients that received BoNT-A showed a reduction in activation within the IPL (p = 0.034), but not in the SMC. The change in IPL activation correlated with the reduction in tremor severity from baseline to 12 weeks (β = 0.608; p = 0.015) in the BoNT-A group. No tremor and fMRI changes were seen in the placebo treated group. CONCLUSION We have shown that reduction in MS-tremor severity after intramuscular injection with BoNT-A is associated with changes in brain activity in sensorimotor integration regions.
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Affiliation(s)
- Frederique M C Boonstra
- Department of Medicine and Radiology, University of Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia.
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Australia; The Bionics Institute, Australia
| | - Gustavo Noffs
- Department of Neurology, Royal Melbourne Hospital, Australia; Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
| | - Thushara Perera
- The Bionics Institute, Australia; Department of Medical Bionics, University of Melbourne, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia; The Bionics Institute, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; Redenlab, Victoria, Australia
| | - Bradford A Moffat
- Department of Medicine and Radiology, University of Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Scott C Kolbe
- Department of Medicine and Radiology, University of Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Florey Institute of Neuroscience and Mental Health, Australia
| | - Anneke van der Walt
- Department of Neurology, Royal Melbourne Hospital, Australia; The Bionics Institute, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia
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Mustalampi S, Ylinen J, Korniloff K, Weir A, Häkkinen A. Reduced Neck Muscle Strength and Altered Muscle Mechanical Properties in Cervical Dystonia Following Botulinum Neurotoxin Injections: A Prospective Study. J Mov Disord 2016; 9:44-9. [PMID: 26828215 PMCID: PMC4734985 DOI: 10.14802/jmd.15035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/23/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate changes in the strength and mechanical properties of neck muscles and disability in patients with cervical dystonia (CD) during a 12-week period following botulinum neurotoxin (BoNT) injections. Methods Eight patients with CD volunteered for this prospective clinical cohort study. Patients had received BoNT injections regularly in neck muscles at three-month intervals for several years. Maximal isometric neck strength was measured by a dynamometer, and the mechanical properties of the splenius capitis were evaluated using two myotonometers. Clinical assessment was performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) before and at 2, 4, 8, and 12 weeks after the BoNT injections. Results Mean maximal isometric neck strength at two weeks after the BoNT injections decreased by 28% in extension, 25% in rotation of the affected side and 17% in flexion. At four weeks, muscle stiffness of the affected side decreased by 17% and tension decreased by 6%. At eight weeks, the muscle elasticity on the affected side increased by 12%. At two weeks after the BoNT injections, the TWSTRS-severity and TWSTRS-total scores decreased by 4.3 and 6.4, respectively. The strength, muscle mechanical properties and TWSTRS scores returned to baseline values at 12 weeks. Conclusions Although maximal neck strength and muscle tone decreased after BoNT injections, the disability improved. The changes observed after BoNT injections were temporary and returned to pre-injection levels within twelve weeks. Despite having a possible negative effect on function and decreasing neck strength, the BoNT injections improved the patients reported disability.
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Affiliation(s)
- Sirpa Mustalampi
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Adam Weir
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland ; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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