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Garau C, Hayes J, Chiacchierini G, McCutcheon JE, Apergis-Schoute J. Involvement of A13 dopaminergic neurons in prehensile movements but not reward in the rat. Curr Biol 2023; 33:4786-4797.e4. [PMID: 37816347 DOI: 10.1016/j.cub.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
Tyrosine hydroxylase (TH)-containing neurons of the dopamine (DA) cell group A13 are well positioned to impact known DA-related functions as their descending projections innervate target regions that regulate vigilance, sensory integration, and motor execution. Despite this connectivity, little is known regarding the functionality of A13-DA circuits. Using TH-specific loss-of-function methodology and techniques to monitor population activity in transgenic rats in vivo, we investigated the contribution of A13-DA neurons in reward and movement-related actions. Our work demonstrates a role for A13-DA neurons in grasping and handling of objects but not reward. A13-DA neurons responded strongly when animals grab and manipulate food items, whereas their inactivation or degeneration prevented animals from successfully doing so-a deficit partially attributed to a reduction in grip strength. By contrast, there was no relation between A13-DA activity and food-seeking behavior when animals were tested on a reward-based task that did not include a reaching/grasping response. Motivation for food was unaffected, as goal-directed behavior for food items was in general intact following A13 neuronal inactivation/degeneration. An anatomical investigation confirmed that A13-DA neurons project to the superior colliculus (SC) and also demonstrated a novel A13-DA projection to the reticular formation (RF). These results establish a functional role for A13-DA neurons in prehensile actions that are uncoupled from the motivational factors that contribute to the initiation of forelimb movements and help position A13-DA circuits into the functional framework regarding centrally located DA populations and their ability to coordinate movement.
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Affiliation(s)
- Celia Garau
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, UK.
| | - Jessica Hayes
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, UK
| | - Giulia Chiacchierini
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, UK; Department of Physiology and Pharmacology, La Sapienza University of Rome, 00185 Rome, Italy; Laboratory of Neuropsychopharmacology, Santa Lucia Foundation, 00143 Rome, Italy
| | - James E McCutcheon
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, UK; Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, 9037 Tromsø, Norway
| | - John Apergis-Schoute
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, UK; Department of Biological and Experimental Psychology, Queen Mary University of London, London E1 4NS, UK.
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Teismann H, Schubert R, Reilmann R, Berger K. Effects of age and sex on outcomes of the Q-Motor speeded finger tapping and grasping and lifting tests-findings from the population-based BiDirect Study. Front Neurol 2022; 13:965031. [PMID: 36247774 PMCID: PMC9561931 DOI: 10.3389/fneur.2022.965031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Q-Motor is a suite of motor tests originally designed to assess motor symptoms in Huntington's disease. Among others, Q-Motor encompasses a finger tapping task and a grasping and lifting task. To date, there are no systematic investigations regarding effects of variables which may affect the performance in specific Q-Motor tests per se, and normative Q-Motor data based on a large population-based sample are not yet available. Objective We investigated effects of age and sex on five selected Q-Motor outcomes representing the two core Q-Motor tasks speeded finger tapping and grasping and lifting in a community sample of middle-aged to elderly adults. Furthermore, we explored effects of the potentially mediating variables educational attainment, alcohol consumption, smoking status, and depressive symptoms. Moreover, we explored inter-examiner variability. Finally, we compared the findings to findings for the Purdue Pegboard test. Methods Based on a sample of 726 community-dwelling adults and using multiple (Gaussian) regression analysis, we modeled the motor outcomes using age, sex, years in full-time education, depressive symptoms in the past seven days, alcohol consumption in the past seven days, and smoking status as explanatory variables. Results With regard to the Q-Motor tests, we found that more advanced age was associated with reduced tapping speed, male sex was associated with increased tapping speed and less irregularity, female sex was associated with less involuntary movement, more years of education were associated with increased tapping speed and less involuntary movement, never smoking was associated with less involuntary movement compared to current smoking, and more alcohol consumed was associated with more involuntary movement. Conclusion The present results show specific effects of age and sex on Q-Motor finger tapping and grasping and lifting performance. In addition, besides effects of education, there also were specific effects of smoking status and alcohol consumption. Importantly, the present study provides normative Q-Motor data based on a large population-based sample. Overall, the results are in favor of the feasibility and validity of Q-Motor finger tapping and grasping and lifting for large observational studies. Due to their low task-complexity and lack of placebo effects, Q-Motor tests may generate additional value in particular with regard to clinical conditions such as Huntington's or Parkinson's disease.
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Affiliation(s)
- Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- *Correspondence: Henning Teismann
| | | | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Li SH, Colson TLL, Abd-Elrahman KS, Ferguson SS. mGluR2/3 Activation Improves Motor Performance and Reduces Pathology in heterozygous zQ175 Huntington's Disease Mice. J Pharmacol Exp Ther 2021; 379:74-84. [PMID: 34330748 DOI: 10.1124/jpet.121.000735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Abstract
Huntington's Disease (HD) is an autosomal dominant neurodegenerative disease that leads to progressive motor impairment with no available disease-modifying treatments. Current evidence indicates that exacerbated postsynaptic glutamate signaling in the striatum plays a key role in the pathophysiology of HD. However, it remains unclear whether reducing glutamate release can be an effective approach to slow the progression of HD. Here, we show that the activation of metabotropic glutamate receptors 2 and 3 (mGluR2/3), which inhibit presynaptic glutamate release, improves HD symptoms and pathology in heterozygous zQ175 knock-in mice. Treatment of both male and female zQ175 mice with the potent and selective mGluR2/3 agonist LY379268 for either 4 or 8 weeks improves both limb coordination and locomotor function in all mice. LY379268 also reduces mutant huntingtin aggregate formation, neuronal cell death, and microglia activation in the striatum of both male and female zQ175 mice. The reduction in mutant huntingtin protein correlates with the activation of a GSK3β-dependent autophagy pathway in male, but not female, zQ175 mice. Furthermore, LY379268 reduces both Akt and ERK1/2 phosphorylation in male zQ175 mice but increases both Akt and ERK1/2 phosphorylation in female zQ175 mice. Taken together, our results indicate that mGluR2/3 activation mitigates HD neuropathology in both male and female mice but is associated with the differential activation and inactivation of cell signaling pathways in heterozygous male and female zQ175 mice. This further highlights the need to take sex into consideration when developing future HD therapeutics. Significance Statement The mGluR2/3 agonist LY379268 improves motor impairments and reduces pathology in male and female zQ175 Huntington's mice. The beneficial outcomes of LY379268 treatment in Huntington's mice were mediated by divergent cell signalling pathways in both sexes. We provide evidence that mGluR2/3 agonists can be repurposed for the treatment of Huntington's disease and we emphasize the importance of investigating sex as a biological variable in preclinical disease modifying studies.
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Medzech S, Sass C, Bohlen S, Lange HW, Koch R, Schubert R, Ringelstein EB, Reilmann R. Impaired Isometric Force Matching in Upper and Lower Limbs Revealed by Quantitative Motor Assessments in Huntington's Disease. J Huntingtons Dis 2020; 8:483-492. [PMID: 31450507 DOI: 10.3233/jhd-190354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Assessment of motor symptoms in Huntington's disease (HD) is based on the Unified-HD-Rating-Scale-Total-Motor-Score (UHDRS-TMS). Its categorical and rater-dependent nature reduces the ability to detect subtle changes and often placebo effects have been observed in trials. We have previously shown that impairments in isometric force matching can be detected by quantitative motor (Q-Motor) assessments of tongue protrusion forces (glossomotography) in HD. OBJECTIVE We aimed to investigate whether similar impairments in isometric force matching can be detected in tasks assessing hand and foot force coordination and whether correlations with clinical measures and the disease burden score can be found. METHODS Using a pre-calibrated force transducer, the ability of subjects to generate and maintain isometric forces at different target levels displayed on a monitor was assessed. Target forces applied in the hand were 1.5 and 5 Newton [N] and in feet 1, 5, and 10 N. Subjects with HD (n = 31) and age-matched controls (n = 22) were recruited from the HD out-patient clinic. RESULTS All paradigms distinguished controls from HD. The static coefficient of variability (%) was the most robust measure across all matching tasks. Correlations with clinical measures, such as the UHDRS-TMS, TFC, and the DBS were found. CONCLUSIONS Assessment of hand and foot force matching tasks was feasible and provided quantitative objective measures for severity of motor phenotype in HD. Since both upper and lower extremity motor function are relevant for everyday activities, these measures should be further assessed as candidates for developing functionally meaningful quantitative motor tasks.
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Affiliation(s)
- Sabrina Medzech
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany.,Department of Neurology, University of Muenster, Muenster, Germany
| | - Christian Sass
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany.,Department of Neurology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Stefan Bohlen
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany.,Institute for Clinical Radiology, University of Muenster, Muenster, Germany
| | - Herwig W Lange
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Muenster, Münster, Germany
| | - Robin Schubert
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany
| | | | - Ralf Reilmann
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Muenster, Germany.,Institute for Clinical Radiology, University of Muenster, Muenster, Germany.,Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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van der Plas E, Schubert R, Reilmann R, Nopoulos PC. A Feasibility Study of Quantitative Motor Assessments in Children Using the Q-Motor Suite. J Huntingtons Dis 2020; 8:333-338. [PMID: 31256146 DOI: 10.3233/jhd-190353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Q-Motor is utilized across various clinical trials in adults with Huntington's disease (HD) to provide quantitative, reliable assessments of motor abilities. With gene-knockdown therapies entering the clinic, development of preventative therapies for pediatric carriers of the HD mutation seems imminent. It is currently unclear if Q-Motor is useful for tracking changes in motor abilities in pediatric HD patients or at-risk youth, as most assessments have never been administered in children. We demonstrate the feasibility of administering Q-Motor tasks in a sample of children recruited from the community, and we show that Q-Motor is sensitive to age-related changes in motor abilities.
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Affiliation(s)
- Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Ralf Reilmann
- George Huntington Institute, Muenster, Germany.,Department of Radiology, University of Muenster, Muenster, Germany.,Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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6
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Gaßner H, Jensen D, Marxreiter F, Kletsch A, Bohlen S, Schubert R, Muratori LM, Eskofier B, Klucken J, Winkler J, Reilmann R, Kohl Z. Gait variability as digital biomarker of disease severity in Huntington's disease. J Neurol 2020; 267:1594-1601. [PMID: 32048014 PMCID: PMC7293689 DOI: 10.1007/s00415-020-09725-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impaired gait plays an important role for quality of life in patients with Huntington's disease (HD). Measuring objective gait parameters in HD might provide an unbiased assessment of motor deficits in order to determine potential beneficial effects of future treatments. OBJECTIVE To objectively identify characteristic features of gait in HD patients using sensor-based gait analysis. Particularly, gait parameters were correlated to the Unified Huntington's Disease Rating Scale, total motor score (TMS), and total functional capacity (TFC). METHODS Patients with manifest HD at two German sites (n = 43) were included and clinically assessed during their annual ENROLL-HD visit. In addition, patients with HD and a cohort of age- and gender-matched controls performed a defined gait test (4 × 10 m walk). Gait patterns were recorded by inertial sensors attached to both shoes. Machine learning algorithms were applied to calculate spatio-temporal gait parameters and gait variability expressed as coefficient of variance (CV). RESULTS Stride length (- 15%) and gait velocity (- 19%) were reduced, while stride (+ 7%) and stance time (+ 2%) were increased in patients with HD. However, parameters reflecting gait variability were substantially altered in HD patients (+ 17% stride length CV up to + 41% stride time CV with largest effect size) and showed strong correlations to TMS and TFC (0.416 ≤ rSp ≤ 0.690). Objective gait variability parameters correlated with disease stage based upon TFC. CONCLUSIONS Sensor-based gait variability parameters were identified as clinically most relevant digital biomarker for gait impairment in HD. Altered gait variability represents characteristic irregularity of gait in HD and reflects disease severity.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Dennis Jensen
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - F Marxreiter
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Anja Kletsch
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Stefan Bohlen
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Robin Schubert
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Lisa M Muratori
- George-Huntington Institute (GHI) GmbH, Münster, Germany
- Rehabilitation Research and Movement Performance Laboratory (RRAMP Lab), Stony Brook University, Stony Brook, NY, USA
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Medical Valley-Digital Health Application Center GmbH, Bamberg, Germany
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ralf Reilmann
- George-Huntington Institute (GHI) GmbH, Münster, Germany
- Department of Radiology, University of Muenster, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Zacharias Kohl
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
- Center for Rare Diseases Erlangen, University Hospital Erlangen, Erlangen, Germany.
- Department of Neurology, University of Regensburg, Regensburg, Germany.
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Schaeffer E, Streich S, Wurster I, Schubert R, Reilmann R, Wolfram S, Berg D. How to evaluate effects of occupational therapy - lessons learned from an exploratory randomized controlled trial. Parkinsonism Relat Disord 2019; 67:42-47. [PMID: 31621606 DOI: 10.1016/j.parkreldis.2019.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 08/25/2019] [Accepted: 09/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although occupational therapy (OT) is frequently prescribed in clinical practice, there is still insufficient evidence regarding its efficacy to improve Parkinson's Disease (PD)-related activity limitations. OBJECTIVES To evaluate the efficacy of OT and the validity of different outcome-parameters to reflect efficacy, including gold-standard clinical rating scales and quantitative motor assessments. METHODS 40 patients were included in an exploratory, randomized-controlled, single-blinded trial, receiving either (I) ten weeks of OT, with a main focus on motor aspects of activity limitations and a ten-week follow-up assessment or (II) no intervention. Inclusion criteria were diagnosis of PD and Hoehn & Yahr stage 2-3. Patients with major depression, other neurological or orthopedic diseases or OT beforehand were excluded from the study. To monitor treatment effects the MDS-UPDRS part II and III were used for patient- and clinician-based assessment. Objective Pegboard as well as Q-Motor "tremormotography" and "digitomotography" were applied. RESULTS The interventional group reported a subjective amelioration of activity limitations, with a significant improvement of MDS-UPDRS part II at the end of the study (p = 0.030). However, clinician's rating and quantitative motor assessment failed to detect a significant improvement of motor impairment and fine motor control. CONCLUSIONS This study goes in line with previous trials, showing an individual improvement of activity limitations from the patients' point of view. The discrepancy between self-perception, focusing on activity limitation, and clinician-based rating, focusing on motor impairment, challenges the current gold standard assessments as valid outcome parameters for occupational therapy trials aiming for an individualized improvement of disease burden.
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Affiliation(s)
- E Schaeffer
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany.
| | - S Streich
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - I Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - R Schubert
- George Huntington Institute, Münster, Germany
| | - R Reilmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; George Huntington Institute, Münster, Germany; Department of Clinical Radiology, University of Münster, Münster, Germany
| | - S Wolfram
- Center for Outpatient Rehabilitation (ZAR), Tuebingen, Germany
| | - D Berg
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Application of Quantitative Motor Assessments in Friedreich Ataxia and Evaluation of Their Relation to Clinical Measures. THE CEREBELLUM 2019; 18:896-909. [DOI: 10.1007/s12311-019-01073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Caligiuri M, Snell C, Park S, Corey-Bloom J. Handwriting Movement Abnormalities in Symptomatic and Premanifest Huntington's Disease. Mov Disord Clin Pract 2019; 6:586-592. [PMID: 31538093 DOI: 10.1002/mdc3.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 11/09/2022] Open
Abstract
Background Kinematic measures of handwriting movements are sensitive to mild subclinical motor abnormalities stemming from a wide range of disorders involving the basal ganglia including Huntington's disease (HD). Prior research has not investigated handwriting movements in at-risk individuals in the premanifest stage of HD. Objectives The purpose of this study was to examine whether handwriting movement abnormalities are present prior to clinically manifest chorea in HD. Methods A total of 38 symptomatic HD, 30 gene-positive premanifest, and 25 healthy control participants completed handwriting tasks consisting of circles, loops, sentences, and spirals with a noninking pen on a digitizing tablet. Multiple measures of pen stroke kinematics and pressure were measured along with the cognitive and motor status of each participant. Burden of pathology and CAG × age product scores were obtained from each participant with HD. Results Participants with HD exhibited significantly longer and more variable stroke durations, decreased handwriting smoothness, and increased and more variable pen pressures when compared with the healthy controls. We found significant positive associations between stroke duration and both burden of pathology and CAG × age product. Results from a discriminant function analysis revealed a 7-factor model that distinguished premanifest from healthy controls with 85% accuracy. Factors in the model included greater variability in stroke amplitude, velocity and pen pressure, higher levels of pen pressure, longer stroke durations, and lower velocities for combinations of handwritten circles, sentences, and spirals. Conclusions These findings support the clinical utility of dynamic measures of handwriting kinematics as a potential early behavioral biomarker in HD.
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Affiliation(s)
- Michael Caligiuri
- Department of Psychiatry University of California San Diego La Jolla California USA
| | - Chase Snell
- Department of Neurosciences University of California San Diego La Jolla California USA
| | - Sungmee Park
- Department of Neurosciences University of California San Diego La Jolla California USA
| | - Jody Corey-Bloom
- Department of Neurosciences University of California San Diego La Jolla California USA
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Quantitative grip force assessment of muscular weakness in chronic inflammatory demyelinating polyneuropathy. BMC Neurol 2019; 19:118. [PMID: 31176377 PMCID: PMC6556046 DOI: 10.1186/s12883-019-1339-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background In patients suffering from Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) disease severity is assessed by Medical Research Counsil (MRC) Scale or Inflammatory Neuropathy Cause and Treatment (INCAT) disability score. However, none of these methods is appropriate to objectively assess muscle weakness or to detect very small subclinical changes. More objective and quantitative measures are needed in order to evaluate treatment efficiency or to detect subclinical affection of upper limps for early diagnosis. The goal of our study was to objectively quantify muscular weakness in CIDP patients with the non-invasive Quantitative Motor (Q-Motor) test of Grip Force Assessment (QGFA) as well as the Involuntary Movement Assessment (QIMA) and to search for differences between typical and atypical CIDP variants. In addition, we hypothesized that Q-Motor findings correlate with disease severity scales such as MRC or INCAT score. Methods In this cross-sectional exploratory proof-of-concept study subjects with confirmed diagnosis of typical or atypical CIDP were examined and compared to healthy controls (HC). For Q-Motor tests all subjects had to lift a device (250 g and 500 g) equipped with an electromagnetic sensor that measured grip force (GF) and three-dimensional changes in position and orientation. The measures “grip force variability” (GFV), “position index” (PI) and “orientation index” (OI) were provided to assess involuntary movements due to muscular weakness. Results 33 patients with CIDP and 28 HC were included. All measures were significantly elevated in CIDP patients for both devices in the right and left hand compared to healthy controls. Subgroup analysis revealed no differences between typical and atypical CIDP variants. INCAT score only weakly correlated with OI and PI. However, there was a stronger correlation between MRC and QIMA parameters in both hands. Conclusion Q-Motor assessments were capable to objectively assess muscular weakness in CIDP. In particular, QIMA measures detected subclinical generalized muscle weakness even in patients with milder disability. Sensitivity and rater-independence of Q-Motor assessments support a further exploration of QIMA measures as potential endpoints for future clinical trials in CIDP.
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11
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Jeppesen Kragh F, Bruun M, Budtz-Jørgensen E, Hjermind LE, Schubert R, Reilmann R, Nielsen JE, Hasselbalch SG. Quantitative Measurements of Motor Function in Alzheimer's Disease, Frontotemporal Dementia, and Dementia with Lewy Bodies: A Proof-of-Concept Study. Dement Geriatr Cogn Disord 2019; 46:168-179. [PMID: 30257254 DOI: 10.1159/000492860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study examines the efficacy of using quantitative measurements of motor dysfunction, compared to clinical ratings, in Alzheimer's disease (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB). METHODS In this cross-sectional study, 49 patients with a diagnosis of AD (n = 17), FTD (n = 19), or DLB (n = 13) were included and underwent cognitive testing, clinical motor evaluation, and quantitative motor tests: pronation/supination hand tapping, grasping and lifting, and finger and foot tapping. RESULTS Our results revealed significantly higher Q-Motor values in pronation/supination and in grip lift force assessment in AD, FTD, and DLB compared to healthy controls (HC). Q-Motor values detected significant differences between AD and HC, while clinical ratings did not. CONCLUSION Our results suggest that quantitative measurements provide more objective and sensitive measurements of motor dysfunction in dementia.
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Affiliation(s)
- Frederikke Jeppesen Kragh
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bruun
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Department of Public Health, Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lena Elisabeth Hjermind
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Ralf Reilmann
- The George Huntington Institute, Münster, Germany.,Department of Clinical Radiology, University of Münster, Münster, Germany.,Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jørgen Erik Nielsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen,
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Reilmann R, Schubert R, Bohlen S, Sass C. On the rise: Quantitative measures in Huntington's disease. Mov Disord 2018; 33:1370-1371. [PMID: 30230629 DOI: 10.1002/mds.27469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ralf Reilmann
- George-Huntington-Institute, Technology Park, Muenster, Germany.,Department of Radiology, University of Muenster, Muenster, Germany.,Department of Neurodegenerative Diseases and Hertie-Institute forClinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Robin Schubert
- George-Huntington-Institute, Technology Park, Muenster, Germany
| | - Stefan Bohlen
- George-Huntington-Institute, Technology Park, Muenster, Germany
| | - Christian Sass
- George-Huntington-Institute, Technology Park, Muenster, Germany.,Department of Neurology, Asklepios Klinikum Harburg, Hamburg, Germany
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Beckmann H, Bohlen S, Saft C, Hoffmann R, Gerss J, Muratori L, Ringelstein EB, Landwehrmeyer GB, Reilmann R. Objective assessment of gait and posture in premanifest and manifest Huntington disease - A multi-center study. Gait Posture 2018; 62:451-457. [PMID: 29660633 DOI: 10.1016/j.gaitpost.2018.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Deficits in posture and gait are known to contribute to the complex motor phenotype of Huntington disease (HD). Objective and quantitative measures of posture and gait provided by posturography and GAITRite® assessments may supplement categorical rating scales such as the UHDRS-TMS and increase power and sensitivity of clinical trials. OBJECTIVES To investigate whether posturography and GAITRite® measures reveal (1) changes in manifest or premanifest HD mutation-carriers, (2) a correlation to the UHDRS-TMS and functional measures in manifest HD, and (3) a correlation to the disease-burden-score (based on CAG-repeat-length and age). METHODS Posturography and GAITRite® were applied in premanifest (n = 26) and manifest HD gene-mutation-carriers (n = 40) in different paradigms compared to age-matched controls (n = 30) in a cross-sectional multi-site study conducted in three centers. Subjects were assessed clinically with the UHDRS Total-Motor-Score, Total-Functional-Capacity and Functional-Assessment-Scale. RESULTS Several posturography measures were able to discriminate between controls, premanifest, and manifest mutation-carriers in both conditions assessed. Only one GAITRite® measure separated controls and premanifest participants, while discrimination between controls and manifest same as between premanifest and manifest participants was possible in several measures. Correlation with all clinical measures was seen in only one measure per device while correlations to the disease-burden-score seen in posturography only. CONCLUSION Overall the results suggests that posturography detects alterations in premanifest and manifest mutation-carriers more reliably than GAITRite® measures. Correlations with clinical assessment scores are limited; correlation with disease-burden-score is seen in posturography only. Data acquisition and analysis was easier with posturography than GAITRite® assessments in out-patient settings.
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Affiliation(s)
- Heike Beckmann
- Department of Neurology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany; George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Johann-Krane Weg 27, 48149 Münster, Germany
| | - Stefan Bohlen
- Department of Neurology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany; George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Johann-Krane Weg 27, 48149 Münster, Germany; Institute for Clinical Radiology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Carsten Saft
- Department of Neurology, St. Josephs-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Rainer Hoffmann
- Department of Neurology, St. Josephs-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, 48149 Münster, Germany
| | - Lisa Muratori
- George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Johann-Krane Weg 27, 48149 Münster, Germany; Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, Stony Brook, NY 11794, USA
| | - E Bernd Ringelstein
- Department of Neurology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | | | - Ralf Reilmann
- Department of Neurology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany; George-Huntington-Institute, Deilmann-Building IV, Technology-Park, Johann-Krane Weg 27, 48149 Münster, Germany; Institute for Clinical Radiology, University of Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany; Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain, Research, University of Tübingen, Tübingen, Germany.
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Abd-Elrahman KS, Hamilton A, Hutchinson SR, Liu F, Russell RC, Ferguson SSG. mGluR5 antagonism increases autophagy and prevents disease progression in thezQ175mouse model of Huntington’s disease. Sci Signal 2017; 10:10/510/eaan6387. [DOI: 10.1126/scisignal.aan6387] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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An Automated Home-Cage System to Assess Learning and Performance of a Skilled Motor Task in a Mouse Model of Huntington's Disease. eNeuro 2017; 4:eN-NWR-0141-17. [PMID: 28929129 PMCID: PMC5602104 DOI: 10.1523/eneuro.0141-17.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
Behavioral testing is a critical step in assessing the validity of rodent models of neurodegenerative disease, as well as evaluating the efficacy of pharmacological interventions. In models of Huntington's disease (HD), a gradual progression of impairments is observed across ages, increasing the need for sensitive, high-throughput and longitudinal assessments. Recently, a number of automated systems have been developed to perform behavioral profiling of animals within their own home-cage, allowing for 24-h monitoring and minimizing experimenter interaction. However, as of yet, few of these have had functionality for the assessment of skilled motor learning, a relevant behavior for movement disorders such as HD. To address this, we assess a lever positioning task within the mouse home-cage. Animals first acquire a simple operant response, before moving to a second phase where they must learn to hold the lever for progressively longer in a rewarded position range. Testing with this paradigm has revealed the presence of distinct phenotypes in the YAC128 mouse model of HD at three early symptomatic time points. YAC128 mice at two months old, but not older, had a motor learning deficit when required to adapt their response to changes in task requirements. In contrast, six-month-old YAC128 mice had disruptions of normal circadian activity and displayed kinematic abnormalities during performance of the task, suggesting an impairment in motor control. This system holds promise for facilitating high throughput behavioral assessment of HD mouse models for preclinical therapeutic screening.
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Depressed Synaptic Transmission and Reduced Vesicle Release Sites in Huntington's Disease Neuromuscular Junctions. J Neurosci 2017; 37:8077-8091. [PMID: 28724748 DOI: 10.1523/jneurosci.0313-17.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 01/25/2023] Open
Abstract
Huntington's disease (HD) is a progressive and fatal degenerative disorder that results in debilitating cognitive and motor dysfunction. Most HD studies have focused on degeneration of the CNS. We previously discovered that skeletal muscle from transgenic R6/2 HD mice is hyperexcitable due to decreased chloride and potassium conductances. The progressive and early onset of these defects suggest a primary myopathy in HD. In this study, we examined the relationship between neuromuscular transmission and skeletal muscle hyperexcitability. We used an ex vivo preparation of the levator auris longus muscle from male and female late-stage R6/2 mice and age-matched wild-type controls. Immunostaining of the synapses and molecular analyses revealed no evidence of denervation. Physiologically, we recorded spontaneous miniature endplate currents (mEPCs) and nerve-evoked EPCs (eEPCs) under voltage-clamp, which, unlike current-clamp records, were independent of the changes in muscle membrane properties. We found a reduction in the number of vesicles released per action potential (quantal content) in R6/2 muscle, which analysis of eEPC variance and morphology indicate is caused by a reduction in the number of vesicle release sites (n) rather than a change in the probability of release (prel). Furthermore, analysis of high-frequency stimulation trains suggests an impairment in vesicle mobilization. The depressed neuromuscular transmission in R6/2 muscle may help compensate for the muscle hyperexcitability and contribute to motor impersistence.SIGNIFICANCE STATEMENT Recent evidence indicates that Huntington's disease (HD) is a multisystem disorder. Our examination of neuromuscular transmission in this study reveals defects in the motor nerve terminal that may compensate for the muscle hyperexcitability in HD. The technique we used eliminates the effects of the altered muscle membrane properties on synaptic currents and thus provides hitherto the most detailed analysis of synaptic transmission in HD. Clinically, the striking depression of neurotransmission we found may help explain the motor impersistence in HD patients. Therapies that target the highly accessible peripheral nerve and muscle system provide a promising new avenue to lessen the debilitating motor symptoms of HD.
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Motor outcome measures in Huntington disease clinical trials. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:209-225. [DOI: 10.1016/b978-0-12-801893-4.00018-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Andrzejewski KL, Dowling AV, Stamler D, Felong TJ, Harris DA, Wong C, Cai H, Reilmann R, Little MA, Gwin JT, Biglan KM, Dorsey ER. Wearable Sensors in Huntington Disease: A Pilot Study. J Huntingtons Dis 2016; 5:199-206. [DOI: 10.3233/jhd-160197] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | - Denzil A. Harris
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Hang Cai
- BioSensics LLC, Cambridge, MA, USA
| | - Ralf Reilmann
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Max A. Little
- Aston University, Birmingham, UK
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Kevin M. Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- CHET, University of Rochester Medical Center, Rochester, NY, USA
| | - E. Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- CHET, University of Rochester Medical Center, Rochester, NY, USA
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Hoffmann S, Siedler J, Brandt AU, Piper SK, Kohler S, Sass C, Paul F, Reilmann R, Meisel A. Quantitative motor assessment of muscular weakness in myasthenia gravis: a pilot study. BMC Neurol 2015; 15:265. [PMID: 26701600 PMCID: PMC4690227 DOI: 10.1186/s12883-015-0517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Muscular weakness in myasthenia gravis (MG) is commonly assessed using Quantitative Myasthenia Gravis Score (QMG). More objective and quantitative measures may complement the use of clinical scales and might detect subclinical affection of muscles. We hypothesized that muscular weakness in patients with MG can be quantified with the non-invasive Quantitative Motor (Q-Motor) test for Grip Force Assessment (QGFA) and Involuntary Movement Assessment (QIMA) and that pathological findings correlate with disease severity as measured by QMG. METHODS This was a cross-sectional pilot study investigating patients with confirmed diagnosis of MG. Data was compared to healthy controls (HC). Subjects were asked to lift a device (250 and 500 g) equipped with electromagnetic sensors that measured grip force (GF) and three-dimensional changes in position and orientation. These were used to calculate the position index (PI) and orientation index (OI) as measures for involuntary movements due to muscular weakness. RESULTS Overall, 40 MG patients and 23 HC were included. PI and OI were significantly higher in MG patients for both weights in the dominant and non-dominant hand. Subgroup analysis revealed that patients with clinically ocular myasthenia gravis (OMG) also showed significantly higher values for PI and OI in both hands and for both weights. Disease severity correlates with QIMA performance in the non-dominant hand. CONCLUSION Q-Motor tests and particularly QIMA may be useful objective tools for measuring motor impairment in MG and seem to detect subclinical generalized motor signs in patients with OMG. Q-Motor parameters might serve as sensitive endpoints for clinical trials in MG.
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Affiliation(s)
- Sarah Hoffmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Jana Siedler
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sophie K Piper
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Centrum für Schlaganfallforschung Berlin (CSB), Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Siegfried Kohler
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Christian Sass
- George-Huntington-Institute, Technology-Park, Johann-Krane Weg 27, 48149, Muenster, Germany. .,Department of Neurology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany.
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ralf Reilmann
- George-Huntington-Institute, Technology-Park, Johann-Krane Weg 27, 48149, Muenster, Germany. .,Department of Radiology, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Muenster, Germany. .,Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Hoppe-Seyler Str. 3, 72076, Tuebingen, Germany.
| | - Andreas Meisel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Schiefer J, Werner CJ, Reetz K. Clinical diagnosis and management in early Huntington's disease: a review. Degener Neurol Neuromuscul Dis 2015; 5:37-50. [PMID: 32669911 PMCID: PMC7337146 DOI: 10.2147/dnnd.s49135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022] Open
Abstract
This review focuses on clinical diagnosis and both pharmacological and nonpharmacological therapeutic options in early stages of the autosomal dominant inherited neurodegenerative Huntington's disease (HD). The available literature has been reviewed for motor, cognitive, and psychiatric alterations, which are the three major symptom domains of this devastating progressive disease. From a clinical point of view, one has to be aware that the HD phenotype can vary highly across individuals and during the course of the disease. Also, symptoms in juvenile HD can differ substantially from those with adult-onset of HD. Although there is no cure of HD and management is limited, motor and psychiatric symptoms often respond to pharmacotherapy, and nonpharmacological approaches as well as supportive care are essential. International treatment recommendations based on study results, critical statements, and expert opinions have been included. This review is restricted to symptomatic and supportive approaches since all attempts to establish a cure for the disease or modifying therapies have failed so far.
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Affiliation(s)
| | | | - Kathrin Reetz
- Euregional Huntington Center
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Department of Neurology, RWTH Aachen University, Aachen, Germany
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21
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Schaeffer E, Maetzler W, Liepelt-Scarfone I, Sass C, Reilmann R, Berg D. Quantitative motor assessment of dyskinesias in Parkinson’s disease. J Neural Transm (Vienna) 2015; 122:1271-8. [DOI: 10.1007/s00702-015-1383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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Reilmann R, Rouzade‐Dominguez M, Saft C, Süssmuth SD, Priller J, Rosser A, Rickards H, Schöls L, Pezous N, Gasparini F, Johns D, Landwehrmeyer GB, Gomez‐Mancilla B. A randomized, placebo‐controlled trial of AFQ056 for the treatment of chorea in Huntington's disease. Mov Disord 2015; 30:427-31. [DOI: 10.1002/mds.26174] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ralf Reilmann
- George‐Huntington‐InstituteMünster Germany
- Institute for Clinical Radiology, University of MünsterMünster Germany
- Department of Neurodegenerative Diseases and Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingen Germany
| | | | - Carsten Saft
- Department of NeurologyHuntington Center NRW, Ruhr‐University Bochum, St. Josef‐HospitalBochum Germany
| | | | - Josef Priller
- Department of NeuropsychiatryCharité‐Universitätsmedizin BerlinBerlin Germany
| | - Anne Rosser
- Cardiff University Schools of Medicine and Biosciences, Neuroscience and Mental Health Research InstituteCardiff United Kingdom
| | - Hugh Rickards
- Department of NeuropsychiatryThe Barberry Birmingham United Kingdom
| | - Ludger Schöls
- Clinical Neurogenetics Unit, Center of Neurology and Hertie‐Institute for Clinical Brain ResearchTübingen Germany
- German Center for Neurodegenerative Diseases (DZNE)Tübingen Germany
| | - Nicole Pezous
- IIS Translational Sciences–Early Development Statistical Research, Novartis Pharma AGBasel Switzerland
| | - Fabrizio Gasparini
- Novartis Institutes for Biomedical Research, Novartis Pharma AGBasel Switzerland
| | - Donald Johns
- Neuroscience Translational Medicine, Novartis Institutes for Biomedical Research Inc.Cambridge Massachusetts USA
| | | | - Baltazar Gomez‐Mancilla
- Novartis Institutes for Biomedical Research, Novartis Pharma AGBasel Switzerland
- Department of Neurology and NeurosurgeryMcGill UniversityMontréal Québec Canada
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Salem L, Saleh N, Youssov K, Olivier A, Charles P, Scherer C, Verny C, Bachoud-Lévi AC, Maison P. The most appropriate primary outcomes to design clinical trials on Huntington's disease: meta-analyses of cohort studies and randomized placebo-controlled trials. Fundam Clin Pharmacol 2014; 28:700-10. [DOI: 10.1111/fcp.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/07/2014] [Accepted: 04/01/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Linda Salem
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
| | - Nadine Saleh
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Katia Youssov
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Audrey Olivier
- CHU Angers; Département de Neurologie; Angers 49000 France
| | - Perrine Charles
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | | | | | - Anne-Catherine Bachoud-Lévi
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Centre de référence maladie de Huntington; Créteil 94010 France
| | - Patrick Maison
- Inserm; U955; Equipe 01; Créteil 94010 France
- Université Paris Est; Faculté de médecine; Créteil 94010 France
- AP-HP; Hôpital H. Mondor- A. Chenevier; Pharmacologie clinique; Créteil 94010 France
- Ecole Normale Supérieure; Département d'études cognitives; Paris 75005 France
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Ross CA, Aylward EH, Wild EJ, Langbehn DR, Long JD, Warner JH, Scahill RI, Leavitt BR, Stout JC, Paulsen JS, Reilmann R, Unschuld PG, Wexler A, Margolis RL, Tabrizi SJ. Huntington disease: natural history, biomarkers and prospects for therapeutics. Nat Rev Neurol 2014; 10:204-16. [PMID: 24614516 DOI: 10.1038/nrneurol.2014.24] [Citation(s) in RCA: 659] [Impact Index Per Article: 65.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Huntington disease (HD) can be seen as a model neurodegenerative disorder, in that it is caused by a single genetic mutation and is amenable to predictive genetic testing, with estimation of years to predicted onset, enabling the entire range of disease natural history to be studied. Structural neuroimaging biomarkers show that progressive regional brain atrophy begins many years before the emergence of diagnosable signs and symptoms of HD, and continues steadily during the symptomatic or 'manifest' period. The continued development of functional, neurochemical and other biomarkers raises hopes that these biomarkers might be useful for future trials of disease-modifying therapeutics to delay the onset and slow the progression of HD. Such advances could herald a new era of personalized preventive therapeutics. We describe the natural history of HD, including the timing of emergence of motor, cognitive and emotional impairments, and the techniques that are used to assess these features. Building on this information, we review recent progress in the development of biomarkers for HD, and potential future roles of these biomarkers in clinical trials.
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Affiliation(s)
- Christopher A Ross
- Division of Neurobiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Russell L Margolis
- Division of Neurobiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Collins LM, Lazic SE, Barker RA. A retrospective analysis of hand tapping as a longitudinal marker of disease progression in Huntington's disease. BMC Neurol 2014; 14:35. [PMID: 24564568 PMCID: PMC3937529 DOI: 10.1186/1471-2377-14-35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 02/21/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Current clinical assessments of motor function in Huntington's Disease (HD) rely on subjective ratings such as the Unified Huntington's Disease Rating scale (UHDRS). The ability to track disease progression using simple, objective, inexpensive, and robust measures would be beneficial. METHODS One objective measure of motor performance is hand-tapping. Over the last 14 years we have routinely collected, using a simple device, the number of taps made by the right and left hand over 30 seconds in HD patients attending our NHS clinics. RESULTS Here we report on a longitudinal cohort of 237 patients, which includes patients at all stages of the disease on a wide range of drug therapies. Hand tapping in these patients declines linearly at a rate of 5.1 taps per year (p < 0.0001; 95% CI = 3.8 to 6.3 taps), and for each additional year of age patients could perform 0.9 fewer taps (main effect of age: p = 0.0007; 95% CI = 0.4 to 1.4). Individual trajectories can vary widely around this average rate of decline, and much of this variation could be attributed to CAG repeat length. Genotype information was available for a subset of 151 patients, and for each additional repeat, patients could perform 5.6 fewer taps (p < 0.0001; 95% CI = 3.3 to 8.0 taps), and progressed at a faster rate of 0.45 fewer taps per year (CAG by time interaction: p = 0.008; 95% CI = 0.12 to 0.78 taps). In addition, for each unit decrease in Total Functional Capacity (TFC) within individuals, the number of taps decreased by 6.3 (95% CI = 5.4 to 7.1, p < 0.0001). CONCLUSIONS Hand tapping is a simple, robust, and reliable marker of disease progression. As such, this simple motor task could be a useful tool by which to assess disease progression as well therapies designed to slow it down.
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Affiliation(s)
| | - Stanley E Lazic
- In Silico Lead Discovery, Novartis Institutes for Biomedical Research, Basel, Switzerland
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26
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Quinn L, Busse M, Dal Bello-Haas V. Management of upper extremity dysfunction in people with Parkinson disease and Huntington disease: facilitating outcomes across the disease lifespan. J Hand Ther 2013; 26:148-54; quiz 155. [PMID: 23231827 DOI: 10.1016/j.jht.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 02/03/2023]
Abstract
Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upper extremities from early in the disease process. The progressive nature of these diseases poses unique challenges for therapists aiming to effectively maximize physical functioning and minimize participation restrictions in these patient groups. Research is underway in both diseases to develop effective disease-modifying agents and pharmacological interventions, as well as mobility-focused rehabilitation protocols. Rehabilitation, and in particular task-specific interventions, has the potential to influence the upper extremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upper extremity function have been limited in both PD, and in particular HD. In this paper, we provide an update of the known pathological features of PD and HD as they relate to upper extremity function. We further review the available literature on the use of outcome measures, and the clinical management of upper extremity function in both conditions. Due to the currently limited evidence base in both diseases, we recommend utilization of a clinical management framework specific for degenerative conditions that can serve as a guideline for disease management.
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Affiliation(s)
- Lori Quinn
- School of Healthcare Studies, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff CF14 4XN, Wales, UK.
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27
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Reilmann R. The pridopidine paradox in Huntington's disease. Mov Disord 2013; 28:1321-4. [DOI: 10.1002/mds.25559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/05/2013] [Accepted: 05/10/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ralf Reilmann
- Huntington Center; Department of Neurology; University Clinic Muenster (UKM), Westfaelische Wilhelms University of Muenster; Muenster Germany
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Lohr JB, May T, Caligiuri MP. Quantitative assessment of motor abnormalities in untreated patients with major depressive disorder. J Affect Disord 2013; 146:84-90. [PMID: 22985485 PMCID: PMC4283485 DOI: 10.1016/j.jad.2012.08.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 08/24/2012] [Accepted: 08/27/2012] [Indexed: 11/23/2022]
Abstract
The primary purpose of this study was to examine motor physiology disturbances in a group of patients with untreated major depressive disorder using sensitive instrumental procedures. The secondary aim of the study was to examine the relationship of the affective symptom state to these motor assessments. The authors studied 40 individuals meeting DSM-IV criteria for unipolar major depressive disorder and 40 healthy comparison subjects. Electromechanical measures of force steadiness (FS), simple reaction time (RT), movement time (MT) and scaling of movement velocity to distance (velocity scaling, VS) were performed. The authors found that performance on the force steadiness, movement time, and velocity scaling measures was significantly poorer in the subjects with depression. There was no difference between the groups on the measure of reaction time. The force steadiness, reaction time, movement time, and velocity scaling scores were not associated with affective state. This study demonstrates that motor abnormalities suggestive of basal ganglia dysfunction occur in many patients with major depressive disorder, and that these abnormalities may exist in the absence of current psychotropic medication treatment. The finding of impaired movement time and velocity scaling in the presence of normal reaction time suggests a neuromotor or parkinsonian pathophysiology for slowness in depression.
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Affiliation(s)
- James B Lohr
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA.
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29
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Huntington’s disease: Towards disease modification – Gaps and bridges, facts and opinions. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.baga.2012.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ferrara JM, Mostile G, Hunter C, Adam OR, Jankovic J. Effect of tetrabenazine on motor function in patients with huntington disease. Neurol Ther 2012; 1:5. [PMID: 26000211 PMCID: PMC4389035 DOI: 10.1007/s40120-012-0005-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction Tetrabenazine (TBZ) reduces chorea related to Huntington disease (HD); however, it is uncertain whether this effect improves functionally relevant motor skills such as hand coordination and balance. The objective of this study was to provide pilot data regarding three motor function tests, which might be useful in monitoring symptom progression and therapeutic response, pending formal validation. Methods The authors assessed 11 ambulatory patients with HD-related chorea on two occasions: (1) while off TBZ (either prior to starting therapy or following a >24 h washout) and (2) when on a stable dose of TBZ, titrated to optimal effect. Study evaluations included the Jebsen-Taylor Hand Function Test (JTHFT) and Berg Balance Scale, a timed 25-foot walk, the Montreal Cognitive Assessment (MoCA) and the complete United Huntington Disease Rating Scale (UHDRS). Results Maximal chorea scores (UHDRS item 12) improved from 11.1 ± 2.9 to 8.5 ± 3.9 while on TBZ (P = 0.03), but we could not detect an improvement in functional measures while on TBZ in this small cohort. Scores of the JTHFT were globally slower than published normative data and correlated with MoCA summary scores, but not UHDRS chorea scores. Conclusions This pilot study did not detect significant functional gains with chorea suppression. The fact that performance on tests of hand function correlates with MoCA but not UHDRS chorea scores highlights the need for additional treatments targeted toward the cognitive aspects of HD.
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Affiliation(s)
- Joseph M Ferrara
- Movement Disorder Clinic, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA USA
| | - Giovanni Mostile
- Department of Neurology, Parkinson Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX USA
| | - Christine Hunter
- Department of Neurology, Parkinson Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX USA
| | - Octavian R Adam
- Division of Neurology, Naval Medical Center, Portsmouth, VI USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX USA
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Grasping multiple sclerosis: do quantitative motor assessments provide a link between structure and function? J Neurol 2012; 260:407-14. [PMID: 22872165 PMCID: PMC3566382 DOI: 10.1007/s00415-012-6639-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 11/13/2022]
Abstract
Motor disability in MS is commonly assessed by the Expanded Disability Status Scale (EDSS). Categorical rating scales are limited by subjective error and inter-rater variability. Therefore, objective and quantitative measures of motor disability may be useful to supplement the EDSS in the setting of clinical trials. It was previously shown that grip-force-variability (GFV) is increased in MS. We hypothesized that GFV may be an objective measure of motor disability in MS. To investigate whether the increase in GFV in MS is correlated to the clinical disability as assessed by the EDSS and to microstructural changes in the brain as assessed by diffusion tensor imaging, GFV was recorded in a grasping and lifting task in 27 MS patients and 23 controls using a grip-device equipped with a force transducer. The EDSS was assessed by neurologists experienced in MS. Patients underwent diffusion tensor imaging at 3T to assess the fractional anisotropy (FA) of the cerebral white matter as a measure of microstructural brain integrity. GFV was increased in MS and correlated to changes in the FA of white matter in the vicinity of the somatosensory and visual cortex. GFV also correlated with the EDSS. GFV may be a useful objective measure of motor dysfunction in MS linked to disability and structural changes in the brain. Our data suggests that GFV should be further explored as an objective measure of motor dysfunction in MS. It could supplement the EDSS, e.g., in proof of concept studies.
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Reilmann R, Rumpf S, Beckmann H, Koch R, Ringelstein EB, Lange HW. Huntington's disease: Objective assessment of posture-A link between motor and functional deficits. Mov Disord 2012; 27:555-9. [DOI: 10.1002/mds.24908] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 11/27/2011] [Accepted: 12/21/2011] [Indexed: 11/09/2022] Open
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Oh DS, Park ES, Choi SM, Kim BC, Kim MK, Cho KH. Oromandibular dyskinesia as the initial manifestation of late-onset huntington disease. J Mov Disord 2011; 4:75-7. [PMID: 24868400 PMCID: PMC4027681 DOI: 10.14802/jmd.11016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/07/2011] [Indexed: 12/29/2022] Open
Abstract
Huntington's disease (HD) is a neurodegenerative disorder characterized by a triad of choreoathetosis, dementia and dominant inheritance. The cause of HD is an expansion of CAG trinucleotide repeats in the HD gene. Typical age at onset of symptoms is in the 40s, but the disorder can manifest at any time. Late-onset (≥ 60 years) HD is clinically different from other adult or juvenile onset HD and characterized by mild motor problem as the initial symptoms, shorter disease duration, frequent lack of family history, and relatively low CAG repeats expansion. We report a case of an 80-year-old female with oromandibular dyskinesia as an initial manifestation of HD and 40 CAG repeats.
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Affiliation(s)
- Dong-Seok Oh
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Eun-Seon Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Byeong-Chae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
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Reilmann R, Bohlen S, Kirsten F, Ringelstein EB, Lange HW. Assessment of involuntary choreatic movements in Huntington's disease-Toward objective and quantitative measures. Mov Disord 2011; 26:2267-73. [DOI: 10.1002/mds.23816] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 05/02/2011] [Accepted: 05/08/2011] [Indexed: 11/09/2022] Open
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Rao AK, Gordon AM, Marder KS. Coordination of fingertip forces during precision grip in premanifest Huntington's disease. Mov Disord 2011; 26:862-9. [PMID: 21394785 DOI: 10.1002/mds.23606] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/01/2010] [Accepted: 11/29/2010] [Indexed: 11/06/2022] Open
Abstract
Precision grip control is important for accurate object manipulation and requires coordination between horizontal (grip) and vertical (load) fingertip forces. Manifest Huntington's disease (HD) subjects demonstrate excessive and highly variable grip force and delayed coordination between grip and load forces. Because the onset of these impairments is unknown, we examined precision grip control in premanifest HD (pre-HD) subjects. Fifteen pre-HD and 15 age- and sex-matched controls performed the precision grip task in a seated position. Subjects grasped and lifted an object instrumented with a force transducer that measured horizontal grip and vertical load forces. Outcomes were preload time, loading time, maximum grip force, mean static grip force, and variability for all measures. We compared outcomes across groups and correlated grip measures with the Unified Huntington's Disease Rating Scale and predicted age of onset. Variability of maximum grip force (P < .0001) and variability of static grip force (P < .00001) were higher for pre-HD subjects. Preload time (P < .007) and variability of preload time (P < .006) were higher in pre-HD subjects. No differences were seen in loading time across groups. Variability of static grip force (r(2) = 0.23) and variability of preload time (r(2) = 0.59) increased with predicted onset and were correlated with tests of cognitive function. Our results indicate that pre-HD patients have poor regulation of the transition between reach and grasp and higher variability in force application and temporal coordination during the precision grip task. Force and temporal variability may be good markers of disease severity because they were correlated with predicted onset of disease.
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Affiliation(s)
- Ashwini K Rao
- Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA.
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Salomonczyk D, Panzera R, Pirogovosky E, Goldstein J, Corey-Bloom J, Simmons R, Gilbert PE. Impaired postural stability as a marker of premanifest Huntington's disease. Mov Disord 2011; 25:2428-33. [PMID: 20818666 DOI: 10.1002/mds.23309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Subtle changes in fine motor control have been observed in individuals who carry the Huntington's disease (HD) mutation but have not yet manifested symptoms, referred to as premanifest HD (preHD). However, few studies have examined gross motor impairments in this population. This study sought to examine the role of sensory involvement in maintaining postural stability during the premanifest and manifest stages of HD using computerized dynamic posturography. Eleven HD participants, 22 preHD subdivided into "preHD Near" (<5 years from estimated clinical onset) and "preHD Far" (>5 years from estimated clinical onset), and 17 nongene carriers (NGC) completed a sensory organization test (SOT) to assess postural control when vestibular, visual, and somatosensory information was systematically degraded. The HD group demonstrated greater postural sway than the NGC and preHD Far groups on all conditions including baseline, and greater postural sway than the preHD Near group when sensory information was manipulated. The preHD Near group showed significantly greater postural sway than the preHD Far group when visual and somatosensory information was degraded and only vestibular information was available and reliable for maintaining postural stability. The results of this study highlight subtle postural deficits in the face of changing sensory conditions in preHD up to 5 years before estimated disease onset. The findings suggest that the SOT may be a highly sensitive indicator of early motor impairment and subsequent phenoconversion to manifest HD in preHD.
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Affiliation(s)
- Danielle Salomonczyk
- Department of Psychology, San Diego State University, San Diego, California 92120, USA
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Tabrizi SJ, Scahill RI, Durr A, Roos RA, Leavitt BR, Jones R, Landwehrmeyer GB, Fox NC, Johnson H, Hicks SL, Kennard C, Craufurd D, Frost C, Langbehn DR, Reilmann R, Stout JC. Biological and clinical changes in premanifest and early stage Huntington's disease in the TRACK-HD study: the 12-month longitudinal analysis. Lancet Neurol 2011; 10:31-42. [PMID: 21130037 DOI: 10.1016/s1474-4422(10)70276-3] [Citation(s) in RCA: 423] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND TRACK-HD is a prospective observational study of Huntington's disease (HD) that examines disease progression in premanifest individuals carrying the mutant HTT gene and those with early stage disease. We report 12-month longitudinal changes, building on baseline findings. METHODS we did a 12-month follow-up of patients recruited from the four TRACK-HD study sites in Canada, France, the Netherlands, and the UK. Participants were premanifest individuals (preHD) carrying the mutant HTT gene, patients with early HD, and controls matched by age and sex with the combined preHD and early HD groups. Data were collected by use of 3T MRI and clinical, cognitive, quantitative motor, oculomotor, and neuropsychiatric measures. Statistical analysis assessed annualised change with the use of linear regression models to estimate differences between groups. FINDINGS 116 preHD individuals, 114 early HD patients, and 115 people in the control group completed follow-up. Four preHD individuals, nine early HD patients, and eight people in the control group did not complete the follow-up. A further nine participants, who completed follow-up assessments, were unable to undergo MRI. After adjustment for demographics, annualised rates of generalised and regional brain atrophy were higher in preHD and early HD groups than in controls. Whole-brain atrophy rates were 0·20% (95% CI 0·05-0·34; p=0·0071) per year higher in preHD participants and 0·60% (0·44-0·76; p<0·0001) in early HD patients, and caudate atrophy rates were 1·37% (0·99-1·75; p<0·0001) per year higher in preHD and 2·86% (2·34-3·39; p<0·0001) in early HD. Voxel-based morphometry revealed grey-matter and white-matter atrophy, even in subjects furthest from predicted disease onset. Quantitative imaging showed statistically significant associations with disease burden, an indicator of disease pathology, and total functional capacity, a widely-used clinical measure of disease severity. Relative to controls, decline in cognition and quantitative motor function was detectable in both pre- and early HD, as was deterioration in oculomotor function in early HD. INTERPRETATION quantitative imaging showed the greatest differentiation across the spectrum of disease and functional measures of decline were sensitive in early HD, with cognitive and quantitative motor impairment also detectable in preHD. We show longitudinal change over 12 months in generalised and regional brain volume, cognition, and quantitative motor tasks in individuals many years from predicted disease onset and show the feasibility of obtaining quantifiable endpoints for future trials.
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Affiliation(s)
- Sarah J Tabrizi
- UCL Institute of Neurology, University College London, Department of Neurodegenerative Disease, Queen Square, London, UK.
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Bechtel N, Scahill RI, Rosas HD, Acharya T, van den Bogaard SJA, Jauffret C, Say MJ, Sturrock A, Johnson H, Onorato CE, Salat DH, Durr A, Leavitt BR, Roos RAC, Landwehrmeyer GB, Langbehn DR, Stout JC, Tabrizi SJ, Reilmann R. Tapping linked to function and structure in premanifest and symptomatic Huntington disease. Neurology 2010; 75:2150-60. [PMID: 21068430 DOI: 10.1212/wnl.0b013e3182020123] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Motor signs are functionally disabling features of Huntington disease. Characteristic motor signs define disease manifestation. Their severity and onset are assessed by the Total Motor Score of the Unified Huntington's Disease Rating Scale, a categorical scale limited by interrater variability and insensitivity in premanifest subjects. More objective, reliable, and precise measures are needed which permit clinical trials in premanifest populations. We hypothesized that motor deficits can be objectively quantified by force-transducer-based tapping and correlate with disease burden and brain atrophy. METHODS A total of 123 controls, 120 premanifest, and 123 early symptomatic gene carriers performed a speeded and a metronome tapping task in the multicenter study TRACK-HD. Total Motor Score, CAG repeat length, and MRIs were obtained. The premanifest group was subdivided into A and B, based on the proximity to estimated disease onset, the manifest group into stages 1 and 2, according to their Total Functional Capacity scores. Analyses were performed centrally and blinded. RESULTS Tapping variability distinguished between all groups and subgroups in both tasks and correlated with 1) disease burden, 2) clinical motor phenotype, 3) gray and white matter atrophy, and 4) cortical thinning. Speeded tapping was more sensitive to the detection of early changes. CONCLUSION Tapping deficits are evident throughout manifest and premanifest stages. Deficits are more pronounced in later stages and correlate with clinical scores as well as regional brain atrophy, which implies a link between structure and function. The ability to track motor phenotype progression with force-transducer-based tapping measures will be tested prospectively in the TRACK-HD study.
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Affiliation(s)
- N Bechtel
- Department of Neurology, University of Münster, Münster, Germany.
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39
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Reilmann R, Bohlen S, Klopstock T, Bender A, Weindl A, Saemann P, Auer DP, Ringelstein EB, Lange HW. Grasping premanifest Huntington's disease - shaping new endpoints for new trials. Mov Disord 2010; 25:2858-62. [DOI: 10.1002/mds.23300] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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40
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Reilmann R, Bohlen S, Klopstock T, Bender A, Weindl A, Saemann P, Auer DP, Ringelstein EB, Lange HW. Tongue force analysis assesses motor phenotype in premanifest and symptomatic Huntington's disease. Mov Disord 2010; 25:2195-202. [DOI: 10.1002/mds.23243] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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41
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Han I, You Y, Kordower JH, Brady ST, Morfini GA. Differential vulnerability of neurons in Huntington's disease: the role of cell type-specific features. J Neurochem 2010; 113:1073-91. [PMID: 20236390 DOI: 10.1111/j.1471-4159.2010.06672.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abnormal expansion of a polyglutamine tract in huntingtin (Htt) protein results in Huntington's disease (HD), an autosomal dominant neurodegenerative disorder involving progressive loss of motor and cognitive function. Contrasting with the ubiquitous tissue expression of polyglutamine-expanded Htt, HD pathology is characterized by the increased vulnerability of specific neuronal populations within the striatum and the cerebral cortex. Morphological, biochemical, and functional characteristics of neurons affected in HD that might render these cells more vulnerable to the toxic effects of polyglutamine-Htt are covered in this review. The differential vulnerability of neurons observed in HD is discussed in the context of various major pathogenic mechanisms proposed to date, and in line with evidence showing a 'dying-back' pattern of degeneration in affected neuronal populations.
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Affiliation(s)
- Ina Han
- Department of Anatomy and Cell Biology. University of Illinois at Chicago, Chicago, Illinois 60612, USA
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42
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The Dynamic Relationship Between Voluntary and Involuntary Motor Behaviours in Patients with Basal Ganglia Disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-1-4419-0340-2_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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43
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Prodoehl J, Corcos DM, Vaillancourt DE. Basal ganglia mechanisms underlying precision grip force control. Neurosci Biobehav Rev 2009; 33:900-8. [PMID: 19428499 DOI: 10.1016/j.neubiorev.2009.03.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/31/2008] [Accepted: 03/06/2009] [Indexed: 10/21/2022]
Abstract
The classic grasping network has been well studied but thus far the focus has been on cortical regions in the control of grasping. Sub-cortically, specific nuclei of the basal ganglia have been shown to be important in different aspects of precision grip force control but these findings have not been well integrated. In this review, we outline the evidence to support the hypothesis that key basal ganglia nuclei are involved in parameterizing specific properties of precision grip force. We review literature from different areas of human and animal work that converges to build a case for basal ganglia involvement in the control of precision gripping. Following on from literature showing anatomical connectivity between the basal ganglia nuclei and key nodes in the cortical grasping network, we suggest a conceptual framework for how the basal ganglia could function within the grasping network, particularly as it relates to the control of precision grip force.
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Affiliation(s)
- Janey Prodoehl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL 60612, USA.
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44
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Busse ME, Hughes G, Wiles CM, Rosser AE. Use of hand-held dynamometry in the evaluation of lower limb muscle strength in people with Huntington's disease. J Neurol 2008; 255:1534-40. [PMID: 19005627 DOI: 10.1007/s00415-008-0964-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 03/24/2008] [Accepted: 04/03/2008] [Indexed: 12/22/2022]
Abstract
PURPOSE Sub-clinical muscle involvement, including myopathic changes and mitochondrial dysfunction of skeletal muscle, has been reported in people with Huntington's disease (HD). Muscle strength was evaluated using a hand-held dynamometer. Reliability and validity in people with HD were determined. METHOD Isometric muscle strength of 6 lower limb muscle groups was measured in 20 people with HD and matched healthy controls. People with HD were evaluated with the Unified Huntington's Disease Rating Scales (UHDRS). Within session reliability using intra-class correlation coefficients (ICC) was calculated. Discriminant and convergent validity was also evaluated. RESULTS UHDRS motor scores of people with HD ranged from 28 to 80. Reliability of strength testing was excellent (ICC 0.86 to 0.98). People with HD had on average about half the strength of healthy matched controls. UHDRS motor scores and strength scores were significantly correlated (convergent) providing a further indication of validity of strength testing. CONCLUSIONS The hand-held dynamometer is a reliable and valid measurement tool to detect strength differences between people with HD and a matched control group. There is significant reduction in lower limb muscle strength in HD which does not appear to have been described previously.
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Affiliation(s)
- Monica E Busse
- Department of Physiotherapy, School of Healthcare Studies, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN, UK.
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45
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Michell AW, Goodman AOG, Silva AHD, Lazic SE, Morton AJ, Barker RA. Hand tapping: a simple, reproducible, objective marker of motor dysfunction in Huntington's disease. J Neurol 2008; 255:1145-52. [PMID: 18465109 DOI: 10.1007/s00415-008-0859-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/14/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
Abstract
Huntington's disease (HD) is a severe neurodegenerative condition in which the impairment in voluntary movement is related to functional disability. Clinical assessment of motor deficit currently relies largely on subjective rating scales without objective measurement. We have developed a quick and easy-to-use hand tapping device that enables measurement of (a) the number of taps in 30 seconds, (b) variability in tapping rhythm and (c) fatigue over the testing period. Initial cross-sectional testing of 178 consecutive HD clinic patients using an early model of the device showed that the total number of taps in 30 seconds correlated with the motor UHDRS (Spearmann's rho, r(s) = -0.81, p < 0.0001) and independence scores (r(s) = 0.78, p = 0.01). Longitudinal data from a small cohort followed over 10 years reveals a correlation between total number of taps in 30 seconds and motor UHDRS over time (rs = -0.49, p < 0.001), and suggests the technique may provide an objective measure of disease progression. Further tests on 15 HD patients and 9 controls were repeated three times in a single day using an updated device. The HD group made significantly fewer taps in 30 seconds (median HD = 79, control = 104, p = 0.009) and had greater variability of inter-tap interval (mean interdecile range HD = 148, control = 56, p = 0.016) compared to controls. Both the total number of taps and variability of inter-tap interval correlated with motor UHDRS. Of vital importance for any potential marker of disease progression is that these tapping parameters were reproducible with repeated measurement. Given that hand tapping parameters differ between HD and control populations, they correlate with motor UHDRS over time and are reproducible, we propose that assessment of hand tapping represents a useful objective adjunct to the clinical assessment of HD patients.
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Affiliation(s)
- A W Michell
- Dept. of Clinical Neurophysiology, 3rd floor Albany wing, National Hospital for Neurology, and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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46
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47
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Andrich J, Saft C, Ostholt N, Müller T. Complex movement behaviour and progression of Huntington's disease. Neurosci Lett 2007; 416:272-4. [PMID: 17321683 DOI: 10.1016/j.neulet.2007.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/06/2007] [Accepted: 02/06/2007] [Indexed: 11/25/2022]
Abstract
Instrumental measurement of complex motion sequences with a peg insertion paradigm reflects impairment in patients with Huntington's disease (HD). Objectives were to study progress of HD symptoms and peg insertion results in 39 HD patients without symptomatic drug treatment over an interval of 3 years. Assessments were at baseline and 3 years later. Unified Huntington's Disease Rating Scale (UHDRS) total score, computed arm score and the specific rating outcomes for bradykinesia, chorea, dystonia and oculomotor symptoms significantly increased over a 3-year period. Motor test outcomes significantly worsened. Cognitive scores did not change significantly, but were significantly related to the peg insertion outcomes and to the various UHDRS rating results at both assessments. Peg insertion scores are nonspecific diagnostic marker for progress in HD. Peg insertion particularly reflects motor impairment and additionally higher cognitive and executive dysfunction. These higher cognitive functions are associated with frontostriatal pathology in HD. Our study results suggest that our motor test reflects these emerging deficits of higher cognitive and motor function abilities in HD. We conclude, that instrumental assessment of complex movement sequences is an additional simple method to follow impairment in HD patients in addition to clinical rating.
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Affiliation(s)
- Jürgen Andrich
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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48
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Abstract
Huntington's disease is an autosomal-dominant, progressive neurodegenerative disorder with a distinct phenotype, including chorea and dystonia, incoordination, cognitive decline, and behavioural difficulties. Typically, onset of symptoms is in middle-age after affected individuals have had children, but the disorder can manifest at any time between infancy and senescence. The mutant protein in Huntington's disease--huntingtin--results from an expanded CAG repeat leading to a polyglutamine strand of variable length at the N-terminus. Evidence suggests that this tail confers a toxic gain of function. The precise pathophysiological mechanisms of Huntington's disease are poorly understood, but research in transgenic animal models of the disorder is providing insight into causative factors and potential treatments.
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Affiliation(s)
- Francis O Walker
- Department of Neurology, Wake Forest University, Medical Center Blvd, Winston Salem, NC 27157, USA.
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Prodoehl J, Corcos DM, Vaillancourt DE. Effects of focal hand dystonia on visually guided and internally guided force control. J Neurol Neurosurg Psychiatry 2006; 77:909-14. [PMID: 16690693 PMCID: PMC2077615 DOI: 10.1136/jnnp.2006.091363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A fundamental feature underlying many movement disorders is increased variability in the motor response. Despite abnormalities of grip force control in people with dystonia, it is not clear whether dystonia is also associated with increased variability in force output and whether force variability in dystonia is affected by the presence or absence of visual feedback. OBJECTIVE To examine force variability in 16 patients with writer's cramp and 16 matched controls. METHODS The variability of force output at the wrist under conditions of both vision and no vision was examined. The underlying frequency structure of the force signal was also compared across groups. Participants produced isometric wrist flexion to targets at 25% and 50% of their maximum voluntary contraction strength under conditions of both vision and no vision. RESULTS Similar levels of force variability were observed in patients with dystonia and controls at the lower force levels, but patients with dystonia were less variable in their force output than controls at the higher force level. This reduction in variability in people with dystonia at 50% maximum voluntary contraction was not affected by vision. Although a similar dominant frequency in force output was observed in people with dystonia and controls, a reduced variability in the group with dystonia at the higher force level was due to reduced power in the 0-4-Hz frequency bin. CONCLUSIONS The first evidence of a movement disorder with reduced variability is provided. The findings are compatible with a model of dystonia, which includes reduced cortical activation in response to sensory input from the periphery and reduced flexibility in motor output.
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Affiliation(s)
- J Prodoehl
- Department of Movement Sciences (M/C 994), College of Applied Health Sciences, University of Illinois at Chicago, 808 South Wood Street, 690 CME, Chicago, Illinois 60612, USA.
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Muratori LM, Dapul G, Bartels MN, Gordon AM. Effect of object transport on grasp coordination in multiple system atrophy. Mov Disord 2005; 21:555-63. [PMID: 16211602 DOI: 10.1002/mds.20730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We examined the effects of the parkinsonian variant of multiple-system atrophy (MSA-P) on grasp and forward transport and release of an object. Twelve patients with MSA-P and 10 age-matched control subjects performed the task with each of three object weights (200, 400, 800 gm). Subjects moved at a self-selected pace using a precision grip. The grip (normal) and load (tangential) forces and the object position were recorded. Results indicate subjects with MSA-P have temporal and force coordination deficits. Temporal delays were seen in all subjects with MSA-P, leading to prolonged overall movement times compared to control subjects. These delays occurred throughout the task, with significantly longer transport phases and delays releasing the object. Despite demonstrating an appropriate anticipatory scaling of forces, with increasing grip and load forces for heavier weights, force coordination was compromised in subjects with MSA-P. These subjects generated significant negative load forces prior to transporting the object. In addition, during the transport phase, subjects with MSA-P generated highly variable grip forces. Overall, the results indicate that subjects with MSA-P demonstrate bradykinesia and difficulty coordinating components of an object transport task.
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Affiliation(s)
- Lisa M Muratori
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, NY 10027, USA
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