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Liu C, Lan C, Chen Y. The use of sertraline to treat an adolescent of dystonia comorbid with major depressive disorder with psychotic features. Neuropsychopharmacol Rep 2024; 44:275-279. [PMID: 37987035 PMCID: PMC10932769 DOI: 10.1002/npr2.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
Dystonia is characterized by sustained or intermittent involuntary muscle contractions. Psychiatric symptoms are essential non-motor features of dystonia, and higher risks of depressive and anxiety disorders have been reported. The precedence of psychiatric to motor symptoms in some patients and the dopaminergic and serotonergic system involvement in both the motor and psychiatric aspects suggest these psychiatric disorders may be intrinsic to the neurobiology of dystonia. Nevertheless, psychiatric comorbidities are often construed as secondary reactions to motor disabilities and the negative bio-psycho-social impacts of dystonia, leading to underdiagnosis and undertreatment. Research on antidepressant use in dystonia is scarce, especially in children and adolescents. This report presents a 17-year-old female with dystonia comorbid with depression with psychotic features, whose motor symptoms improved but psychiatric symptoms persisted with dopaminergic pharmacotherapy. Sertraline was finally added 5 years after the onset and successfully managed her psychotic depression without worsening motor symptoms. Early detection, prompt diagnosis, and timely holistic treatment with dopaminergic agents, antidepressants, and psychosocial interventions are critical for the mental health of dystonia patients.
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Affiliation(s)
- Chia‐Chien Liu
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Chen‐Chia Lan
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan
| | - Ying‐Sheue Chen
- Department of PsychiatryTaipei Veterans General HospitalTaipeiTaiwan
- Department of PsychiatryChina Medical University HospitalTaichungTaiwan
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2
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Martino D. What can epidemiological studies teach on the pathophysiology of adult-onset isolated dystonia? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:21-60. [PMID: 37482393 DOI: 10.1016/bs.irn.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Several demographic and environmental factors may play an important role in determining the risk of developing adult-onset isolated dystonia (AOID) and/or modifying its course. However, epidemiologic studies have provided to date only partial insight on the disease mechanisms that are actively influenced by these factors. The age-related increase in female predominance in both patients diagnosed with AOID and subjects carrying its putative mediational phenotype suggests sexual dimorphism that has been demonstrated for mechanisms related to blepharospasm and cervical dystonia. The opposite relationship that spread and spontaneous remission of AOID have with age suggests age-related decline of compensatory mechanisms that protect from the progression of AOID. Epidemiological studies focusing on environmental risk factors yielded associations only with specific forms of AOID, even for those factors that are not likely to predispose exclusively to specific focal forms (for example, only writing dystonia was found associated with head trauma, and only blepharospasm with coffee intake). Other factors show biological plausibility of their mechanistic role for specific forms, e.g., dry eye syndrome or sunlight exposure for blepharospasm, scoliosis for cervical dystonia, repetitive writing for writing dystonia. Overall, the relationship between environment and AOID remains complex and incompletely defined. Both hypothesis-driven preclinical studies and well-designed cross-sectional or prospective clinical studies are still necessary to decipher this intricate relationship.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Hospital Drive NW, Calgary, AB, Canada; The Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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Kim JH, Kim HK, Lee SW, Son YD, Kim JH. The Relationship between Character Traits and In Vivo Cerebral Serotonin Transporter Availability in Healthy Subjects: A High-Resolution PET Study with C-11 DASB. Pharmaceuticals (Basel) 2023; 16:ph16050759. [PMID: 37242542 DOI: 10.3390/ph16050759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
To elucidate the potential roles of serotonergic activity in human character traits (i.e., self-directedness, cooperativeness, and self-transcendence), we investigated the relationship between these character traits and serotonin transporter (5-HTT) in healthy subjects. Twenty-four participants underwent High-Resolution Research Tomograph-positron emission tomography scans with [11C]DASB. To quantify 5-HTT availability, binding potential (BPND) of [11C]DASB was obtained using the simplified reference tissue model. The Temperament and Character Inventory was used to assess subjects' levels of three character traits. There were no significant correlations between the three character traits. Self-directedness was significantly positively correlated with [11C]DASB BPND in the left hippocampus, left middle occipital gyrus, bilateral superior parietal gyrus, left inferior parietal gyrus, left middle temporal gyrus (MTG), and left inferior temporal gyrus (ITG). Cooperativeness was significantly negatively correlated with [11C]DASB BPND in the median raphe nucleus. Self-transcendence was significantly negatively correlated with [11C]DASB BPND in the right MTG and right ITG. Our results show significant correlations between the three character traits and 5-HTT availability in specific brain regions. In particular, self-directedness was significantly positively correlated with 5-HTT availability, suggesting that a goal-oriented, self-confident, and resourceful character may be related to higher serotonergic neurotransmission.
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Affiliation(s)
- Jeong-Hee Kim
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Hang-Keun Kim
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
| | - Sang-Wha Lee
- Department of Chemical and Biological Engineering, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Young-Don Son
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
| | - Jong-Hoon Kim
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea
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Rafee S, Al-Hinai M, Douglas G, Ndukwe I, Hutchinson M. Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life. Clin Park Relat Disord 2023; 8:100186. [PMID: 36747896 PMCID: PMC9898436 DOI: 10.1016/j.prdoa.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
Background Cervical dystonia (CD) has a high prevalence of anxiety and depression. The relationship between motor severity, mood symptoms and QoL is unclear and how to adequately assess these is also unknown. Instruments like the BAI, BDI and HADS are often used but items within these relating to somatic symptoms might influence the results. Methods Patients with idiopathic cervical dystonia (CD) were included. The BAI, BDI, HADS, CIDP58 and TWSTRS2- severity score were used for assessment of motor, mood and QoL symptoms. Pearson's correlations between motor and non-motor symptom scores were assessed. The psychometric properties of the psychiatric tools were measured and principal component analysis performed after identifying items that could correspond to somatic symptoms. Results 201 participants were included. 42% of participants had either significant depression or anxiety symptoms or both when measured by BAI and BDI and 51% of patients met criteria on HADS. HADS-A and HADS-D, BAI and BDI were poorly correlated with TWSTRS2-S. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58. Psychometric and principal component analysis on 149/201 participants did not reveal factor loadings consistent with the a priori somatic groupings. However mean scores were higher for somatic items. Conclusion A good score on the CDIP58, a commonly used tool, does not indicate mild disease severity or minimal mood symptoms. Minimal motor symptoms, similarly, also does not imply a positive QoL. Clinicians should be mindful on ideal methods for performing a holistic assessment of CD patients. This likely warrants a combination of motor, QoL and mood assessment tools.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Corresponding author at: Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland.
| | - Mahmood Al-Hinai
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Gillian Douglas
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Ihedinachi Ndukwe
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
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Bailey GA, Matthews C, Szewczyk-krolikowski K, Moore P, Komarzynski S, Davies EH, Peall KJ. Use of remote monitoring and integrated platform for the evaluation of sleep quality in adult-onset idiopathic cervical dystonia. J Neurol 2023; 270:1759-1769. [PMID: 36414751 PMCID: PMC9971061 DOI: 10.1007/s00415-022-11490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Up to 70% of individuals diagnosed with adult-onset idiopathic focal cervical dystonia (AOIFCD) report difficulties with sleep. Larger cohort studies using wrist-worn accelerometer devices have emerged as an alternative to smaller polysomnography studies, in order to evaluate sleep architecture. METHODS To measure activity during the sleep/wake cycle, individuals wore a consumer-grade wrist device (Garmin vivosmart 4) continuously over 7 days on their non-dominant wrist, while completing a daily sleep diary and standardised sleep and non-motor questionnaires via a dedicated app. Sleep measures were derived from the captured raw triaxial acceleration and heart rate values using previously published validated algorithms. RESULTS Data were collected from 50 individuals diagnosed with AOIFCD and 47 age- and sex-matched controls. Those with AOIFCD self-reported significantly higher levels of excessive daytime sleepiness (p = 0.04) and impaired sleep quality (p = 0.03), while accelerometer measurements found the AOIFCD cohort to have significantly longer total sleep times (p = 0.004) and time spent in NREM sleep (p = 0.009), compared to controls. Overall, there was limited agreement between wearable-derived sleep parameters, and self-reported sleep diary and visual analogue scale records. DISCUSSION This study shows the potential feasibility of using consumer-grade wearable devices in estimating sleep measures at scale in dystonia cohorts. Those diagnosed with AOIFCD were observed to have altered sleep architecture, notably longer total sleep time and NREM sleep, compared to controls. These findings suggest that previously reported disruptions to brainstem circuitry and serotonin neurotransmission may contribute to both motor and sleep pathophysiology.
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Affiliation(s)
- Grace A. Bailey
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | | | | | - Peter Moore
- grid.416928.00000 0004 0496 3293The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Kathryn J. Peall
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
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Huang X, Zhang M, Li B, Shang H, Yang J. Structural and functional brain abnormalities in idiopathic cervical dystonia: A multimodal meta-analysis. Parkinsonism Relat Disord 2022; 103:153-165. [DOI: 10.1016/j.parkreldis.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022]
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Zheng CJ, Van Drunen S, Egorova-Brumley N. Neural correlates of co-occurring pain and depression: an activation-likelihood estimation (ALE) meta-analysis and systematic review. Transl Psychiatry 2022; 12:196. [PMID: 35545623 PMCID: PMC9095719 DOI: 10.1038/s41398-022-01949-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between pain and depression is thought to be bidirectional and the underlying neurobiology 'shared' between the two conditions. However, these claims are often based on qualitative comparisons of brain regions implicated in pain or depression, while focused quantitative studies of the neurobiology of pain-depression comorbidity are lacking. Particularly, the direction of comorbidity, i.e., pain with depression vs. depression with pain, is rarely addressed. In this systematic review (PROSPERO registration CRD42020219876), we aimed to delineate brain correlates associated with primary pain with concomitant depression, primary depression with concurrent pain, and equal pain and depression comorbidity, using activation likelihood estimation (ALE) meta-analysis. Neuroimaging studies published in English until the 28th of September 2021 were evaluated using PRISMA guidelines. A total of 70 studies were included, of which 26 reported stereotactic coordinates and were analysed with ALE. All studies were assessed for quality by two authors, using the National Institute of Health Quality Assessment Tool. Our results revealed paucity of studies that directly investigated the neurobiology of pain-depression comorbidity. The ALE analysis indicated that pain with concomitant depression was associated with the right amygdala, while depression with concomitant pain was related primarily to the left dorsolateral prefrontal cortex (DLPFC). We provide evidence that pain and depression have a cumulative negative effect on a specific set of brain regions, distinct for primary diagnosis of depression vs. pain.
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Affiliation(s)
| | | | - Natalia Egorova-Brumley
- The University of Melbourne, Parkville, VIC, Australia.
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.
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Serotonergic system in vivo with [ 11C]DASB PET scans in GTP-cyclohydrolase deficient dopa-responsive dystonia patients. Sci Rep 2022; 12:6292. [PMID: 35428769 PMCID: PMC9012759 DOI: 10.1038/s41598-022-10067-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
GTP-cyclohydrolase deficiency in dopa-responsive dystonia (DRD) patients impairs the biosynthesis of dopamine, but also of serotonin. The high prevalence of non-motor symptoms suggests involvement of the serotonergic pathway. Our study aimed to investigate the serotonergic system in vivo in the brain of`DRD patients and correlate this to (non-)motor symptoms. Dynamic [11C]DASB PET scans, a marker of serotonin transporter availability, were performed. Ten DRD, 14 cervical dystonia patients and 12 controls were included. Univariate- and network-analysis did not show differences in binding between DRD patients compared to controls. Sleep disturbances were correlated with binding in the dorsal raphe nucleus (all participants: rs = 0.45, p = 0.04; patients: rs = 0.64, p = 0.05) and participants with a psychiatric disorder had a lower binding in the hippocampus (all participants: p = 0.00; patients: p = 0.06). Post-hoc analysis with correction for psychiatric co-morbidity showed a significant difference in binding in the hippocampus between DRD patients and controls (p = 0.00). This suggests that psychiatric symptoms might mask the altered serotonergic metabolism in DRD patients, but definite conclusions are difficult as psychiatry is considered part of the phenotype. We hypothesize that an imbalance between different neurotransmitter systems is responsible for the non-motor symptoms, and further research investigating multiple neurotransmitters and psychiatry in DRD is necessary.
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Ray S, Kutty B, Pal PK, Yadav R. Sleep and other Non-motor Symptoms in Patients with Idiopathic Oromandibular Dystonia and Meige Syndrome: A Questionnaire-based Study. Ann Indian Acad Neurol 2021; 24:351-355. [PMID: 34446996 PMCID: PMC8370173 DOI: 10.4103/aian.aian_906_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: Non-motor symptoms are an essential cause of comorbidity in generalized and focal dystonia. However, there are few studies on dystonia involving the craniofacial regions. Methods: We studied non-motor symptoms in patients with oromandibular dystonia (OMD) and Meige syndrome using a questionnaire, and validated instruments for depression, anxiety, REM behaviour disorder, restless leg syndrome, sleep quality, excessive daytime sleepiness, and self-esteem. The severity of dystonia and blepharospasm was also studied. Results: Nineteen patients with OMD were recruited into the study. Among patients with OMD, depression was seen in 63.6% (n = 7), sleep impairment in 27.3% (n = 3), excessive daytime sleepiness in 27.3% (n = 3), and poor self- esteem in 18.2% (n = 2) of the patients. Among patients with Meige syndrome, depression was seen in 37.5% (n = 3), sleep impairment in 12.5% (n = 1), excessive daytime sleepiness in 25% (n = 2), low self-esteem in 25% (n = 2) of the patients. Conclusion: This study highlights the significant frequency of depression and sleep disturbances in patients with idiopathic OMD and Meige syndrome.
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Affiliation(s)
- Somdattaa Ray
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bindu Kutty
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Abstract
Dystonia is a complex neurological movement disorder characterized by involuntary muscle contractions. Increasing studies implicate the microbiome as a possible key susceptibility factor for neurological disorders, but the relationship between the gut microbiota and dystonia remains poorly explored. Here, the gut microbiota of 57 patients with isolated dystonia and 27 age- and environment-matched healthy controls was analyzed by 16S rRNA gene amplicon sequencing. Further, integrative analysis of the gut microbiome and serum metabolome measured by high-performance liquid chromatography-mass spectrometry was performed. No difference in α-diversity was found, while β-diversity was significantly different, with a more heterogeneous community structure among dystonia patients than among controls. The most significant changes in dystonia highlighted an increase in Clostridiales, including Blautia obeum, Dorea longicatena, and Eubacterium hallii, and a reduction in Bacteroides vulgatus and Bacteroides plebeius. The functional analysis revealed that genes related to tryptophan and purine biosynthesis were more abundant in gut microbiota from patients with dystonia, while genes linked to citrate cycle, vitamin B6, and glycan metabolism were less abundant. The evaluation of serum metabolites revealed altered levels of l-glutamic acid, taurine, and d-tyrosine, suggesting changes in neurotransmitter metabolism. The most modified metabolites strongly inversely correlated with the abundance of members belonging to the Clostridiales, revealing the effect of the gut microbiota on neurometabolic activity. This study is the first to reveal gut microbial dysbiosis in patients with isolated dystonia and identified potential links between gut microbiota and serum neurotransmitters, providing new insight into the pathogenesis of isolated dystonia. IMPORTANCE Dystonia is the third most common movement disorder after essential tremor and Parkinson’s disease. However, the cause for the majority of cases is not known. This is the first study so far that reveals significant alterations of gut microbiome and correlates the alteration of serum metabolites with gut dysbiosis in patients with isolated dystonia. We demonstrated a general overrepresentation of Clostridiales and underrepresentation of Bacteroidetes in patients with dystonia in comparison with healthy controls. The functional analysis found that genes related to the biosynthesis of tryptophan, which is the precursor of the neurotransmitter serotonin, were more active in isolated dystonia patients. Altered levels of several serum metabolites were found to be associated with microbial changes, such as d-tyrosine, taurine, and glutamate, indicating differences in neurotransmitter metabolism in isolated dystonia. Integrative analysis suggests that neurotransmitter system dysfunction may be a possible pathway by which the gut microbiome participates in the development of dystonia. The gut microbiome changes provide new insight into the pathogenesis of dystonia, suggesting new potential therapeutic directions.
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Matteo C, Daniele B, Isabella B, Annalisa M, Fabrizia D, Viola B, Arianna T, Gina F, Massimo P, Antonella C, Giovanni F, Giovanni D, Alfredo B. Motor and non-motor subtypes of cervical dystonia. Parkinsonism Relat Disord 2021; 88:108-113. [PMID: 34174552 DOI: 10.1016/j.parkreldis.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Cervical dystonia (CD) is a heterogeneous condition. However, while motor subtypes of CD have recently been identified, it is still unknown whether and how non-motor symptoms contribute to CD heterogeneity. In the present cross-sectional study, we aimed to identify clinical CD subtypes on the basis of motor and non-motor symptoms by using a hypothesis-free data-driven approach. METHODS Fifty-seven patients with CD participated in the study. Patients underwent a clinical evaluation that assessed motor and non-motor features of CD with standardized clinical scales. We investigated five clinical domains, including motor symptoms, psychiatric disturbances, sleep disorders, cognitive impairment and pain. These domains were used as variables in a k-means cluster analysis with two-, three-, and four-cluster solutions. RESULTS The two-cluster solution best fits our sample. Cluster I (n = 32) included patients who were younger and had less severe non-motor symptoms and a lower disability level than patients included in Cluster II (n = 25). The two clusters showed similar sex distribution and disease duration. Similarly, the type of motor pattern and the occurrence of tremor and sensory trick were equally distributed in the two subtypes. CONCLUSIONS We identified two clinical subtypes of CD. The two subtypes shared similar motor features but were characterized by different non-motor symptom severity. These findings suggest that motor network dysfunction is a common pathophysiological feature of CD, whereas the extent of non-motor network involvement may differ in CD, with age acting as a possible modulating factor.
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Affiliation(s)
- Costanzo Matteo
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Belvisi Daniele
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy; IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Berardelli Isabella
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maraone Annalisa
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - D'Antonio Fabrizia
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Baione Viola
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Toscano Arianna
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Ferrazzano Gina
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Pasquini Massimo
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy
| | - Conte Antonella
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy; IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Fabbrini Giovanni
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy; IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Defazio Giovanni
- Department of Medical Sciences and Public Health, University of Cagliari, SS 554 Bivio Sestu - 09042, Monserrato, CA, Italy
| | - Berardelli Alfredo
- Department of Human Neurosciences, Sapienza, University of Rome, Viale Dell' Università 30, 00185, Rome, Italy; IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.
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The prevalence of depression in adult onset idiopathic dystonia: Systematic review and metaanalysis. Neurosci Biobehav Rev 2021; 125:221-230. [PMID: 33662441 DOI: 10.1016/j.neubiorev.2021.02.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Adult onset idiopathic dystonia (AOID) is the third most common movement disorder in adults. Co-existing depressive symptoms and disorders represent major contributors of disability and quality of life in these patients, but their prevalence remains unclear. We investigated the point prevalence of supra-clinical threshold depressive symptoms/depressive disorders in AOID in a systematic review with qualitative synthesis and meta-analysis. Our search identified 60 articles suitable for qualitative synthesis and 54 for meta-analysis. The overall pooled prevalence of either supra-clinical threshold depressive symptoms or depressive disorders was 31.5 % for cervical dystonia, 29.2 % for cranial dystonia, and 33.6 % for clinical samples with mixed forms of AOID. Major depressive disorder was more prevalent than dysthymia in cervical dystonia, whereas dysthymia was more prevalent in cranial dystonia. In cervical dystonia, the prevalence of supra-clinical threshold depressive symptoms screened by rating scales was higher than that of depressive disorders diagnosed with structured interviews. Prevalence studies using rating scales yielded higher heterogeneity. More research is warranted to standardize screening methodology and characterization of mood disorders in AOID.
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Kim JE, Chae S, Kim S, Jung YJ, Kang MG, Heo WD, Kim D. Cerebellar 5HT-2A receptor mediates stress-induced onset of dystonia. SCIENCE ADVANCES 2021; 7:7/10/eabb5735. [PMID: 33658190 PMCID: PMC7929497 DOI: 10.1126/sciadv.abb5735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
Stress is a key risk factor for dystonia, a debilitating motor disorder characterized by cocontractions of muscles leading to abnormal body posture. While the serotonin (5HT) system is known to control emotional responses to stress, its role in dystonia remains unclear. Here, we reveal that 5HT neurons in the dorsal raphe nuclei (DRN) send projections to the fastigial deep cerebellar nuclei (fDCN) and that photostimulation of 5HT-fDCN induces dystonia in wild-type mice. Moreover, we report that photoinhibition of 5HT-fDCN reduces dystonia in a1A tot/tot mice, a genetic model of stress-induced dystonia, and administration of a 5HT-2A receptor inverse agonist (MDL100907; 0.1 to 1 mg/kg) or shRNA-mediated knockdown of the ht2ar gene in fDCN can notably reduce the onset of dystonia in a1A tot/tot mice. These results support the serotonin theory of dystonia and suggest strategies for alleviating symptoms in human patients by blocking 5HT-2A receptors.
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Affiliation(s)
- Jung Eun Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Sujin Chae
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Sungsoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Yeon-Joo Jung
- Bio Core Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Myoung-Goo Kang
- Department of Neuroscience, Cell Biology, and Anatomy, The University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Won Do Heo
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
| | - Daesoo Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea.
- KAIST Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
- Bio Core Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic of Korea
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14
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Han V, Skorvanek M, Smit M, Turcanova Koprusakova M, Hoekstra T, Dijk JP, Tijssen MA, Gdovinova Z, Reijneveld SA. Prevalence of non-motor symptoms and their association with quality of life in cervical dystonia. Acta Neurol Scand 2020; 142:613-622. [PMID: 32579704 DOI: 10.1111/ane.13304] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Non-motor symptoms (NMS) are commonly present along with motor impairment in patients with cervical dystonia (CD) and have a significant impact on health-related quality of life (HRQoL). However, the prevalence of NMS and their association with dystonia are still unclear. The aim of our study was to assess the prevalence of depression, anxiety, fatigue, apathy, pain, sleep problems, and excessive daytime sleepiness (EDS) in CD using different evaluation approaches and to explore their association with HRQoL relative to that of motor symptoms. MATERIALS AND METHODS We enrolled 102 Slovak patients with CD. The severity of both motor and non-motor symptoms was assessed using validated scales. HRQoL was determined by the 36-item Short Form Health Survey (SF-36). Association of NMS with poor HRQoL was assessed using multiple regressions. RESULTS The most frequent NMS in our sample were sleep impairment (67.3%), anxiety (65.5%), general and physical fatigue (57.5% and 52.9%, respectively), depression (47.1%), mental fatigue (31.4%), apathy (30.4%), reduced activity (29.4%), EDS (20.2%), and reduced motivation (18.6%). Univariate analysis showed that NMS, but not motor symptoms, were significantly linked to poor HRQoL, with EDS being most commonly associated with poor HRQoL, followed by disrupted sleep, depression, and fatigue. CONCLUSIONS The prevalence of NMS among patients with CD is high, and some NMS are strongly associated with poor HRQoL, while motor impairment was not associated with the severity of NMS or poor HRQoL. Actively diagnosing and treating NMS should therefore be a routine part of the clinical management of patients with CD.
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Affiliation(s)
- Vladimir Han
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
- Graduate School Kosice Institute for Society and Health Faculty of Medicine Safarik University Kosice Slovakia
| | - Matej Skorvanek
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
| | - Marenka Smit
- Department of Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Monika Turcanova Koprusakova
- Department of Neurology University Hospital in Martin Martin Slovakia
- Department of Neurology Jessenius Faculty of Medicine Comenius University in Bratislava Martin Slovakia
| | - Tialda Hoekstra
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Jitse P. Dijk
- Graduate School Kosice Institute for Society and Health Faculty of Medicine Safarik University Kosice Slovakia
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
| | - Marina A.J. Tijssen
- Department of Neurology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Zuzana Gdovinova
- Department of Neurology Faculty of Medicine Safarik University Kosice Slovakia
- Department of Neurology University Hospital L. Pasteur Kosice Slovakia
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Medicine University Medical Center GroningenUniversity of Groningen Groningen The Netherlands
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15
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Perturbed Ca2+-dependent signaling of DYT2 hippocalcin mutant as mechanism of autosomal recessive dystonia. Neurobiol Dis 2019; 132:104529. [DOI: 10.1016/j.nbd.2019.104529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
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