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Krivošík M, Košutzká Z, Šaling M, Boleková V, Brauneckerová R, Gábor M, Valkovič P. Analysis of Eye Movements in Adults with Spinal Muscular Atrophy. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:571. [PMID: 40282862 PMCID: PMC12028716 DOI: 10.3390/medicina61040571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 03/02/2025] [Accepted: 03/20/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Spinal muscular atrophy (SMA) is a progressive, autosomal recessive, rare neuromuscular disorder caused by a genetic defect in the SMN1 gene, where the SMN2 gene cannot sufficiently compensate. Patients experience progressive and predominantly proximal muscular weakness and atrophy. Oculomotor disorders are currently not regarded as a typical feature of SMA. The aim of this study was to determine whether oculomotor abnormalities are present in subjects with SMA and to assess a potential relationship between the oculomotor parameters and disease duration. Materials and Methods: An analysis of 15 patients with SMA type 2 and type 3 and 15 age-matched healthy controls was conducted. The oculomotor performance, including the analysis of smooth pursuit velocity gain and saccades parameters (latency, velocity, accuracy) in the horizontal and vertical directions, was compared between both groups. Results: The analysis of smooth pursuit gain in the participants revealed a marginally significant reduction between the SMA patients and the healthy controls in the horizontal direction at a frequency of 0.2 Hz (p = 0.051), but no significant differences were observed at any other frequency or direction. The vertical velocity of the saccade eye movements of the SMA patients was increased compared with the healthy subjects, which was statistically significant for the amplitude of ±10° (p = 0.030), but not for the amplitude of ±16.5° (p = 0.107). The horizontal saccade latency, saccade velocity and saccade accuracy did not differ significantly between the SMA patients and the controls. None of the oculomotor parameters were associated with disease duration. Conclusions: While certain oculomotor abnormalities, such as increased vertical saccade velocity, were observed in the SMA patients, these findings do not indicate a defining role of oculomotor impairment in SMA pathology or its clinical characteristics.
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Affiliation(s)
- Marek Krivošík
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
| | - Zuzana Košutzká
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
| | - Marián Šaling
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
| | - Veronika Boleková
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
- Faculty of Psychology, Institute of Clinical Psychology, Pan-European University, 821 02 Bratislava, Slovakia
| | - Rebeka Brauneckerová
- Department of Physiotherapy, Balneology and Medical Rehabilitation, Slovak Medical University, 833 03 Bratislava, Slovakia;
| | - Martin Gábor
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
- Department of Physiotherapy, Balneology and Medical Rehabilitation, University Hospital Bratislava, 821 01 Bratislava, Slovakia
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia; (Z.K.); (M.Š.); (V.B.); (M.G.)
- Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, 813 71 Bratislava, Slovakia
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Tokunaga S, Shimomura H, Horibe T, Taniguchi N, Lee T, Takeshima Y. Experience of nusinersen treatment in advanced spinal muscular atrophy type 1: Characteristics of late responders with delayed treatment efficacy. Eur J Paediatr Neurol 2025; 54:171-177. [PMID: 39955912 DOI: 10.1016/j.ejpn.2025.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 02/04/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025]
Abstract
OBJECTIVE Little clinical data is available for advanced cases of spinal muscular atrophy (SMA) type 1, particularly those requiring ventilation support. Therefore, this study aimed to evaluate the effectiveness of nusinersen treatment on motor and respiratory function in advanced cases of SMA type 1. METHODS This observational cohort study included seven patients with advanced SMA type 1, requiring permanent ventilator support and tracheostomy, at Hyogo Medical University School of Medicine Hospital between July 2017 and July 2019. The primary outcome was change in motor function, assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) score. Subjective changes, which could not be measured with CHOP-INTEND, were also evaluated. The secondary outcomes included changes in respiratory function, measured by tidal volume (TV) and transcutaneous carbon dioxide (TcCO2) levels. RESULTS Two patients showed a meaningful improvement in CHOP-INTEND scores (an increase of 4 points) after 2-3 years of nusinersen treatment. The remaining five showed changes ranging from 0 to 2 points. Subjective changes were observed in all patients. Patient respiratory function outcomes varied; TV increased in two patients and decreased in five, and TcCO2 levels decreased in three patients and increased in four. CONCLUSIONS Nusinersen may provide meaningful improvement in motor function in some patients with advanced SMA type 1; however, treatment response may take a while and varies between individuals. Further research is needed to substantiate these findings and identify potential prognostic factors for nusinersen treatment.
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Affiliation(s)
- Sachi Tokunaga
- Department of Pediatrics, Hyogo Medical University School of Medicine, Japan.
| | - Hideki Shimomura
- Department of Pediatrics, Hyogo Medical University School of Medicine, Japan
| | - Takuya Horibe
- Department of Pediatrics, Chibune General Hospital, Japan
| | - Naoko Taniguchi
- Department of Pediatrics, Hyogo Medical University School of Medicine, Japan
| | - Tomoko Lee
- Department of Pediatrics, Hyogo Medical University School of Medicine, Japan
| | - Yasuhiro Takeshima
- Department of Pediatrics, Hyogo Medical University School of Medicine, Japan
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Berkman O, Raveh E, Harpaz E, Kreitman R, Ben-Ami E, Nechushtan E, Birman N, Drory VE. Changes in saccadic intrusions over time as an objective biomarker to follow ALS disease progression. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:760-766. [PMID: 38975625 DOI: 10.1080/21678421.2024.2376732] [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: 04/05/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024]
Abstract
Objective: Saccadic Intrusions (SIs) are abnormal eye movements during gaze fixation. Studies have indicated the clinical relevance of SIs, especially of square wave jerks (SWJ) in ALS. We used a software-based platform to extract SIs as a part of an interventional drug trial. The objective was to examine SIs' change over time as a potential biomarker of ALS disease progression. Methods: 28 ALS patients (61.95 ± 8.6 years) were assessed with the revised ALS Functional Rating Scale (ALSFRS-R) and with an oculometric test. Changes of SIs over time and correlations with ALSFRS-R and its bulbar subscale were calculated. A power calculation was conducted to understand the practical implications of results. Results: A significant increase of SWJ over trial duration was observed, with an increase in frequency (mean rise of 0.14 ± 0.28, p < 0.01), amplitude (0.001 ± 0.0016 degrees, p < 0.005), overall duration of SWJ (0.13 ± 0.25, in %, p < 0.01), and in their relative part out of all intrusions (0.18 ± 0.32, in %, p < 0.005). Negative correlations were found with the bulbar subscale (R=-0.43, -0.41, -0.39 and -0.47, respectively, p < 0.001). The required sample size for observing a 40% reduction in bulbar aspects when using the oculometric test (α = 0.05 and β = 0.8), was found to be 150 patients per arm, compared with 200 patients using the bulbar subscale. Conclusions: Evaluation of saccadic intrusions during fixation was able to detect disease progression over time, correlated with ALSFRS-R bulbar subscale. Eye movements can potentially serve as an objective biomarker in ALS clinical trials and reduce the required sample size to show clinical effect of therapies.
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Affiliation(s)
| | | | | | | | | | - Elisheva Nechushtan
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and
| | - Nurit Birman
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, and Tel-Aviv Faculty of Medical Sciences, Tel-Aviv University, Tel Aviv, Israel
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Akodad S, De Smedt D, Baijot S, Stevens H, Deconinck N. Cognition and communication in patients with spinal muscular atrophy: A systematic review. Heliyon 2024; 10:e33677. [PMID: 39040255 PMCID: PMC11261103 DOI: 10.1016/j.heliyon.2024.e33677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
•Synthesizes evidence from 12 studies on cognitive and communicative impacts in SMA, focusing on nuanced functional outcomes.•Highlights cognitive variability in SMA1, revealing subtle challenges in SMA2 and 3, and stresses tailored assessment methodologies.•Identifies communication barriers in SMA, emphasizing the urgency of investigating their potential interplay with cognitive functions.•Stresses integrating cognitive and communicative assessments into SMA management, to enhanceunderstanding of treatment impacts.•Calls for standardized, sensitive tools to evaluate cognition and communication, ensuring consistent assessments across SMA phenotypes.
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Affiliation(s)
- Sanae Akodad
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Faculté de Médecine, Solvay Brussels School of Economics and Management, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Simon Baijot
- Université Libre de Bruxelles, ULB, Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Department of Paediatric Neurology and Neuromuscular Reference Center, Brussels, Belgium
- Université Libre de Bruxelles, ULB, Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Department of Neuropsychology and Speech Therapy, Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Center for Research in Cognition and Neurosciences (CRCN) and ULB Neurosciences Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hilde Stevens
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Faculté de Médecine, Solvay Brussels School of Economics and Management, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Deconinck
- Université Libre de Bruxelles, ULB, Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Department of Paediatric Neurology and Neuromuscular Reference Center, Brussels, Belgium
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Ueda Y, Egawa K, Kawamura K, Ochi N, Goto T, Kimura S, Narugami M, Nakakubo S, Nakajima M, Manabe A, Shiraishi H. Nusinersen induces detectable changes in compound motor action potential response in spinal muscular atrophy type 1 patients with severe impairment of motor function. Brain Dev 2024; 46:149-153. [PMID: 38103972 DOI: 10.1016/j.braindev.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Most long-term affected spinal muscular atrophy (SMA) type 1 patients have severe impairment of motor function and are dependent on mechanical ventilation with tracheostomy. The efficacy and safety of nusinersen in these patients have not been established. METHODS We retrospectively evaluated the efficacy of intrathecal nusinersen treatment in patients with SMA type 1 who continued treatment for at least 12 months. There were three patients enrolled in our study (3, 4 and 16 years of age) who had severe impairment of gross motor function without head control or the ability to roll over. All three needed mechanical ventilation with tracheostomy and tube feeding. Motor function was assessed using the Children s Hospital of Philadelphia infant test of neuromuscular disorders (CHOP-INTEND) and the caregivers' evaluations. Concurrently, we examined nerve conduction longitudinally and compared compound motor action potential (CMAP) amplitudes. RESULTS All patients continued nusinersen administration without significant adverse events for more than three years. While CHOP-INTEND scores did not remarkably increase, according to the caregivers, all three patients had improved finger or facial muscle movements that enabled them to make their intentions understood. Some CMAPs before treatment were not identified but became traces after nusinersen administration. CONCLUSIONS The improvement in motor function that leads to smoother communication could be a basis for continuing nusinersen treatment. Currently available motor function scorings are not efficient for assessing therapeutic interventions in SMA patients with medical care complexity. Longitudinal nerve conduction studies could be an objective indicator.
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Affiliation(s)
- Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.
| | - Kiyoshi Egawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Kawamura
- Toseikai Healthcare Corporation, Life-Long Care Clinic for Disabled People, Sapporo, Japan
| | - Noriki Ochi
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takeru Goto
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Shuhei Kimura
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Masashi Narugami
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiko Nakakubo
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Midori Nakajima
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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