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Yeow D, Rudaks LI, Siow SF, Davis RL, Kumar KR. Genetic Testing of Movements Disorders: A Review of Clinical Utility. Tremor Other Hyperkinet Mov (N Y) 2024; 14:2. [PMID: 38222898 PMCID: PMC10785957 DOI: 10.5334/tohm.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Currently, pathogenic variants in more than 500 different genes are known to cause various movement disorders. The increasing accessibility and reducing cost of genetic testing has resulted in increasing clinical use of genetic testing for the diagnosis of movement disorders. However, the optimal use case(s) for genetic testing at a patient level remain ill-defined. Here, we review the utility of genetic testing in patients with movement disorders and also highlight current challenges and limitations that need to be considered when making decisions about genetic testing in clinical practice. Highlights The utility of genetic testing extends across multiple clinical and non-clinical domains. Here we review different aspects of the utility of genetic testing for movement disorders and the numerous associated challenges and limitations. These factors should be weighed on a case-by-case basis when requesting genetic tests in clinical practice.
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Affiliation(s)
- Dennis Yeow
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Laura I. Rudaks
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sue-Faye Siow
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ryan L. Davis
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Neurogenetics Research Group, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kishore R. Kumar
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Pontrucher A, Barth M, Ziegler A, Chao de la Barca JM, Mirebeau-Prunier D, Reynier P, Homedan C. Case report: Diagnosis of ADCY5-related dyskinesia explaining the entire phenotype in a patient with atypical citrullinemia type I. Front Neurol 2023; 14:1266686. [PMID: 38020658 PMCID: PMC10665474 DOI: 10.3389/fneur.2023.1266686] [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: 07/25/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
In this case study, we report the case of a 13-year-old girl with citrullinemia type 1 (MIM #215700), an autosomal recessive inherited disorder of the urea cycle, which was confirmed by the identification of a homozygous pathogenic variant in the argininosuccinate synthetase 1 (ASS1) gene. However, the patient presented abnormal hyperkinetic movements with global developmental delay and clinical signs that were not fully consistent with those of citrullinemia type 1 or with those of her siblings with isolated citrullinemia type 1. Exome sequencing showed the presence of a de novo heterozygous pathogenic variant in the adenylate cyclase type 5 (ADCY5) gene. The variant confirmed the overlap with the so-called ADCY5-related dyskinesia with orofacial involvement, which is autosomal dominant (MIM #606703), a disorder disrupting the enzymatic conversion of adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). In addition to the citrullinemia-related low-protein diet and arginine supplementation, the identification of this second disease led to the introduction of a treatment with caffeine, which considerably improved the dyskinesia neurological picture. In conclusion, this case highlights the importance of clinical-biological confrontation for the interpretation of genetic variants, as one hereditary metabolic disease may hide another with therapeutic consequences. Summary This article reports the misleading superposition of two inherited metabolic diseases, showing the importance of clinical-biological confrontation in the interpretation of genetic variants.
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Affiliation(s)
- Audrey Pontrucher
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
| | - Magalie Barth
- Service de Génétique, Centre Hospitalier Universitaire, Angers, France
| | - Alban Ziegler
- Service de Génétique, Centre Hospitalier Universitaire, Angers, France
- Service de Génétique, CRMR AnDDI-Rares, CHU Reims, Reims, France
| | | | | | - Pascal Reynier
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
| | - Chadi Homedan
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
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Menon PJ, Nilles C, Silveira‐Moriyama L, Yuan R, de Gusmao CM, Münchau A, Carecchio M, Grossman S, Grossman G, Méneret A, Roze E, Pringsheim T. Scoping Review on ADCY5-Related Movement Disorders. Mov Disord Clin Pract 2023; 10:1048-1059. [PMID: 37476318 PMCID: PMC10354615 DOI: 10.1002/mdc3.13796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 05/04/2023] [Indexed: 07/22/2023] Open
Abstract
Background Adenylyl cyclase 5 (ADCY5)-related movement disorder (ADCY5-RMD) is a rare, childhood-onset disease resulting from pathogenic variants in the ADCY5 gene. The clinical features, diagnostic options, natural history, and treatments for this disease are poorly characterized and have never been established through a structured approach. Objective This scoping review attempts to summarize all available clinical literature on ADCY5-RMD. Methods Eighty-seven articles were selected for inclusion in this scoping review. The majority of articles identified were case reports or case series. Results These articles demonstrate that patients with ADCY5-RMD suffer from permanent and/ or paroxysmal hyperkinetic movements. The paroxysmal episodes can be worsened by environmental triggers, in particular the sleep-wake transition phase in the early morning. Occurrence of nocturnal paroxysmal dyskinesias and perioral twitches are highly suggestive of the diagnosis when present. In the majority of patients intellectual capacity is preserved. ADCY5-RMD is considered a non-progressive disorder, with inter-individual variations in evolution with aging. Somatic mosaicism, mode of inheritance and the location of the mutation within the protein can influence phenotype. Conclusions The current evidence for therapeutic options for ADCY5-RMD is limited: caffeine, benzodiazepines and deep brain stimulation have been consistently reported to be useful in case reports and case series.
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Affiliation(s)
- Poornima Jayadev Menon
- Sorbonne University, APHP—Salpêtrière Hospital, CNRS, INSERM, Paris Brain InstituteParisFrance
- School of Postgraduate StudiesRoyal College of Surgeons in IrelandDublinIreland
| | - Christelle Nilles
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryABCanada
| | | | - Ruiyi Yuan
- Sorbonne University, APHP—Salpêtrière Hospital, CNRS, INSERM, Paris Brain InstituteParisFrance
| | - Claudio M. de Gusmao
- Department of NeurologyUniversity of Campinas (UNICAMP)CampinasBrazil
- Boston Children's HospitalBostonMAUSA
| | | | - Miryam Carecchio
- Center for the Study of Neurodegeneration (CESNE) and Department of NeuroscienceUniversity of PaduaPaduaItaly
| | | | | | - Aurélie Méneret
- Sorbonne University, APHP—Salpêtrière Hospital, CNRS, INSERM, Paris Brain InstituteParisFrance
| | - Emmanuel Roze
- Sorbonne University, APHP—Salpêtrière Hospital, CNRS, INSERM, Paris Brain InstituteParisFrance
| | - Tamara Pringsheim
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryABCanada
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Di Rocco M, Galosi S, Follo FC, Lanza E, Folli V, Martire A, Leuzzi V, Martinelli S. Phenotypic Assessment of Pathogenic Variants in GNAO1 and Response to Caffeine in C. elegans Models of the Disease. Genes (Basel) 2023; 14:319. [PMID: 36833246 PMCID: PMC9957173 DOI: 10.3390/genes14020319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
De novo mutations affecting the G protein α o subunit (Gαo)-encoding gene (GNAO1) cause childhood-onset developmental delay, hyperkinetic movement disorders, and epilepsy. Recently, we established Caenorhabditis elegans as an informative experimental model for deciphering pathogenic mechanisms associated with GNAO1 defects and identifying new therapies. In this study, we generated two additional gene-edited strains that harbor pathogenic variants which affect residues Glu246 and Arg209-two mutational hotspots in Gαo. In line with previous findings, biallelic changes displayed a variable hypomorphic effect on Gαo-mediated signaling that led to the excessive release of neurotransmitters by different classes of neurons, which, in turn, caused hyperactive egg laying and locomotion. Of note, heterozygous variants showed a cell-specific dominant-negative behavior, which was strictly dependent on the affected residue. As with previously generated mutants (S47G and A221D), caffeine was effective in attenuating the hyperkinetic behavior of R209H and E246K animals, indicating that its efficacy is mutation-independent. Conversely, istradefylline, a selective adenosine A2A receptor antagonist, was effective in R209H animals but not in E246K worms, suggesting that caffeine acts through both adenosine receptor-dependent and receptor-independent mechanisms. Overall, our findings provide new insights into disease mechanisms and further support the potential efficacy of caffeine in controlling dyskinesia associated with pathogenic GNAO1 mutations.
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Affiliation(s)
- Martina Di Rocco
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
- Department of Human Neuroscience, ‘Sapienza’ University of Rome, 00185 Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, ‘Sapienza’ University of Rome, 00185 Rome, Italy
| | - Francesca C. Follo
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Enrico Lanza
- Center for Life Nano Science, Istituto Italiano di Tecnologia, 00161 Rome, Italy
| | - Viola Folli
- Center for Life Nano Science, Istituto Italiano di Tecnologia, 00161 Rome, Italy
- D-tails s.r.l., 00165 Rome, Italy
| | - Alberto Martire
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, ‘Sapienza’ University of Rome, 00185 Rome, Italy
| | - Simone Martinelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
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Cif L, Demailly D, Gehin C, Chan Seng E, Dornadic M, Huby S, Poulen G, Roubertie A, Villessot M, Roujeau T, Coubes P. Deep brain stimulation effect in genetic dyskinetic cerebral palsy: The case of ADCY5- related disease. Mol Genet Metab 2023; 138:106970. [PMID: 36610259 DOI: 10.1016/j.ymgme.2022.106970] [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: 07/01/2022] [Revised: 11/06/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cerebral Palsy (CP) represents a frequent cause of disability in childhood. Early in life, genetic disorders may present with motor dysfunction and diagnosed as CP. Establishing the primary, genetic etiology allows more accurate prognosis, genetic counselling, and planning for symptomatic interventions in homogeneous etiological groups. Deep brain stimulation (DBS) is recommended in refractory movement disorders, including isolated pediatric dystonias. For dystonia evolving in more complex associations in genetic CP, the effect of DBS is still understudied and currently only sporadically described. OBJECTIVES To report the effect of DBS applied to the globus pallidus pars interna (GPi) in children with complex movement disorders caused by pathogenic ADCY5 variants, diagnosed as dyskinetic CP previous to genetic diagnostic. METHODS We conducted a retrospective study on evolution of treatment with DBS in ADCY5-related disease. A standardized proforma including the different type of movement disorders and associated neurological signs was completed at each follow-up time, based on video recordings, as well as functional assessments used in children with CP. RESULTS Four children (mean of age, 13 ± 2.9 years) received GPi-DBS. The same de novo pathogenic missense variant (c.1252C > T, p.R418W) was identified in three out of four and a splice site variant (c.2088 + 2G > T) in one subject. Developmental delay and overlapping features including axial hypotonia, chorea, dystonic attacks, myoclonus, and cranial dyskinesia were present. The median age at DBS was 9 years and follow-up with DBS, 2.6 years. We identified a pattern of clinical response with early suppression of dystonic attacks, followed by improvement of myoclonus and facial dyskinesia. Effect on chorea was delayed and more limited. Two patients gained notable functional benefit related to sitting, standing, gait, use of upper limbs and speech. CONCLUSION ADCY5-related disease may benefit from GPi-DBS. The most significant clinical response relates to the early and sustained benefit on dystonic attacks and a variable but still positive response on the other hyperkinetic features. Genetic etiology of CP will contribute to further elucidate genotype-phenotype correlations and to refine DBS indication as network-related symptomatic interventions.
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Affiliation(s)
- Laura Cif
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France.
| | - Diane Demailly
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Claire Gehin
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Emilie Chan Seng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Morgan Dornadic
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sophie Huby
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Gaetan Poulen
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Agathe Roubertie
- Department of Neuropaediatrics, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Matthieu Villessot
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France; Département de Neurologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Thomas Roujeau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - Philippe Coubes
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
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Garofalo M, Beudel M, Dijk J, Bonouvrié L, Buizer A, Geytenbeek J, Prins R, Schuurman P, van de Pol L. Elective and Emergency Deep Brain Stimulation in Refractory Pediatric Monogenetic Movement Disorders Presenting with Dystonia: Current Practice Illustrated by Two Cases. Neuropediatrics 2022; 54:44-52. [PMID: 36223877 PMCID: PMC9842449 DOI: 10.1055/a-1959-9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dystonia is characterized by sustained or intermittent muscle contractions, leading to abnormal posturing and twisting movements. In pediatric patients, dystonia often negatively influences quality of life. Pharmacological treatment for dystonia is often inadequate and causes adverse effects. Deep brain stimulation (DBS) appears to be a valid therapeutic option for pharmacoresistant dystonia in children. METHODS To illustrate the current clinical practice, we hereby describe two pediatric cases of monogenetic movement disorders presenting with dystonia and treated with DBS. We provide a literature review of similar previously described cases and on different clinical aspects of DBS in pediatric dystonia. RESULTS The first patient, a 6-year-old girl with severe dystonia, chorea, and myoclonus due to an ADCY5 gene mutation, received DBS in an elective setting. The second patient, an 8-year-old boy with GNAO1-related dystonia and chorea, underwent emergency DBS due to a pharmacoresistant status dystonicus. A significant amelioration of motor symptoms (65% on the Burke-Fahn-Marsden Dystonia Rating Scale) was observed postoperatively in the first patient and her personal therapeutic goals were achieved. DBS was previously reported in five patients with ADCY5-related movement disorders, of which three showed objective improvement. Emergency DBS in our second patient resulted in the successful termination of his GNAO1-related status dystonicus, this being the eighth case reported in the literature. CONCLUSION DBS can be effective in monogenetic pediatric dystonia and should be considered early in the disease course. To better evaluate the effects of DBS on patients' functioning, patient-centered therapeutic goals should be discussed in a multidisciplinary approach.
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Affiliation(s)
- M. Garofalo
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M. Beudel
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J.M. Dijk
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L.A. Bonouvrié
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - A.I. Buizer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - J. Geytenbeek
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands
| | - R.H.N. Prins
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - P.R. Schuurman
- Department of Neurosurgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - L.A. van de Pol
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands,Department of Child Neurology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Address for correspondence L.A. van de Pol, MD, PhD Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije UniversiteitBoelelaan 1117, 1081 HV Amsterdamthe Netherlands
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Seliverstov Y, Karpacheva N. Improvement of
ADCY5
‐Related Dyskinesias with Coffee. Mov Disord Clin Pract 2022; 10:329-330. [PMID: 36989009 PMCID: PMC9941936 DOI: 10.1002/mdc3.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yury Seliverstov
- Department of Neurology Ulm University Ulm Germany
- Kazaryan Clinic of Epileptology and Neurology Moscow Russia
| | - Natalia Karpacheva
- Central Clinical Hospital of the Presidential Administration of the Russian Federation Moscow Russia
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Desai NA, Manchala DA, Patki NI. ADCY5 Mutation-Movement Disorder with Sleep Disruption Improving with Caffeine. Neurol India 2022; 70:2211-2212. [PMID: 36352647 DOI: 10.4103/0028-3886.359291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Neelu A Desai
- Department of Pediatric Neurology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - David A Manchala
- Department of Pediatric Neurology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Neha I Patki
- Department of Pediatric Neurology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Chen SY, Ho CJ, Lu YT, Lin CH, Tsai MH. ADCY5-related dyskinesia: a case report. Neurol Res Pract 2022; 4:39. [PMID: 35965335 PMCID: PMC9377057 DOI: 10.1186/s42466-022-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Adenylyl cyclase 5 (ADCY5) related dyskinesia is a rare disorder characterized by early-onset paroxysmal choreoathetosis, dystonia, myoclonus, or a combination of the above, which primarily involved the limbs, face, and neck. Other common clinical features are axial hypotonia and episodic exacerbation of dyskinesia. Both sporadic and inherited cases have been reported and the predomiant mode of inheritance is autosomal dominant. Herein, we describe the first ADCY5-related dyskinesia patient in Taiwan.
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di Biase L, Di Santo A, Caminiti ML, Pecoraro PM, Carbone SP, Di Lazzaro V. Dystonia Diagnosis: Clinical Neurophysiology and Genetics. J Clin Med 2022; 11:jcm11144184. [PMID: 35887948 PMCID: PMC9320296 DOI: 10.3390/jcm11144184] [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: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 12/12/2022] Open
Abstract
Dystonia diagnosis is based on clinical examination performed by a neurologist with expertise in movement disorders. Clues that indicate the diagnosis of a movement disorder such as dystonia are dystonic movements, dystonic postures, and three additional physical signs (mirror dystonia, overflow dystonia, and geste antagonists/sensory tricks). Despite advances in research, there is no diagnostic test with a high level of accuracy for the dystonia diagnosis. Clinical neurophysiology and genetics might support the clinician in the diagnostic process. Neurophysiology played a role in untangling dystonia pathophysiology, demonstrating characteristic reduction in inhibition of central motor circuits and alterations in the somatosensory system. The neurophysiologic measure with the greatest evidence in identifying patients affected by dystonia is the somatosensory temporal discrimination threshold (STDT). Other parameters need further confirmations and more solid evidence to be considered as support for the dystonia diagnosis. Genetic testing should be guided by characteristics such as age at onset, body distribution, associated features, and coexistence of other movement disorders (parkinsonism, myoclonus, and other hyperkinesia). The aim of the present review is to summarize the state of the art regarding dystonia diagnosis focusing on the role of neurophysiology and genetic testing.
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Affiliation(s)
- Lazzaro di Biase
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
- Brain Innovations Lab., Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
- Correspondence: or ; Tel.: +39-062-2541-1220
| | - Alessandro Di Santo
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Maria Letizia Caminiti
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pasquale Maria Pecoraro
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Simona Paola Carbone
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (P.M.P.); (S.P.C.); (V.D.L.)
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
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11
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Méneret A, Mohammad SS, Cif L, Doummar D, DeGusmao C, Anheim M, Barth M, Damier P, Demonceau N, Friedman J, Gallea C, Gras D, Gurgel-Giannetti J, Innes EA, Necpál J, Riant F, Sagnes S, Sarret C, Seliverstov Y, Paramanandam V, Shetty K, Tranchant C, Doulazmi M, Vidailhet M, Pringsheim T, Roze E. Efficacy of Caffeine in ADCY5-Related Dyskinesia: A Retrospective Study. Mov Disord 2022; 37:1294-1298. [PMID: 35384065 DOI: 10.1002/mds.29006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/08/2022] [Accepted: 03/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND ADCY5-related dyskinesia is characterized by early-onset movement disorders. There is currently no validated treatment, but anecdotal clinical reports and biological hypotheses suggest efficacy of caffeine. OBJECTIVE The aim is to obtain further insight into the efficacy and safety of caffeine in patients with ADCY5-related dyskinesia. METHODS A retrospective study was conducted worldwide in 30 patients with a proven ADCY5 mutation who had tried or were taking caffeine for dyskinesia. Disease characteristics and treatment responses were assessed through a questionnaire. RESULTS Caffeine was overall well tolerated, even in children, and 87% of patients reported a clear improvement. Caffeine reduced the frequency and duration of paroxysmal movement disorders but also improved baseline movement disorders and some other motor and nonmotor features, with consistent quality-of-life improvement. Three patients reported worsening. CONCLUSION Our findings suggest that caffeine should be considered as a first-line therapeutic option in ADCY5-related dyskinesia. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aurélie Méneret
- Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Assistance Publique-Hôpitaux de Paris, DMU Neurosciences, Sorbonne University, Paris, France
| | - Shekeeb S Mohammad
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Laura Cif
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Diane Doummar
- Service de Neuropédiatrie-Pathologie du développement, centre de référence mouvements anormaux enfant, Hôpital Trousseau AP-HP.SU, FHU I2D2, Sorbonne Université, Paris, France
| | | | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Philippe Damier
- CHU de Nantes, INSERM, CIC 1314, Hôpital Laennec, Nantes, France
| | | | - Jennifer Friedman
- Departments of Neurosciences and Pediatrics, University of California San Diego, La Jolla, California, USA.,Division of Neurology, Rady Children's Hospital, San Diego, California, USA.,Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Cécile Gallea
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, Paris, France
| | - Domitille Gras
- U1141 Neurodiderot, équipe 5 inDev, Inserm, CEA, UP, UNIACTNeurospin, Joliot, DRF, CEA, Saclay, France
| | | | - Emily A Innes
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia.,University of Notre Dame Australia, School of Medicine, Sydney, NSW, Australia
| | - Ján Necpál
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - Florence Riant
- Service de Génétique Moléculaire, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandrine Sagnes
- Délégation à la Recherche Clinique et à l'Innovation-DRCI (Clinical Research and Innovation Department) and URC (Clinical Research Unit) GH Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Sarret
- Service de pédiatrie, hôpital Estaing, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yury Seliverstov
- Research Center of Neurology, Moscow, Russia.,Kazaryan Clinic of Epileptology and Neurology, Moscow, Russia
| | | | - Kuldeep Shetty
- Department of Neurology, Mazumdar Shaw Medical Center, Bangalore, India
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Mohamed Doulazmi
- Adaptation Biologique et Vieillissement, Institut de Biologie Paris Seine, Sorbonne University, CNRS, Paris, France
| | - Marie Vidailhet
- Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Assistance Publique-Hôpitaux de Paris, DMU Neurosciences, Sorbonne University, Paris, France
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Emmanuel Roze
- Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Assistance Publique-Hôpitaux de Paris, DMU Neurosciences, Sorbonne University, Paris, France
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12
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Mahesh B, Singh VK, Pathak A, Kumar A, Chaurasia RN. ADCY5 Related Dyskinesia-A Rare Mutation. Mov Disord Clin Pract 2022; 9:553-555. [PMID: 35586523 PMCID: PMC9092730 DOI: 10.1002/mdc3.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bandari Mahesh
- Department of Neurology, Institute of Medical ScienceBanaras Hindu UniversityVaranasiIndia
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical ScienceBanaras Hindu UniversityVaranasiIndia
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical ScienceBanaras Hindu UniversityVaranasiIndia
| | - Anand Kumar
- Department of Neurology, Institute of Medical ScienceBanaras Hindu UniversityVaranasiIndia
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13
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Méneret A, Garcin B, Frismand S, Lannuzel A, Mariani LL, Roze E. Treatable Hyperkinetic Movement Disorders Not to Be Missed. Front Neurol 2021; 12:659805. [PMID: 34925200 PMCID: PMC8671871 DOI: 10.3389/fneur.2021.659805] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022] Open
Abstract
Hyperkinetic movement disorders are characterized by the presence of abnormal involuntary movements, comprising most notably dystonia, chorea, myoclonus, and tremor. Possible causes are numerous, including autoimmune disorders, infections of the central nervous system, metabolic disturbances, genetic diseases, drug-related causes and functional disorders, making the diagnostic process difficult for clinicians. Some diagnoses may be delayed without serious consequences, but diagnosis delays may prove detrimental in treatable disorders, ranging from functional disabilities, as in dopa-responsive dystonia, to death, as in Whipple's disease. In this review, we focus on treatable disorders that may present with prominent hyperkinetic movement disorders.
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Affiliation(s)
- Aurélie Méneret
- Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Béatrice Garcin
- Service de Neurologie, Hôpital Avicenne, APHP, Bobigny, France
| | - Solène Frismand
- Département de Neurologie, Hôpital universitaire de Nancy, Nancy, France
| | - Annie Lannuzel
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
- Département de Neurologie, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
- Faculté de Médecine, Université Des Antilles, Pointe-à-Pitre, France
- Centre D'investigation Clinique Antilles Guyane, Pointe-à-Pitre, France
| | - Louise-Laure Mariani
- Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Emmanuel Roze
- Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
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14
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Di Rocco M, Galosi S, Lanza E, Tosato F, Caprini D, Folli V, Friedman J, Bocchinfuso G, Martire A, Di Schiavi E, Leuzzi V, Martinelli S. Caenorhabditis elegans provides an efficient drug screening platform for GNAO1-related disorders and highlights the potential role of caffeine in controlling dyskinesia. Hum Mol Genet 2021; 31:929-941. [PMID: 34622282 PMCID: PMC8947233 DOI: 10.1093/hmg/ddab296] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Dominant GNAO1 mutations cause an emerging group of childhood-onset neurological disorders characterized by developmental delay, intellectual disability, movement disorders, drug-resistant seizures and neurological deterioration. GNAO1 encodes the α-subunit of an inhibitory GTP/GDP-binding protein regulating ion channel activity and neurotransmitter release. The pathogenic mechanisms underlying GNAO1-related disorders remain largely elusive and there are no effective therapies. Here, we assessed the functional impact of two disease-causing variants associated with distinct clinical features, c.139A > G (p.S47G) and c.662C > A (p.A221D), using Caenorhabditis elegans as a model organism. The c.139A > G change was introduced into the orthologous position of the C. elegans gene via CRISPR/Cas9, whereas a knock-in strain carrying the p.A221D variant was already available. Like null mutants, homozygous knock-in animals showed increased egg laying and were hypersensitive to aldicarb, an inhibitor of acetylcholinesterase, suggesting excessive neurotransmitter release by different classes of motor neurons. Automated analysis of C. elegans locomotion indicated that goa-1 mutants move faster than control animals, with more frequent body bends and a higher reversal rate and display uncoordinated locomotion. Phenotypic profiling of heterozygous animals revealed a strong hypomorphic effect of both variants, with a partial dominant-negative activity for the p.A221D allele. Finally, caffeine was shown to rescue aberrant motor function in C. elegans harboring the goa-1 variants; this effect is mainly exerted through adenosine receptor antagonism. Overall, our findings establish a suitable platform for drug discovery, which may assist in accelerating the development of new therapies for this devastating condition, and highlight the potential role of caffeine in controlling GNAO1-related dyskinesia.
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Affiliation(s)
- Martina Di Rocco
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00161, Italy.,Department of Human Neuroscience, "Sapienza" University of Rome, Rome 00185, Italy
| | - Serena Galosi
- Department of Human Neuroscience, "Sapienza" University of Rome, Rome 00185, Italy
| | - Enrico Lanza
- Center for Life Nano Science, Istituto Italiano di Tecnologia, Rome 00161, Italy
| | - Federica Tosato
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Davide Caprini
- Center for Life Nano Science, Istituto Italiano di Tecnologia, Rome 00161, Italy
| | - Viola Folli
- Center for Life Nano Science, Istituto Italiano di Tecnologia, Rome 00161, Italy
| | - Jennifer Friedman
- UCSD Department of Neuroscience and Pediatrics, Rady Children's Hospital Division of Neurology; Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Gianfranco Bocchinfuso
- Department of Chemical Sciences and Technologies, University of Rome "Tor Vergata", Rome, 00133, Italy
| | - Alberto Martire
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Elia Di Schiavi
- Institute of Biosciences and BioResources, National Research Council, Naples 80131, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, "Sapienza" University of Rome, Rome 00185, Italy
| | - Simone Martinelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome 00161, Italy
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15
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Soo AKS, Ferrini A, Kurian MA. Precision medicine for genetic childhood movement disorders. Dev Med Child Neurol 2021; 63:925-933. [PMID: 33763868 DOI: 10.1111/dmcn.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
Increasingly effective targeted precision medicine is either already available or in development for a number of genetic childhood movement disorders. Patient-centred, personalized approaches include the repurposing of existing treatments for specific conditions and the development of novel therapies that target the underlying genetic defect or disease mechanism. In tandem with these scientific advances, close collaboration between clinicians, researchers, affected families, and stakeholders in the wider community will be key to successfully delivering such precision therapies to children with movement disorders. What this paper adds Precision medicine for genetic childhood movement disorders is developing rapidly. Accurate diagnosis, disease-specific outcome measures, and collaborative multidisciplinary work will accelerate the progress of such strategies.
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Affiliation(s)
- Audrey K S Soo
- Developmental Neurosciences, UCL Great Ormond Street Hospital, Zayed Centre for Research into Rare Disease in Children, London, UK.,Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - Arianna Ferrini
- Developmental Neurosciences, UCL Great Ormond Street Hospital, Zayed Centre for Research into Rare Disease in Children, London, UK
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street Hospital, Zayed Centre for Research into Rare Disease in Children, London, UK.,Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
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16
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Harvey S, King MD, Gorman KM. Paroxysmal Movement Disorders. Front Neurol 2021; 12:659064. [PMID: 34177764 PMCID: PMC8232056 DOI: 10.3389/fneur.2021.659064] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Paroxysmal movement disorders (PxMDs) are a clinical and genetically heterogeneous group of movement disorders characterized by episodic involuntary movements (dystonia, dyskinesia, chorea and/or ataxia). Historically, PxMDs were classified clinically (triggers and characteristics of the movements) and this directed single-gene testing. With the advent of next-generation sequencing (NGS), how we classify and investigate PxMDs has been transformed. Next-generation sequencing has enabled new gene discovery (RHOBTB2, TBC1D24), expansion of phenotypes in known PxMDs genes and a better understanding of disease mechanisms. However, PxMDs exhibit phenotypic pleiotropy and genetic heterogeneity, making it challenging to predict genotype based on the clinical phenotype. For example, paroxysmal kinesigenic dyskinesia is most commonly associated with variants in PRRT2 but also variants identified in PNKD, SCN8A, and SCL2A1. There are no radiological or biochemical biomarkers to differentiate genetic causes. Even with NGS, diagnosis rates are variable, ranging from 11 to 51% depending on the cohort studied and technology employed. Thus, a large proportion of patients remain undiagnosed compared to other neurological disorders such as epilepsy, highlighting the need for further genomic research in PxMDs. Whole-genome sequencing, deep-sequencing, copy number variant analysis, detection of deep-intronic variants, mosaicism and repeat expansions, will improve diagnostic rates. Identifying the underlying genetic cause has a significant impact on patient care, modification of treatment, long-term prognostication and genetic counseling. This paper provides an update on the genetics of PxMDs, description of PxMDs classified according to causative gene rather than clinical phenotype, highlighting key clinical features and providing an algorithm for genetic testing of PxMDs.
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Affiliation(s)
- Susan Harvey
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Mary D King
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Kathleen M Gorman
- Department of Paediatric Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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17
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Ferrini A, Steel D, Barwick K, Kurian MA. An Update on the Phenotype, Genotype and Neurobiology of ADCY5-Related Disease. Mov Disord 2021; 36:1104-1114. [PMID: 33934385 DOI: 10.1002/mds.28495] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/23/2020] [Accepted: 12/21/2020] [Indexed: 01/11/2023] Open
Abstract
Adenylyl cyclase 5 (ADCY5)-related phenotypes comprise an expanding disease continuum, but much remains to be understood about the underlying pathogenic mechanisms of the disease. ADCY5-related disease comprises a spectrum of hyperkinetic disorders involving chorea, myoclonus, and/or dystonia, often with paroxysmal exacerbations. Hypotonia, developmental delay, and intellectual disability may be present. The causative gene encodes adenylyl cyclase, the enzyme responsible for the conversion of adenosine triphosphate (ATP) to cyclic adenosine-3',5'-monophosphate (cAMP). cAMP is a second messenger that exerts a wide variety of effects via several intracellular signaling pathways. ADCY5 is the most commonly expressed isoform of adenylyl cyclase in medium spiny neurons (MSNs) of the striatum, and it integrates and controls dopaminergic signaling. Through cAMP pathway, ADCY5 is a key regulator of the cortical and thalamic signaling that control initiation of voluntary movements and prevention of involuntary movements. Gain-of-function mutations in ADCY5 have been recently linked to a rare genetic disorder called ADCY5-related dyskinesia, where dysregulation of the cAMP pathway leads to reduced inhibitory activity and involuntary hyperkinetic movements. Here, we present an update on the neurobiology of ADCY5, together with a detailed overview of the reported clinical phenotypes and genotypes. Although a range of therapeutic approaches has been trialed, there are currently no disease-modifying treatments. Improved in vitro and in vivo laboratory models will no doubt increase our understanding of the pathogenesis of this rare genetic movement disorder, which will improve diagnosis, and also facilitate the development of precision medicine approaches for this, and other forms of hyperkinesia. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Arianna Ferrini
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, United Kingdom
| | - Dora Steel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, United Kingdom.,Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Katy Barwick
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, United Kingdom
| | - Manju A Kurian
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research into Rare Disease in Children, London, United Kingdom
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18
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Liao JY, Salles PA, Shuaib UA, Fernandez HH. Genetic updates on paroxysmal dyskinesias. J Neural Transm (Vienna) 2021; 128:447-471. [PMID: 33929620 DOI: 10.1007/s00702-021-02335-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
The paroxysmal dyskinesias are a diverse group of genetic disorders that manifest as episodic movements, with specific triggers, attack frequency, and duration. With recent advances in genetic sequencing, the number of genetic variants associated with paroxysmal dyskinesia has dramatically increased, and it is now evident that there is significant genotype-phenotype overlap, reduced (or incomplete) penetrance, and phenotypic variability. In addition, a variety of genetic conditions can present with paroxysmal dyskinesia as the initial symptom. This review will cover the 34 genes implicated to date and propose a diagnostic workflow featuring judicious use of whole-exome or -genome sequencing. The goal of this review is to provide a common understanding of paroxysmal dyskinesias so basic scientists, geneticists, and clinicians can collaborate effectively to provide diagnoses and treatments for patients.
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Affiliation(s)
- James Y Liao
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Philippe A Salles
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Centro de Trastornos del Movimiento, CETRAM, Santiago, Chile
| | - Umar A Shuaib
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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19
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Pringsheim TM, Cothros N, Roze E. Teaching Video NeuroImage: Paroxysmal Nocturnal Dyskinesias: A Characteristic Feature of ADCY5 Mutation. Neurology 2021; 97:e1062. [PMID: 33827957 DOI: 10.1212/wnl.0000000000011920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tamara M Pringsheim
- From the Department of Clinical Neurosciences (T.M.P., N.C.), University of Calgary, Canada; and Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France.
| | - Nicholas Cothros
- From the Department of Clinical Neurosciences (T.M.P., N.C.), University of Calgary, Canada; and Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France
| | - Emmanuel Roze
- From the Department of Clinical Neurosciences (T.M.P., N.C.), University of Calgary, Canada; and Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France
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20
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Delorme C, Giron C, Bendetowicz D, Méneret A, Mariani LL, Roze E. Current challenges in the pathophysiology, diagnosis, and treatment of paroxysmal movement disorders. Expert Rev Neurother 2020; 21:81-97. [PMID: 33089715 DOI: 10.1080/14737175.2021.1840978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Paroxysmal movement disorders mostly comprise paroxysmal dyskinesia and episodic ataxia, and can be the consequence of a genetic disorder or symptomatic of an acquired disease. AREAS COVERED In this review, the authors focused on certain hot-topic issues in the field: the respective contribution of the cerebellum and striatum to the generation of paroxysmal dyskinesia, the importance of striatal cAMP turnover in the pathogenesis of paroxysmal dyskinesia, the treatable causes of paroxysmal movement disorders not to be missed, with a special emphasis on the treatment strategy to bypass the glucose transport defect in paroxysmal movement disorders due to GLUT1 deficiency, and functional paroxysmal movement disorders. EXPERT OPINION Treatment of genetic causes of paroxysmal movement disorders is evolving towards precision medicine with targeted gene-specific therapy. Alteration of the cerebellar output and modulation of the striatal cAMP turnover offer new perspectives for experimental therapeutics, at least for paroxysmal movement disorders due to selected causes. Further characterization of cell-specific molecular pathways or network dysfunctions that are critically involved in the pathogenesis of paroxysmal movement disorders will likely result in the identification of new biomarkers and testing of innovative-targeted therapeutics.
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Affiliation(s)
- Cécile Delorme
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France
| | - Camille Giron
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France
| | - David Bendetowicz
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France.,Inserm U 1127, CNRS UMR 7225- Institut du cerveau (ICM), Sorbonne Université , Paris, France
| | - Aurélie Méneret
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France.,Inserm U 1127, CNRS UMR 7225- Institut du cerveau (ICM), Sorbonne Université , Paris, France
| | - Louise-Laure Mariani
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France.,Inserm U 1127, CNRS UMR 7225- Institut du cerveau (ICM), Sorbonne Université , Paris, France
| | - Emmanuel Roze
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière , Paris, France.,Inserm U 1127, CNRS UMR 7225- Institut du cerveau (ICM), Sorbonne Université , Paris, France
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21
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Shetty K, Sarma AS, Devan M, Dalal A, Dash GK, Jannabhatla A, Patil SJ. Recurrent ADCY5 Mutation in Mosaic Form with Nocturnal Paroxysmal Dyskinesias and Video Electroencephalography Documentation of Dramatic Response to Caffeine Treatment. J Mov Disord 2020; 13:238-240. [PMID: 32713175 PMCID: PMC7502297 DOI: 10.14802/jmd.20014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/26/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kuldeep Shetty
- Department of Neurology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Hospital, Bangalore, India
| | - Asodu Sandeep Sarma
- Diagnostic Division, Center for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Meera Devan
- Diagnostic Division, Center for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Ashwin Dalal
- Diagnostic Division, Center for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Gopal Krishna Dash
- Department of Neurology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Hospital, Bangalore, India
| | - Apuroopa Jannabhatla
- Department of Neurology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Hospital, Bangalore, India
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22
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Deep brain stimulation reduces (nocturnal) dyskinetic exacerbations in patients with ADCY5 mutation: a case series. J Neurol 2020; 267:3624-3631. [PMID: 32647899 PMCID: PMC7674568 DOI: 10.1007/s00415-020-09871-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
Mutations in the ADCY5 gene can cause a complex hyperkinetic movement disorder. Episodic exacerbations of dyskinesia are a particularly disturbing symptom as they occur predominantly during night and interrupt sleep. We present the clinical short- and long-term effects of pallidal deep brain stimulation (DBS) in three patients with a confirmed pathogenic ADCY5 mutation. Patients were implanted with bilateral pallidal DBS at the age of 34, 20 and 13 years. Medical records were reviewed for clinical history. Pre- and postoperative video files were assessed using the “Abnormal Involuntary Movement Scale” (AIMS) as well as the motor part of the “Burke Fahn Marsden Dystonia Rating Scale” (BFMDRS). All patients reported subjective general improvement ranging from 40 to 60%, especially the reduction of nocturnal episodic dyskinesias (80–90%). Objective scales revealed only a mild decrease of involuntary movements in all and reduced dystonia in one patient. DBS-induced effects were sustained up to 13 years after implantation. We demonstrate that treatment with pallidal DBS was effective in reducing nocturnal dyskinetic exacerbations in patients with ADCY5-related movement disorder, which was sustained over the long term.
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Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias. Int J Mol Sci 2020; 21:ijms21103603. [PMID: 32443735 PMCID: PMC7279391 DOI: 10.3390/ijms21103603] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main categories of PMDs are recognized based on the phenomenology: Paroxysmal dyskinesias (PxDs) are characterized by transient episodes hyperkinetic movement disorders, while attacks of cerebellar dysfunction are the hallmark of episodic ataxias (EAs). From an etiological point of view, both primary (genetic) and secondary (acquired) causes of PMDs are known. Recognition and diagnosis of PMDs is based on personal and familial medical history, physical examination, detailed reconstruction of ictal phenomenology, neuroimaging, and genetic analysis. Neurophysiological or laboratory tests are reserved for selected cases. Genetic knowledge of PMDs has been largely incremented by the advent of next generation sequencing (NGS) methodologies. The wide number of genes involved in the pathogenesis of PMDs reflects a high complexity of molecular bases of neurotransmission in cerebellar and basal ganglia circuits. In consideration of the broad genetic and phenotypic heterogeneity, a NGS approach by targeted panel for movement disorders, clinical or whole exome sequencing should be preferred, whenever possible, to a single gene approach, in order to increase diagnostic rate. This review is focused on clinical and genetic features of PMDs with the aim to (1) help clinicians to recognize, diagnose and treat patients with PMDs as well as to (2) provide an overview of genes and molecular mechanisms underlying these intriguing neurogenetic disorders.
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Vijiaratnam N, Bhatia KP, Lang AE, Raskind WH, Espay AJ. ADCY5-Related Dyskinesia: Improving Clinical Detection of an Evolving Disorder. Mov Disord Clin Pract 2019; 6:512-520. [PMID: 31538084 DOI: 10.1002/mdc3.12816] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background The phenotypic spectrum of adenylyl cyclase 5 (ADCY5)-related disease has expanded considerably since the first description of the disorder in 1978 as familial essential chorea in a multiplex family. Objective To examine recent advances in the understanding of ADCY5-related dyskinesia and outline a diagnostic approach to enhance clinical detection. Methods A pragmatic review of the ADCY5 literature was undertaken to examine unique genetic and pathophysiological features as well as distinguishing clinical features. Results With over 70 cases reported to date, the phenotype is recognized to be broad, although distinctive features include prominent facial dyskinesia, motor exacerbations during drowsiness or sleep arousal, episodic painful dystonic posturing increased with stress or illness, and axial hypotonia with delayed developmental milestones. Uncommon phenotypes include childhood-onset chorea, myoclonus-dystonia, isolated nongeneralized dystonia, and alternating hemiplegia. Conclusion The ongoing expansion in clinical features suggests that ADCY5 remains underdiagnosed and may account for a proportion of "idiopathic" hyperkinetic movement disorders. Enhanced understanding of its clinical features may help clinicians improve the detection of complex or uncommon cases.
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Affiliation(s)
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London United Kingdom
| | - Anthony E Lang
- Department of Medicine, Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital University of Toronto Toronto Ontario Canada
| | - Wendy H Raskind
- Departments of Medicine and Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
| | - Alberto J Espay
- Department of Neurology (J.S.), Kingston General Hospital, Canada; Department of Neurology (D.M.-G.), Hospital Universitario Virgen del Rocío, Seville, Spain; and UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders (A.Z., A.J.E.), Department of Neurology University of Cincinnati Ohio USA
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Méneret A, Roze E, Maranci JB, Dodet P, Doummar D, Riant F, Tranchant C, Fraix V, Anheim M, Ekmen A, McGovern E, Vidailhet M, Arnulf I, Leu-Semenescu S. Sleep in ADCY5-Related Dyskinesia: Prolonged Awakenings Caused by Abnormal Movements. J Clin Sleep Med 2019; 15:1021-1029. [PMID: 31383240 DOI: 10.5664/jcsm.7886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES ADCY5 mutations cause early-onset hyperkinetic movement disorders comprising diurnal and nocturnal paroxysmal dyskinesia, and patient-reported sleep fragmentation. We aimed to characterize all movements occurring during sleep and in the transition from sleep to awakening, to ascertain if there is a primary sleep disorder, or if the sleep disturbance is rather a consequence of the dyskinesia. METHODS Using video polysomnography, we evaluated the nocturnal motor events and abnormal movements in 7 patients with ADCY5-related dyskinesia and compared their sleep measures with those of 14 age- and sex-matched healthy controls. RESULTS We observed an increased occurrence of abnormal movements during wake periods compared to sleep in patients with ADCY5-related dyskinesia. While asleep, abnormal movements occurred more frequently during stage N2 and REM sleep, in contrast with stage N3 sleep. Abnormal movements were also more frequent during morning awakenings compared to wake periods before falling asleep. The pattern of the nocturnal abnormal movements mirrored those observed during waking hours. Compared to controls, patients with ADCY5-related dyskinesia had lower sleep efficiencies due to prolonged awakenings secondary to the abnormal movements, but no other differences in sleep measures. Notably, sleep onset latency was short and devoid of violent abnormal movements. CONCLUSIONS In this series of patients with ADCY5-related dyskinesia, nocturnal paroxysmal dyskinesia were not associated with drowsiness or delayed sleep onset, but emerged during nighttime awakenings with subsequent delayed sleep, whereas sleep architecture was normal.
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Affiliation(s)
- Aurélie Méneret
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Jean-Baptiste Maranci
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Pauline Dodet
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Diane Doummar
- Department of Pediatric Neurology, Hôpital Armand-Trousseau, Paris, France
| | - Florence Riant
- Groupe hospitalier Lariboisière-Fernand Widal, Laboratoire de Génétique, Paris, France.,Université Paris, Paris, France
| | - Christine Tranchant
- Department of Neurology, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France.,Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Illkirch, France.,Strasbourg Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Valérie Fraix
- Service de Neurologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Mathieu Anheim
- Department of Neurology, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France.,Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Illkirch, France.,Strasbourg Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Asya Ekmen
- Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Eavan McGovern
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.,Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Isabelle Arnulf
- Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France.,Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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