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Vasthare R, Lim Y R A, Bagga A, Nayak PP, Bhat B, S S. The phenomenological approach in dentistry - a narrative review. Int J Qual Stud Health Well-being 2024; 19:2341450. [PMID: 38634343 PMCID: PMC11028029 DOI: 10.1080/17482631.2024.2341450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Phenomenology is a branch of philosophy that focuses on human lived experience. Illness including dental diseases can affect this living experience. Within the dental literature, there is very little reported on the use of phenomenology compared to other healthcare sciences. Hence, the aim was to review the literature and provide an overview of various applications of phenomenology in dental research. METHODS This study was a narrative review using literature in the last 10 years identified by web-based search on PubMed and Scopus using keywords. A total of 33 articles that were closely related to the field and application in dentistry were included. The methodology, main results, and future research recommendations, if applicable, were extracted and reviewed. RESULTS The authors in this study had identified several areas such as orofacial pain and pain control research, dental anxiety, dental education, oral healthcare perceptions and access, living with dental diseases and dental treatment experience in which the phenomenological method was used to gain an in-depth understanding of the topic. CONCLUSIONS There are several advantages of using the phenomenological research method, such as the small sample size needed, the diverse and unique perspective that can be obtained and the ability to improve current understanding, especially from the first-person perspective.
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Affiliation(s)
- Ramprasad Vasthare
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Arron Lim Y R
- Department of Orthodontics, National University of Malaysia, Bangi, Malaysia
| | - Aayushi Bagga
- Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Prajna P. Nayak
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Bhargav Bhat
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sahana S
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
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2
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Scorr LM, Kilic-Berkmen G, Sutcliffe DJ, Dinasarapu AR, McKay JL, Bagchi P, Powell MD, Boss JM, Cereb N, Little M, Gragert L, Hanfelt J, McKeon A, Tyor W, Jinnah HA. Exploration of potential immune mechanisms in cervical dystonia. Parkinsonism Relat Disord 2024; 122:106036. [PMID: 38462403 DOI: 10.1016/j.parkreldis.2024.106036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Although there are many possible causes for cervical dystonia (CD), a specific etiology cannot be identified in most cases. Prior studies have suggested a relationship between autoimmune disease and some cases of CD, pointing to possible immunological mechanisms. OBJECTIVE The goal was to explore the potential role of multiple different immunological mechanisms in CD. METHODS First, a broad screening test compared neuronal antibodies in controls and CD. Second, unbiased blood plasma proteomics provided a broad screen for potential biologic differences between controls and CD. Third, a multiplex immunoassay compared 37 markers associated with immunological processes in controls and CD. Fourth, relative immune cell frequencies were investigated in blood samples of controls and CD. Finally, sequencing studies investigated the association of HLA DQB1 and DRB1 alleles in controls versus CD. RESULTS Screens for anti-neuronal antibodies did not reveal any obvious abnormalities. Plasma proteomics pointed towards certain abnormalities of immune mechanisms, and the multiplex assay pointed more specifically towards abnormalities in T lymphocytes. Abnormal immune cell frequencies were identified for some CD cases, and these cases clustered together as a potential subgroup. Studies of HLA alleles indicated a possible association between CD and DRB1*15:03, which is reported to mediate the penetrance of autoimmune disorders. CONCLUSIONS Altogether, the association of CD with multiple different blood-based immune measures point to abnormalities in cell-mediated immunity that may play a pathogenic role for a subgroup of individuals with CD.
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Affiliation(s)
- Laura M Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Diane J Sutcliffe
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ashok R Dinasarapu
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - J Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Biomedical Infortmatics, Emory School of Medicine, Atlanta, GA, 30322, USA
| | - Pritha Bagchi
- Integrated Proteomics Core, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael D Powell
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jeremy M Boss
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Marian Little
- Division of Biomedical Informatics and Genomics, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Loren Gragert
- Division of Biomedical Informatics and Genomics, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Neurology and Immunology and Department of Neurology, Mayo Clinic, Rochester Mayo Clinic, Rochester, 55902, MN, USA
| | - William Tyor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Atlanta VA Medical Center, Decatur, GA, 30033, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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3
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Idrissi S, Velucci V, Esposito M, Trinchillo A, Habestwallner F, Belvisi D, Fabbrini G, Ferrazzano G, Rizzo V, Terranova C, Girlanda P, Pellicciari R, Avanzino L, Di Biasio F, Marchese R, Bono F, Idone G, Laterza V, Lettieri C, Rinaldo S, Eleopra R, Castagna A, Altavista MC, Moschella V, Erro R, Barone P, Barbero P, Ceravolo R, Mazzucchi S, Mascia MM, Ercoli T, Muroni A, Zibetti M, Lopiano L, Scaglione CLM, Bentivoglio AR, Petracca M, Magistrelli L, Cotelli MS, Cossu G, Squintani GM, De Santis T, Schirinzi T, Misceo S, Pisani A, Berardelli A, Defazio G. Does thyroid diseases contribute to the natural history of idiopathic adult-onset dystonia? Data from the Italian Dystonia Registry. J Neural Transm (Vienna) 2024; 131:369-375. [PMID: 38376582 DOI: 10.1007/s00702-024-02753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
A few earlier observations and recent controlled studies pointed to the possible contribution of thyroid diseases in idiopathic adult-onset dystonia (IAOD). The aim of this study was to investigate the association between thyroid status and clinical characteristics of IAOD, focusing on dystonia localization, spread, and associated features such as tremors and sensory tricks. Patients were identified from those included in the Italian Dystonia Registry, a multicentre dataset of patients with adult-onset dystonia. The study population included 1518 IAOD patients. Patients with hypothyroidism and hyperthyroidism were compared with those without any thyroid disease. In the 1518 IAOD patients, 167 patients (11%; 95% CI 9.5-12.6%) were diagnosed with hypothyroidism and 42 (2.8%; 95% CI 1.99-3.74) with hyperthyroidism. The three groups were comparable in age at dystonia onset, but there were more women than men in the groups with thyroid disease. Analysing the anatomical distribution of dystonia, more patients with blepharospasm were present in the hyperthyroidism group, but the difference did not reach statistical significance after the Bonferroni correction. The remaining dystonia-affected body sites were similarly distributed in the three groups, as did dystonia-associated features and spread. Our findings provided novel information indicating that the high rate of thyroid diseases is not specific for any specific dystonia subpopulation and does not appear to influence the natural history of the disease.
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Affiliation(s)
- Sarah Idrissi
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy.
| | - Vittorio Velucci
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
| | | | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II" University, Naples, Italy
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Pellicciari
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
| | - Laura Avanzino
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Francesco Bono
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Giovanni Idone
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Vincenzo Laterza
- Centre for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Christian Lettieri
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Castagna
- IRCCS, Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | | | | | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Tommaso Ercoli
- Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Antonella Muroni
- Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | | | - Martina Petracca
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Eastern Piedmont, Novara, Italy
| | | | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Giovanna Maddalena Squintani
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tiziana De Santis
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Antonio Pisani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), "Aldo Moro" University of Bari, Bari, Italy
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Bailey GA, Rawlings A, Torabi F, Pickrell WO, Peall KJ. Prevalence and temporal relationship of clinical co-morbidities in idiopathic dystonia: a UK linkage-based study. J Neurol 2024:10.1007/s00415-024-12284-6. [PMID: 38512523 DOI: 10.1007/s00415-024-12284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
While motor and psychiatric phenotypes in idiopathic dystonia are increasingly well understood, a few studies have examined the rate, type, and temporal pattern of other clinical co-morbidities in dystonia. Here, we determine the rates of clinical diagnoses across 13 broad systems-based diagnostic groups, comparing an overall idiopathic dystonia cohort, and sub-cohorts of cervical dystonia, blepharospasm, and dystonic tremor, to a matched-control cohort. Using the SAIL databank, we undertook a longitudinal population-based cohort study (January 1st 1994-December 31st 2017) using anonymised electronic healthcare records for individuals living in Wales (UK), identifying those diagnosed with dystonia through use of a previously validated algorithm. Clinical co-morbid diagnoses were identified from primary health care records, with a 10% prevalence threshold required for onward analysis. Using this approach, 54,166 dystonia cases were identified together with 216,574 matched controls. Within this cohort, ten of the main ICD-10 diagnostic codes exceeded the 10% prevalence threshold over the 20-year period (infection, neurological, respiratory, gastrointestinal, genitourinary, dermatological, musculoskeletal, circulatory, neoplastic, and endocrinological). In the overall dystonia cohort, musculoskeletal (aOR: 1.89, aHR: 1.74), respiratory (aOR: 1.84; aHR: 1.65), and gastrointestinal (aOR: 1.72; aHR: 1.6) disorders had the strongest associations both pre- and post-dystonia diagnosis. However, variation in the rate of association of individual clinical co-morbidities was observed across the cervical, blepharospasm, and tremor dystonia groups. This study suggests an increased rate of specific co-morbid clinical disorders both pre- and post-dystonia diagnosis which should be considered during clinical assessment of those with dystonia to enable optimum symptomatic management.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Anna Rawlings
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - Fatemeh Torabi
- Swansea University Medical School, Singleton Park, Swansea, UK
- Health Data Research UK, Swansea, UK
| | - W Owen Pickrell
- Swansea University Medical School, Singleton Park, Swansea, UK
- Department of Neurology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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5
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Velucci V, Idrissi S, Pellicciari R, Esposito M, Trinchillo A, Belvisi D, Fabbrini G, Ferrazzano G, Terranova C, Girlanda P, Majorana G, Rizzo V, Bono F, Idone G, Laterza V, Avanzino L, Di Biasio F, Marchese R, Castagna A, Ramella M, Lettieri C, Rinaldo S, Altavista MC, Polidori L, Bertolasi L, Tozzi MC, Erro R, Barone P, Barbero P, Ceravolo R, Mascia MM, Ercoli T, Muroni A, Artusi CA, Zibetti M, Scaglione CLM, Bentivoglio AR, Cotelli MS, Magistrelli L, Cossu G, Albanese A, Squintani GM, Schirinzi T, Gigante AF, Maderna L, Eleopra R, Pisani A, Cassano D, Romano M, Rizzo M, Berardelli A, Defazio G. Does sex influence the natural history of idiopathic adult-onset dystonia? J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332927. [PMID: 38429083 DOI: 10.1136/jnnp-2023-332927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Several earlier studies showed a female predominance in idiopathic adult-onset dystonia (IAOD) affecting the craniocervical area and a male preponderance in limb dystonia. However, sex-related differences may result from bias inherent to study design. Moreover, information is lacking on whether sex-related differences exist in expressing other dystonia-associated features and dystonia spread. OBJECTIVE To provide accurate information on the relationship between sex differences, motor phenomenology, dystonia-associated features and the natural history of IAOD. METHODS Data of 1701 patients with IAOD from the Italian Dystonia Registry were analysed. RESULTS Women predominated over men in blepharospasm, oromandibular, laryngeal and cervical dystonia; the sex ratio was reversed in task-specific upper limb dystonia; and no clear sex difference emerged in non-task-specific upper limb dystonia and lower limb dystonia. This pattern was present at disease onset and the last examination. Women and men did not significantly differ for several dystonia-associated features and tendency to spread. In women and men, the absolute number of individuals who developed dystonia tended to increase from 20 to 60 years and then declined. However, when we stratified by site of dystonia onset, different patterns of female-to-male ratio over time could be observed in the various forms of dystonia. CONCLUSIONS Our findings provide novel evidence on sex as a key mediator of IAOD phenotype at disease onset. Age-related sexual dimorphism may result from the varying exposures to specific age-related and sex-related environmental risk factors interacting in a complex manner with biological factors such as hormonal sex factors.
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Affiliation(s)
- Vittorio Velucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Sarah Idrissi
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Roberta Pellicciari
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University Hospital, Naples, Italy
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Daniele Belvisi
- Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Majorana
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Bono
- Center for Botulinum Toxin Therapy, Neurologic Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovanni Idone
- Center for Botulinum Toxin Therapy, Neurologic Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Vincenzo Laterza
- Center for Botulinum Toxin Therapy, Neurologic Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | - Christian Lettieri
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Luigi Polidori
- Neurology Unit, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Laura Bertolasi
- Neurologic Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Maria Chiara Tozzi
- Neurologic Unit, Integrated University Hospital of Verona, Verona, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Anna Rita Bentivoglio
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Eastern Piedmont, Novara, Italy
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Marcello Romano
- Neurology Unit, Villa Sofia Cervello United Hospitals, Palermo, Italy
| | - Marina Rizzo
- Neurology Unit, Villa Sofia Cervello United Hospitals, Palermo, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, University of Rome La Sapienza, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
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6
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Colucci F, Pugliatti M, Casetta I, Capone JG, Diozzi E, Sensi M, Tugnoli V. Idiopathic cervical dystonia and non-motor symptoms: a pilot case-control study on autonomic nervous system. Neurol Sci 2024; 45:629-638. [PMID: 37648939 PMCID: PMC10791952 DOI: 10.1007/s10072-023-07033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Non-motor symptoms, such as sleep disturbances, fatigue, neuropsychiatric manifestations, cognitive impairment, and sensory abnormalities, have been widely reported in patients with idiopathic cervical dystonia (ICD). This study aimed to clarify the autonomic nervous system (ANS) involvement in ICD patients, which is still unclear in the literature. METHODS We conducted a pilot case-control study to investigate ANS in twenty ICD patients and twenty age-sex-matched controls. The Composite Autonomic System Scale 31 was used for ANS clinical assessment. The laser Doppler flowmetry quantitative spectral analysis, applied to the skin and recorded from indices, was used to measure at rest, after a parasympathetic activation (six deep breathing) and two sympathetic stimuli (isometric handgrip and mental calculation), the power of high-frequency and low-frequency oscillations, and the low-frequency/high-frequency ratio. RESULTS ICD patients manifested higher clinical dysautonomic symptoms than controls (p < 0.05). At rest, a lower high-frequency power band was detected among ICD patients than controls, reaching a statistically significant difference in the age group of ≥ 57-year-olds (p < 0.05). In the latter age group, ICD patients showed a lower low-frequency/high-frequency ratio than controls at rest (p < 0.05) and after mental calculation (p < 0.05). Regardless of age, during handgrip, ICD patients showed (i) lower low-frequency/high-frequency ratio (p < 0.05), (ii) similar increase of the low-frequency oscillatory component compared to controls, and (iii) stable high-frequency oscillatory component, which conversely decreased in controls. No differences between the two groups were detected during deep breathing. CONCLUSION ICD patients showed ANS dysfunction at clinical and neurophysiological levels, reflecting an abnormal parasympathetic-sympathetic interaction likely related to abnormal neck posture and neurotransmitter alterations.
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Affiliation(s)
- Fabiana Colucci
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy.
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Jay Guido Capone
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Enrica Diozzi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Valeria Tugnoli
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
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Mascia MM, Belvisi D, Esposito M, Pellicciari R, Trinchillo A, Terranova C, Bertino S, Avanzino L, Di Biasio F, Bono F, Laterza V, Lettieri C, Eleopra R, Fabbrini G, Barbero P, Bertolasi L, Altavista MC, Erro R, Ceravolo R, Castagna A, Zibetti M, Bentivoglio AR, Cossu G, Magistrelli L, Scaglione C, Albanese A, Cotelli MS, Misceo S, Pisani A, Schirinzi T, Maderna L, Squintani G, Berardelli A, Defazio G. Do cerebrovascular risk factors impact the clinical expression of idiopathic isolated adult-onset dystonia? Parkinsonism Relat Disord 2023; 115:105851. [PMID: 37717501 DOI: 10.1016/j.parkreldis.2023.105851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Although acquired dystonia may develop following ischaemic/haemorrhagic stroke, the relationship between cerebrovascular disease and idiopathic dystonia has been poorly investigated. This cross sectional study aimed at evaluating the impact of cerebrovascular risk factors on the clinical expression of idiopathic adult onset dystonia (IAOD), with reference to dystonia localization and dystonia-associated features. METHODS Data were obtained from the Italian Dystonia Registry. Patients with IAOD were stratified into two groups according to the presence of diabetes mellitus and/or arterial hypertension and/or dyslipidemia and/or heart disease. The two groups were compared for demographic features, dystonia phenotype, and dystonia-associated features (sensory trick, tremor, eye symptoms in blepharospasm, and neck pain in cervical dystonia). RESULTS A total of 1108 patients participated into the study. Patients who reported one cerebrovascular factor or more (n = 555) had higher age and longer disease duration than patients who did not. On multivariable logistic regression analysis, blepharospasm was the only localization, and sensory trick was the only dystonia-associated feature that was significantly associated with cerebrovascular risk factors. Linear regression analysis showed that the strength of the association between cerebrovascular factors and blepharospasm/sensory trick increased with increasing the number of cerebrovascular factors per patient. CONCLUSIONS Results of the present study showed that cerebrovascular risk factors may be associated with specific features of IAOD that is development of blepharospasm and sensory trick. Further studies are needed to better understand the meaning and the mechanisms underlying this association.
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Affiliation(s)
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | | | - Roberta Pellicciari
- Department of Translational Biomedicine and Neuroscience, University of Bari, Bari, Italy
| | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | - Carmen Terranova
- Department of clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Salvatore Bertino
- Department of clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Bono
- Center for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater domini, Catanzaro, Italy
| | - Vincenzo Laterza
- Center for Botulinum Toxin Therapy, Neurologic Unit, A.O.U. Mater domini, Catanzaro, Italy
| | - Christian Lettieri
- Neurology Unit, University Hospital S.Maria della Misericordia, Udine, Italy
| | - Roberto Eleopra
- Neurology Unit, University Hospital S.Maria della Misericordia, Udine, Italy; Neurology Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | | | | | | | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" University of Salerno, Salerno, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anna Castagna
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Zibetti
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; PhD programme in clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | - Cesa Scaglione
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | | | | | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Giovanna Squintani
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, Bari, Italy
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Fan Y, Si Z, Wang L, Zhang L. DYT- TOR1A dystonia: an update on pathogenesis and treatment. Front Neurosci 2023; 17:1216929. [PMID: 37638318 PMCID: PMC10448058 DOI: 10.3389/fnins.2023.1216929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
DYT-TOR1A dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal movements. It is a severe genetic form of dystonia caused by mutations in the TOR1A gene. TorsinA is a member of the AAA + family of adenosine triphosphatases (ATPases) involved in a variety of cellular functions, including protein folding, lipid metabolism, cytoskeletal organization, and nucleocytoskeletal coupling. Almost all patients with TOR1A-related dystonia harbor the same mutation, an in-frame GAG deletion (ΔGAG) in the last of its 5 exons. This recurrent variant results in the deletion of one of two tandem glutamic acid residues (i.e., E302/303) in a protein named torsinA [torsinA(△E)]. Although the mutation is hereditary, not all carriers will develop DYT-TOR1A dystonia, indicating the involvement of other factors in the disease process. The current understanding of the pathophysiology of DYT-TOR1A dystonia involves multiple factors, including abnormal protein folding, signaling between neurons and glial cells, and dysfunction of the protein quality control system. As there are currently no curative treatments for DYT-TOR1A dystonia, progress in research provides insight into its pathogenesis, leading to potential therapeutic and preventative strategies. This review summarizes the latest research advances in the pathogenesis, diagnosis, and treatment of DYT-TOR1A dystonia.
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Affiliation(s)
- Yuhang Fan
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
| | - Zhibo Si
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, China
| | - Linlin Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lei Zhang
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
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9
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Defazio G, Gigante AF, Erro R, Belvisi D, Esposito M, Trinchillo A, De Joanna G, Ceravolo R, Mazzucchi S, Unti E, Barone P, Scannapieco S, Cotelli MS, Turla M, Bianchi M, Bertolasi L, Pisani A, Valentino F, Altavista MC, Moschella V, Girlanda P, Terranova C, Bono F, Spano G, Fabbrini G, Ferrazzano G, Albanese A, Castagna A, Cassano D, Coletti Moja M, Pellicciari R, Bentivoglio AR, Eleopra R, Cossu G, Ercoli T, Mascia MM, Di Biasio F, Misceo S, Magistrelli L, Romano M, Scaglione CLM, Tinazzi M, Maderna L, Zibetti M, Berardelli A. Phenotypic Variability in Acquired and Idiopathic Dystonia. Mov Disord Clin Pract 2023; 10:1107-1113. [PMID: 37476305 PMCID: PMC10354612 DOI: 10.1002/mdc3.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background To date, a few studies have systematically investigated differences in the clinical spectrum between acquired and idiopathic dystonias. Objectives To compare demographic data and clinical features in patients with adult-onset acquired and idiopathic dystonias. Methods Patients were identified from among those included in the Italian Dystonia Registry, a multicenter Italian dataset of patients with adult-onset dystonia. Study population included 116 patients with adult-onset acquired dystonia and 651 patients with isolated adult-onset idiopathic dystonia. Results Comparison of acquired and idiopathic dystonia revealed differences in the body distribution of dystonia, with oromandibular dystonia, limb and trunk dystonia being more frequent in patients with acquired dystonia. The acquired dystonia group was also characterized by lower age at dystonia onset, greater tendency to spread, lower frequency of head tremor, sensory trick and eye symptoms, and similar frequency of neck pain associated with CD and family history of dystonia/tremor. Conclusions The clinical phenomenology of dystonia may differ between acquired and idiopathic dystonia, particularly with regard to the body localization of dystonia and the tendency to spread. This dissimilarity raises the possibility of pathophysiological differences between etiologic categories.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | - Daniele Belvisi
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | | | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology“Federico II” UniversityNaplesItaly
| | | | - Roberto Ceravolo
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Sonia Mazzucchi
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Elisa Unti
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | - Sara Scannapieco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | | | | | | | | | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | | | | | | | - Paolo Girlanda
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Carmen Terranova
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Francesco Bono
- Center for Botulinum Toxin TherapyNeurology Unit, A.O.U. Mater dominiCatanzaroItaly
| | - Giorgio Spano
- Center for Botulinum Toxin TherapyNeurology Unit, A.O.U. Mater dominiCatanzaroItaly
| | - Giovanni Fabbrini
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Alberto Albanese
- Department of NeurologyIRCCS Humanitas Research HospitalMilanItaly
| | | | | | | | - Roberta Pellicciari
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
| | - Anna Rita Bentivoglio
- Agostino Gemelli IRCCS University Hospital FoundationRomeItaly
- Institute of NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Roberto Eleopra
- Neurology Unit 1, Fondazione IRCSSIstituto Neurologico “Carlo Besta”MilanItaly
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of NeuroscienceAO BrotzuCagliariItaly
| | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | | | | | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | | | | | - Michele Tinazzi
- Neurology Unit, Department of Neuroscience, Biomedicine and MovementUniversity of VeronaVeronaItaly
| | - Luca Maderna
- Department of Neuroscience, U.O. of NeurophysiologyIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Maurizio Zibetti
- Department of Neuroscience “Rita Levi Montalcini”University of TorinoTorinoItaly
- Neurology 2 UnitA.O.U. Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Alfredo Berardelli
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
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10
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Kilic-Berkmen G, Scorr LM, Rosen A, Wu E, Freeman A, Silver M, Hanfelt J, Jinnah HA. Thyroid disease in cervical dystonia. Parkinsonism Relat Disord 2023; 107:105274. [PMID: 36621155 PMCID: PMC10257803 DOI: 10.1016/j.parkreldis.2022.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
There are many possible etiologies for cervical dystonia (CD), but a cause cannot be identified in most cases. Most recent attention has focused on genetic causes, although a few prior studies have highlighted autoimmune mechanisms instead. Because autoimmune disorders frequently co-exist, the current study evaluated the hypothesis that autoimmune disorders might be more common in CD than neurological controls. The frequency of 32 common autoimmune disorders was evaluated using a systematic survey comparing 300 subjects with CD with 391 neurological controls. The frequency of thyroid disease was significantly higher in CD (20%) compared with controls (6%). Regression analyses that accounted for age and sex revealed an odds ratio of 4.5 (95% CI 2.5-8.1, p < 0.001). All other autoimmune disorders occurred with similar frequencies in CD and controls. Although these studies do not establish a mechanistic link between CD and autoimmune disease, they suggest the need for further attention to a potential relationship, and more specifically with thyroid disease.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Laura M Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ami Rosen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ellen Wu
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Alan Freeman
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael Silver
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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11
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Battistella G, Simonyan K. Clinical Implications of Dystonia as a Neural Network Disorder. Adv Neurobiol 2023; 31:223-240. [PMID: 37338705 DOI: 10.1007/978-3-031-26220-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Isolated dystonia is a neurological disorder of diverse etiology, multifactorial pathophysiology, and wide spectrum of clinical presentations. We review the recent neuroimaging advances that led to the conceptualization of dystonia as a neural network disorder and discuss how current knowledge is shaping the identification of biomarkers of dystonia and the development of novel pharmacological therapies.
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Affiliation(s)
- Giovanni Battistella
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
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12
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Erro R, Pilotto A, Esposito M, Olivola E, Nicoletti A, Lazzeri G, Magistrelli L, Dallocchio C, Marchese R, Bologna M, Tessitore A, Misceo S, Gigante AF, Terranova C, Moschella V, di Biase L, Di Giacopo R, Morgante F, Valentino F, De Rosa A, Trinchillo A, Malaguti MC, Brusa L, Matinella A, Di Biasio F, Paparella G, De Micco R, Contaldi E, Modugno N, Di Fonzo A, Padovani A, Barone P. The Italian tremor Network (TITAN): rationale, design and preliminary findings. Neurol Sci 2022; 43:5369-5376. [PMID: 35608737 PMCID: PMC9385818 DOI: 10.1007/s10072-022-06104-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The recently released classification has revised the nosology of tremor, defining essential tremor (ET) as a syndrome and fueling an enlightened debate about some newly conceptualized entities such as ET-plus. As a result, precise information of demographics, clinical features, and about the natural history of these conditions are lacking. METHODS The ITAlian tremor Network (TITAN) is a multicenter data collection platform, the aim of which is to prospectively assess, according to a standardized protocol, the phenomenology and natural history of tremor syndromes. RESULTS In the first year of activity, 679 patients have been recruited. The frequency of tremor syndromes varied from 32% of ET and 41% of ET-plus to less than 3% of rare forms, including focal tremors (2.30%), task-specific tremors (1.38%), isolated rest tremor (0.61%), and orthostatic tremor (0.61%). Patients with ET-plus were older and had a higher age at onset than ET, but a shorter disease duration, which might suggest that ET-plus is not a disease stage of ET. Familial aggregation of tremor and movement disorders was present in up to 60% of ET cases and in about 40% of patients with tremor combined with dystonia. The body site of tremor onset was different between tremor syndromes, with head tremor being most commonly, but not uniquely, associated with dystonia. CONCLUSIONS The TITAN study is anticipated to provide clinically relevant prospective information about the clinical correlates of different tremor syndromes and their specific outcomes and might serve as a basis for future etiological, pathophysiological, and therapeutic research.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Via Allende 43, 84081, Baronissi, SA, Italy.
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Alessandra Nicoletti
- Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | - Matteo Bologna
- Neuromed Institute IRCCS, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, Università Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Misceo
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Angelo Fabio Gigante
- Neurosensory Department, Neurology Unit, San Paolo Hospital, ASL Bari, Bari, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Lazzaro di Biase
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Rome, Italy.,Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy.,Brain Innovations Lab, Università Campus Bio-Medico Di Roma, Rome, Italy
| | | | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Assunta Trinchillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Livia Brusa
- Neurology Department, S.Eugenio Hospital, Rome, Italy
| | - Angela Matinella
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | | | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | | | - Alessio Di Fonzo
- Neurology Unit, Department of Neuroscience, Dino Ferrari Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Via Allende 43, 84081, Baronissi, SA, Italy
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13
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Merchant SHI, Wu T, Hallett M. Diagnostic Neurophysiologic Biomarkers for
Task‐Specific
Dystonia. Mov Disord Clin Pract 2022; 9:468-472. [PMID: 35586528 PMCID: PMC9092748 DOI: 10.1002/mdc3.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 11/09/2022] Open
Abstract
Background Task-specific dystonia (TSD) is a challenging clinical diagnosis with no objective diagnostic biomarkers. Objective The objective of this study was to test 2 neurophysiologic variables using transcranial magnetic stimulation as potential diagnostic biomarkers for TSD. Methods We tested (1) cortical silent period (CSP) and (2) dorsal inferior parietal lobule-motor cortex (dIPL-M1) physiologic connectivity in 9 patients with the writer's cramp form of TSD and 12 healthy volunteers on 2 separate sessions. Results CSP was significantly prolonged (P < 0.0001) in TSD and could classify TSD with high sensitivity and specificity with areas under the receiver operating characteristic curve (AUCs) = 0.94 and 0.90, respectively, for 2 separate sessions with an intraclass correlation = 0.79. dIPL-M1 interaction was notable for significant motor cortical inhibition in TSD compared with facilitation in healthy subjects (P < 0.0001) and could classify TSD with high sensitivity and specificity with AUCs = 0.96 and 0.86, respectively. Conclusion CSP and dIPL-M1 physiologic connectivity can classify TSD with high sensitivity, specificity, reproducibility, and reliability.
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Affiliation(s)
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke National Institute of Health Bethesda MD USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke National Institute of Health Bethesda MD USA
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14
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Ercoli T, Defazio G, Geroin C, Marcuzzo E, Fabbrini G, Bono F, Mechelli A, Ceravolo R, Romito LM, Albanese A, Pisani A, Zibetti M, Altavista MC, Maderna L, Petracca M, Girlanda P, Mascia MM, Berardelli A, Tinazzi M. Sudden Onset, Fixed Dystonia and Acute Peripheral Trauma as Diagnostic Clues for Functional Dystonia. Mov Disord Clin Pract 2021; 8:1107-1111. [PMID: 34631946 PMCID: PMC8485608 DOI: 10.1002/mdc3.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background The differentiation of functional dystonia from idiopathic dystonia may be clinically challenging. Objective To identify clinical features suggestive of functional dystonia to guide physicians to distinguish functional dystonia from idiopathic dystonia. Methods Patient data were extracted from the Italian Registry of Functional Motor Disorders and the Italian Registry of Adult Dystonia. Patients with functional and idiopathic dystonia were followed up at the same clinical sites, and they were similar in age and sex. Results We identified 113 patients with functional dystonia and 125 with idiopathic dystonia. Sudden onset of dystonia, evidence of fixed dystonia, and acute peripheral trauma before dystonia onset were more frequent in the functional dystonia group. No study variable alone achieved satisfactory sensitivity and specificity, whereas a combination of variables yielded 85% sensitivity and 98% specificity. A diagnostic algorithm was developed to reduce the risk of misclassifying functional dystonia. Conclusion Our findings extend the current diagnostic approach to functional dystonia by showing that clinical information about symptom onset, fixed dystonia, and history of peripheral trauma may provide key clues in the diagnosis of functional dystonia.
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Affiliation(s)
- Tommaso Ercoli
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences Sapienza University of Rome Rome Italy.,IRCCS Neuromed Pozzilli Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini Catanzaro Italy
| | | | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Alberto Albanese
- Department of Neurology IRCCS Humanitas Research Hospital Rozzano Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy.,IRCCS Mondino Foundation Pavia Italy
| | - Maurizio Zibetti
- Department of Neuroscience-Rita Levi Montalcini University of Turin Turin Italy
| | | | - Luca Maderna
- Department of Neurology-Stroke Unit and Laboratory of Neurosciences Istituto Auxologico Italiano, IRCCS Milan Italy
| | - Martina Petracca
- Fondazione Policlinico Universitario 'Agostino Gemelli'-IRCCS Rome Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Marcello Mario Mascia
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Rome Italy.,IRCCS Neuromed Pozzilli Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences University of Verona Verona Italy
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15
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Rauschenberger L, Knorr S, Pisani A, Hallett M, Volkmann J, Ip CW. Second hit hypothesis in dystonia: Dysfunctional cross talk between neuroplasticity and environment? Neurobiol Dis 2021; 159:105511. [PMID: 34537328 DOI: 10.1016/j.nbd.2021.105511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 01/08/2023] Open
Abstract
One of the great mysteries in dystonia pathophysiology is the role of environmental factors in disease onset and development. Progress has been made in defining the genetic components of dystonic syndromes, still the mechanisms behind the discrepant relationship between dystonic genotype and phenotype remain largely unclear. Within this review, the preclinical and clinical evidence for environmental stressors as disease modifiers in dystonia pathogenesis are summarized and critically evaluated. The potential role of extragenetic factors is discussed in monogenic as well as adult-onset isolated dystonia. The available clinical evidence for a "second hit" is analyzed in light of the reduced penetrance of monogenic dystonic syndromes and put into context with evidence from animal and cellular models. The contradictory studies on adult-onset dystonia are discussed in detail and backed up by evidence from animal models. Taken together, there is clear evidence of a gene-environment interaction in dystonia, which should be considered in the continued quest to unravel dystonia pathophysiology.
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Affiliation(s)
- Lisa Rauschenberger
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Susanne Knorr
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
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16
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Ercoli T, Erro R, Fabbrini G, Pellicciari R, Girlanda P, Terranova C, Avanzino L, Di Biasio F, Barone P, Esposito M, De Joanna G, Eleopra R, Bono F, Manzo L, Bentivoglio AR, Petracca M, Mascia MM, Albanese A, Castagna A, Ceravolo R, Altavista MC, Scaglione C, Magistrelli L, Zibetti M, Bertolasi L, Coletti Moja M, Cotelli MS, Cossu G, Minafra B, Pisani A, Misceo S, Modugno N, Romano M, Cassano D, Berardelli A, Defazio G; Italian Dystonia Registry Participants. Spread of segmental/multifocal idiopathic adult-onset dystonia to a third body site. Parkinsonism Relat Disord 2021; 87:70-4. [PMID: 33991781 DOI: 10.1016/j.parkreldis.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adult-onset focal dystonia can spread to involve one, or less frequently, two additional body regions. Spread of focal dystonia to a third body site is not fully characterized. MATERIALS AND METHODS We retrospectively analyzed data from the Italian Dystonia Registry, enrolling patients with segmental/multifocal dystonia involving at least two parts of the body or more. Survival analysis estimated the relationship between dystonia features and spread to a third body part. RESULTS We identified 340 patients with segmental/multifocal dystonia involving at least two body parts. Spread of dystonia to a third body site occurred in 42/241 patients (17.4%) with focal onset and 10/99 patients (10.1%) with segmental/multifocal dystonia at onset. The former had a greater tendency to spread than patients with segmental/multifocal dystonia at onset. Gender, years of schooling, comorbidity, family history of dystonia/tremor, age at dystonia onset, and disease duration could not predict spread to a third body site. Among patients with focal onset in different body parts (cranial, cervical, and upper limb regions), there was no association between site of focal dystonia onset and risk of spread to a third body site. DISCUSSION AND CONCLUSION Spread to a third body site occurs in a relative low percentage of patients with idiopathic adult-onset dystonia affecting two body parts. Regardless of the site of dystonia onset and of other demographic/clinical variables, focal onset seems to confer a greater risk of spread to a third body site in comparison to patients with segmental/multifocal dystonia at onset.
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17
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Fabbrini G, Conte A, Ferrazzano G, Esposito M, Albanese A, Pellicciari R, Di Biasio F, Bono F, Eleopra R, Ercoli T, Altavista MC, Berardelli A, Defazio G. Neuroimaging in idiopathic adult-onset focal dystonia. Neurol Sci 2021; 42:2947-2950. [PMID: 33389253 DOI: 10.1007/s10072-020-05025-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
We aimed to study the attitude of Italian neurologists in the use of conventional MRI in patients with idiopathic adult-onset focal dystonia. Patients were included in the Italian Dystonia Registry by experts working in different Italian centers. MRI was available for 1045 of the 1471 (71%) patients included in the analysis. Using logistic regression analysis, we found that MRI was more likely to be performed in patients with cervical dystonia, spasmodic dysphonia, or non-task-specific upper limb dystonia, whereas it was less likely to be performed in patients with blepharospasm or task-specific upper limb dystonia. We did not find differences in the number of MRIs performed between neurological centers in Northern, Central, and Southern Italy. We conclude that although the diagnosis of idiopathic adult-onset dystonia is mainly based on clinical grounds, many movement disorder experts rely on MRI to confirm a diagnosis of idiopathic dystonia. We suggest that neuroimaging should be used in patients with adult-onset focal dystonia to rule out secondary forms.
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Affiliation(s)
- Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy. .,IRCCS Neuromed, Pozzilli, Italy.
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit "Esposito Marcello", Cardarelli Hospital, Naples, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience, and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | | | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater domini, Catanzaro, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, IRCCS Foundation, Neurology Institute "Carlo Besta", Milan, Italy
| | - Tommaso Ercoli
- Department of Medical Science and Public Health, Institute of Neurology, University of Cagliari, Cagliari, Italy
| | | | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Giovanni Defazio
- Department of Medical Science and Public Health, Institute of Neurology, University of Cagliari, Cagliari, Italy
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18
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Mohammadi S, Dolatshahi M, Rahmani F. Shedding light on thyroid hormone disorders and Parkinson disease pathology: mechanisms and risk factors. J Endocrinol Invest 2021; 44:1-13. [PMID: 32500445 DOI: 10.1007/s40618-020-01314-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons. Dopaminergic system is interconnected with the hypothalamic-pituitary-thyroid axis. Dopamine (DA) upregulates thyrotropin releasing hormone (TRH) while downregulating thyroid stimulating hormone (TSH) and thyroid hormones. Moreover, TRH stimulates DA release. PD is associated with impaired regulation of TSH and thyroid hormones (TH) levels, which in turn associate with severity and different subtypes of PD, while levodopa and bromocriptine treatment can interfere with hypothalamic-pituitary-thyroid axis. Thyroid disturbances, including hypothyroidism, Hashimoto's thyroiditis (HT), hyperthyroidism and Graves' disease (GD) not only increase the risk of PD but also share some clinical signs with PD. Also, several genes including RASD2, WSB1, MAPT, GIRK2, LRRK2 and gene products like neurotensin and NOX/DUOX affect the risk for both PD and thyroid disease. Hypothyroidism is associated with obesity, hypercholesterolemia, anemia and altered cerebral blood flow which are associated with PD pathology. Herein we provide a comprehensive view on the association between PD and thyroid hormones regulation and dysregulations, hoping to provide new avenues towards targeted treatment of PD. We performed a comprehensive search in literature using Pubmed and Scopus, yielding to a total number of 36 original articles that had addressed the association between thyroid hormone disorders and PD.
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Affiliation(s)
- S Mohammadi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - M Dolatshahi
- Student's Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - F Rahmani
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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19
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Valeriani D, Simonyan K. A microstructural neural network biomarker for dystonia diagnosis identified by a DystoniaNet deep learning platform. Proc Natl Acad Sci U S A 2020; 117:26398-405. [PMID: 33004625 DOI: 10.1073/pnas.2009165117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This research identified a microstructural neural network biomarker for objective and accurate diagnosis of isolated dystonia based on the disorder pathophysiology using an advanced deep learning algorithm, DystoniaNet, and raw structural brain images of large cohorts of patients with isolated focal dystonia and healthy controls. DystoniaNet significantly outperformed shallow machine-learning pipelines and substantially exceeded the current agreement rates between clinicians, reaching an overall accuracy of 98.8% in diagnosing different forms of isolated focal dystonia. These results suggest that DystoniaNet could serve as an objective, robust, and generalizable algorithmic platform of dystonia diagnosis for enhanced clinical decision-making. Implementation of the identified biomarker for objective and accurate diagnosis of dystonia may be transformative for clinical management of this disorder. Isolated dystonia is a neurological disorder of heterogeneous pathophysiology, which causes involuntary muscle contractions leading to abnormal movements and postures. Its diagnosis is remarkably challenging due to the absence of a biomarker or gold standard diagnostic test. This leads to a low agreement between clinicians, with up to 50% of cases being misdiagnosed and diagnostic delays extending up to 10.1 y. We developed a deep learning algorithmic platform, DystoniaNet, to automatically identify and validate a microstructural neural network biomarker for dystonia diagnosis from raw structural brain MRIs of 612 subjects, including 392 patients with three different forms of isolated focal dystonia and 220 healthy controls. DystoniaNet identified clusters in corpus callosum, anterior and posterior thalamic radiations, inferior fronto-occipital fasciculus, and inferior temporal and superior orbital gyri as the biomarker components. These regions are known to contribute to abnormal interhemispheric information transfer, heteromodal sensorimotor processing, and executive control of motor commands in dystonia pathophysiology. The DystoniaNet-based biomarker showed an overall accuracy of 98.8% in diagnosing dystonia, with a referral of 3.5% of cases due to diagnostic uncertainty. The diagnostic decision by DystoniaNet was computed in 0.36 s per subject. DystoniaNet significantly outperformed shallow machine-learning algorithms in benchmark comparisons, showing nearly a 20% increase in its diagnostic performance. Importantly, the microstructural neural network biomarker and its DystoniaNet platform showed substantial improvement over the current 34% agreement on dystonia diagnosis between clinicians. The translational potential of this biomarker is in its highly accurate, interpretable, and generalizable performance for enhanced clinical decision-making.
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20
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Di Biasio F, Marchese R, Abbruzzese G, Baldi O, Esposito M, Silvestre F, Tescione G, Berardelli A, Fabbrini G, Ferrazzano G, Pellicciari R, Eleopra R, Devigili G, Bono F, Santangelo D, Bertolasi L, Altavista MC, Moschella V, Barone P, Erro R, Albanese A, Scaglione C, Liguori R, Cotelli MS, Cossu G, Ceravolo R, Coletti Moja M, Zibetti M, Pisani A, Petracca M, Tinazzi M, Maderna L, Girlanda P, Magistrelli L, Misceo S, Romano M, Minafra B, Modugno N, Aguggia M, Cassano D, Defazio G, Avanzino L. Motor and Sensory Features of Cervical Dystonia Subtypes: Data From the Italian Dystonia Registry. Front Neurol 2020; 11:906. [PMID: 33013628 PMCID: PMC7493687 DOI: 10.3389/fneur.2020.00906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Cervical dystonia (CD) is one of the most common forms of adult-onset isolated dystonia. Recently, CD has been classified according to the site of onset and spread, in different clinical subgroups, that may represent different clinical entities or pathophysiologic subtypes. In order to support this hypothesis, in this study we have evaluated whether different subgroups of CD, that clinically differ for site of onset and spread, also imply different sensorimotor features. Methods: Clinical and demographic data from 842 patients with CD from the Italian Dystonia Registry were examined. Motor features (head tremor and tremor elsewhere) and sensory features (sensory trick and neck pain) were investigated. We analyzed possible associations between motor and sensory features in CD subgroups [focal neck onset, no spread (FNO-NS); focal neck onset, segmental spread (FNO-SS); focal onset elsewhere with segmental spread to neck (FOE-SS); segmental neck involvement without spread (SNI)]. Results: In FNO-NS, FOE-SS, and SNI subgroups, head tremor was associated with the presence of tremor elsewhere. Sensory trick was associated with pain in patients with FNO-NS and with head tremor in patients with FNO-SS. Conclusion: The frequent association between head tremor and tremor elsewhere may suggest a common pathophysiological mechanism. Two mechanisms may be hypothesized for sensory trick: a gating mechanism attempting to reduce pain and a sensorimotor mechanism attempting to control tremor.
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Affiliation(s)
| | | | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Ottavia Baldi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Marcello Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Francesco Silvestre
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Girolamo Tescione
- "Salvatore Maugeri" Foundation, Institute of Telese Terme (BN), Benevento, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | - Roberto Eleopra
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UOC Neurologia 1, Milan, Italy
| | - Grazia Devigili
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UOC Neurologia 1, Milan, Italy
| | - Francesco Bono
- Neurology Unit, Center for Botulinum Toxin Therapy, A.O.U. Mater Domini, Catanzaro, Italy
| | - Domenico Santangelo
- Neurology Unit, Center for Botulinum Toxin Therapy, A.O.U. Mater Domini, Catanzaro, Italy
| | | | | | | | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, Universitá di Salerno, Baronissi, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, Universitá di Salerno, Baronissi, Italy
| | | | - Cesa Scaglione
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maurizio Zibetti
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Antonio Pisani
- Neurology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Petracca
- Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
| | | | | | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | | | - Giovanni Defazio
- Neurology Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Avanzino
- IRCCS Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
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21
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Tinazzi M, Erro R, Mascia MM, Esposito M, Ercoli T, Ferrazzano G, Di Biasio F, Pellicciari R, Eleopra R, Bono F, Bertolasi L, Barone P, Scaglione CLM, Pisani A, Altavista MC, Cotelli MS, Ceravolo R, Cossu G, Zibetti M, Moja MC, Girlanda P, Maderna L, Albanese A, Petracca M, Magistrelli L, Misceo S, Minafra B, Romano M, Squintani GM, Modugno N, Aguggia M, Cassano D, Castagna A, Morgante F, Berardelli A, Defazio G. Demographic and clinical determinants of neck pain in idiopathic cervical dystonia. J Neural Transm (Vienna) 2020; 127:1435-9. [PMID: 32851476 DOI: 10.1007/s00702-020-02245-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
Cervical dystonia is associated with neck pain in a significant proportion of cases, but the mechanisms underlying pain are largely unknown. In this exploratory study, we compared demographic and clinical variables in cervical dystonia patients with and without neck pain from the Italian Dystonia Registry. Univariable and multivariable logistic regression analysis indicated a higher frequency of sensory trick and a lower educational level among patients with pain.
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22
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Defazio G, Ercoli T, Erro R, Pellicciari R, Mascia MM, Fabbrini G, Albanese A, Lalli S, Eleopra R, Barone P, Marchese R, Ceravolo R, Scaglione C, Liguori R, Esposito M, Bentivoglio AR, Bertolasi L, Altavista MC, Bono F, Pisani A, Girlanda P, Berardelli A, Cimino P, Ferrazzano G, Devigili G, Scannapieco S, Di Biasio F, Mazzucchi S, Habetswallner F, Petracca M, Zivelonghi C, Polidori L, Manzo L, Di Lazzaro G, Terranova C, Cotelli MS, Castagna A, Minafra B, Misceo S, Magistrelli L, Zibetti M, Cossu G, Coletti Moja M. Idiopathic
Non‐task‐Specific
Upper Limb Dystonia, a Neglected Form of Dystonia. Mov Disord 2020; 35:2038-2045. [DOI: 10.1002/mds.28199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Giovanni Defazio
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Tommaso Ercoli
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Roberto Erro
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | - Roberta Pellicciari
- Department of Basic Science, Neuroscience and Sense Organs Aldo Moro University of Bari Bari Italy
| | - Marcello Mario Mascia
- Department of Medical Science and Public Health Institute of Neurology, University of Cagliari Cagliari Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
| | - Alberto Albanese
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | - Stefania Lalli
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano, Milan Italy
| | | | - Paolo Barone
- Department of Medicine Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno Baronissi (SA) Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Cesa Scaglione
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | - Rocco Liguori
- IRCCS ‐ Institute of Neurological Sciences Bologna Italy
| | | | - Anna Rita Bentivoglio
- Gemelli University Hospital ‐ IRCCS Rome Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore Rome Italy
| | | | | | - Francesco Bono
- Center for Botulinum Toxin Therapy, Neurologic Unit Mater Domini University Hospital Catanzaro Italy
| | - Antonio Pisani
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
- IRCSS Neuromed Pozzili Italy
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Berman BD, Groth CL, Sillau SH, Pirio Richardson S, Norris SA, Junker J, Brüggemann N, Agarwal P, Barbano RL, Espay AJ, Vizcarra JA, Klein C, Bäumer T, Loens S, Reich SG, Vidailhet M, Bonnet C, Roze E, Jinnah HA, Perlmutter JS. Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study. J Neurol Neurosurg Psychiatry 2020; 91:314-320. [PMID: 31848221 PMCID: PMC7024047 DOI: 10.1136/jnnp-2019-321794] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Isolated focal dystonia can spread to muscles beyond the initially affected body region, but risk of spread has not been evaluated in a prospective manner. Furthermore, body regions at risk for spread and the clinical factors associated with spread risk are not well characterised. We sought here to prospectively characterise risk of spread in recently diagnosed adult-onset isolated focal dystonia patients. METHODS Patients enrolled in the Dystonia Coalition with isolated dystonia affecting only the neck, upper face, hand or larynx at onset of symptoms were included. Timing of follow-up visits was based on a sliding scale depending on symptom onset and ranged from 1 to 4 years. Descriptive statistics, Kaplan-Meier survival curves and Cox proportional hazard regression models were used to assess clinical characteristics associated with dystonia spread. RESULTS 487 enrolled participants (68.3% women; mean age: 55.6±12.2 years) met our inclusion/exclusion criteria. Spread was observed in 50% of blepharospasm, 8% of cervical dystonia, 17% of hand dystonia and 16% of laryngeal dystonia cases. Most common regions for first spread were the oromandibular region (42.2%) and neck (22.4%) for blepharospasm, hand (3.5%) for cervical dystonia and neck for hand (12.8%) and laryngeal (15.8%) dystonia. Increased spread risk was associated with a positive family history (HR=2.18, p=0.012) and self-reported alcohol responsiveness (HR=2.59, p=0.009). CONCLUSIONS Initial body region affected in isolated focal dystonia has differential risk and patterns of spread. Genetic factors likely influence the risk of spread. These findings can aid clinical prognostication and inform future investigations into potential disease-modifying treatments.
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Affiliation(s)
- Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Scott A Norris
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Johanna Junker
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Pinky Agarwal
- Booth Gardner Parkinson's Center, Evergreen Health, Kirkland, Washington, USA
| | - Richard L Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joaquin A Vizcarra
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Stephen G Reich
- Department of Neurology, University of Maryland Medical Centre, Baltimore, Maryland, USA
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Cecilia Bonnet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Hyder A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Defazio G, Fabbrini G, Erro R, Albanese A, Barone P, Zibetti M, Esposito M, Pellicciari R, Avanzino L, Bono F, Eleopra R, Bertolasi L, Altavista MC, Cotelli MS, Ceravolo R, Scaglione C, Bentivoglio AR, Cossu G, Coletti Moja M, Girlanda P, Misceo S, Pisani A, Mascia MM, Ercoli T, Tinazzi M, Maderna L, Minafra B, Magistrelli L, Romano M, Aguggia M, Tambasco N, Castagna A, Cassano D, Berardelli A, Ferrazzano G, Lalli S, Silvestre F, Manganelli F, Di Biasio F, Marchese R, Demonte G, Santangelo D, Devigili G, Durastanti V, Turla M, Mazzucchi S, Petracca M, Oppo V, Barbero P, Morgante F, Di Lazzaro G, Squintani G, Modugno N. Does acute peripheral trauma contribute to idiopathic adult-onset dystonia? Parkinsonism Relat Disord 2020; 71:40-3. [DOI: 10.1016/j.parkreldis.2020.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 11/24/2022]
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Abstract
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
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26
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Castagna A, Caronni A, Crippa A, Sciumè L, Giacobbi G, Corrini C, Montesano A, Ramella M. Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia-an observational study. Neurol Sci 2019; 41:131-138. [PMID: 31478151 DOI: 10.1007/s10072-019-04061-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Idiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD. METHODS Fifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection. RESULTS Six weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT. CONCLUSIONS SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients' difficulties in the activities of daily living. TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).
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Affiliation(s)
- Anna Castagna
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Antonio Caronni
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy.
| | - Alessandro Crippa
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Luciana Sciumè
- U. O. di Medicina riabilitativa e neuroriabilitazione, Ospedale Niguarda, Milan, Italy
| | - Giulia Giacobbi
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Chiara Corrini
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Angelo Montesano
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Marina Ramella
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
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27
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Macerollo A, Edwards MJ, Huang HC, Lu MK, Chen HJ, Tsai CH, Chen JC. Peripheral trauma and risk of dystonia: What are the evidences and potential co-risk factors from a population insurance database? PLoS One 2019; 14:e0216772. [PMID: 31075156 PMCID: PMC6510449 DOI: 10.1371/journal.pone.0216772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 04/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Dystonia is a neurological syndrome typically resulting in abnormal postures. Objectives We tested the role of physical injury as potential risk factor for development of dystonia using The National Health Insurance Research Database of Taiwan. Methods We identified 65704 people who were coded in the database as having had peripheral traumatic injuries (ICD-9-CM 807–848 and 860–959) in the year 2000. Patients with traumatic brain or spine injuries were excluded from analysis. We matched them using purposive sampling with 65704 people in the database who had not suffered peripheral trauma. We looked then at the incidence of dystonia occurring at least 1 year from the date of the peripheral trauma until 2011. Psychiatric symptoms (depression and anxiety) and sleeps difficulties have been investigated as potential covariates. Results We found 189 patients with dystonia (0.28%) in the trauma group, and 52 patients with dystonia (0.08%) in the non-trauma group. Trauma was independently associated with dystonia (adjusted HR = 3.12, 95% CI = 2.30–4.24). The incidence density of dystonia in the trauma group was 2.27 per 10000 person-years, while it was 0.71 per 10000 person-years in the non-trauma group Beyond the peripheral trauma, other variables associated to the incidence of dystonia included female sex, aged 40 years and above, depression and sleep disorders. Conclusion These data from a large population dataset support traumatic injury as a risk factor for the development of dystonia.
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Affiliation(s)
- Antonella Macerollo
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mark J. Edwards
- Department of Molecular and Clinical Sciences, St George’s University of London, London, United Kingdom
| | - Hui-Chun Huang
- Department of Neurology, China Medical University Hospital, Taichung City, Taiwan
| | - Ming-Kuei Lu
- Department of Neurology, China Medical University Hospital, Taichung City, Taiwan
- School of Medicine, China Medical University, Taichung City, Taiwan
| | - Hsuan-Ju Chen
- School of Medicine, China Medical University, Taichung City, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung City, Taiwan
- School of Medicine, China Medical University, Taichung City, Taiwan
| | - Jui Cheng Chen
- Department of Neurology, China Medical University Hospital, Taichung City, Taiwan
- School of Medicine, China Medical University, Taichung City, Taiwan
- * E-mail:
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28
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Marciniec M, Szczepańska-Szerej A, Kulczyński M, Sapko K, Popek-Marciniec S, Rejdak K. Pain in cervical dystonia and the antinociceptive effects of botulinum toxin: what is currently known? Rev Neurosci 2019; 30:771-779. [DOI: 10.1515/revneuro-2018-0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Pain is the most common and disabling non-motor symptom in cervical dystonia (CD). Up to 88.9% of patients report pain at some point in the course of the disease. It is still a matter of debate whether CD-related pain originates only from prolonged muscle contraction. Recent data suggest that the alterations of transmission and processing of nociceptive stimuli play a crucial role in pain development. Botulinum toxin (BT) is the first-line therapy for CD. Despite fully elucidated muscle relaxant action, the antinociceptive effect of BT remains unclear and probably exceeds a simple decompression of the nerve fibers due to the reduction in muscle tone. The proposed mechanisms of the antinociceptive action of BT include inhibition of pain mediator release, inhibition of membrane sodium channels, retrograde axonal transport and impact on the other pain pathways. This article summarizes the current knowledge about the antinociceptive properties of BT and the clinical analgesic efficacy in the treatment of CD patients.
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Affiliation(s)
- Michał Marciniec
- Chair and Department of Neurology , Medical University of Lublin , Independent Public Clinical Hospital , No. 4, ul. Jaczewskiego 8 , 20-954 Lublin , Poland
| | | | - Marcin Kulczyński
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
| | - Klaudia Sapko
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
| | - Sylwia Popek-Marciniec
- Department of Cancer Genetics with Cytogenetics Laboratory , Medical University of Lublin , Lublin , Poland
| | - Konrad Rejdak
- Chair and Department of Neurology , Medical University of Lublin , Lublin , Poland
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29
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Mainka T, Erro R, Rothwell J, Kühn AA, Bhatia KP, Ganos C. Remission in dystonia - Systematic review of the literature and meta-analysis. Parkinsonism Relat Disord 2019; 66:9-15. [PMID: 30898428 DOI: 10.1016/j.parkreldis.2019.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/20/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
In isolated, sporadic dystonia, it has been occasionally reported that some patients might undergo symptom remission. However, the exact clinical characteristics of patients with remission remain understudied. Given the important prognostic and pathophysiological implications of dystonic remission, we here provide a systematic review of the literature and a meta-analysis to assess demographic and clinical features associated with this phenomenon. We also provide a list of operational criteria to better define dystonic remission. Using PubMed and Embase, we conducted a systematic literature search in March 2018. 626 records were screened, 31 studies comprising data of 2551 cases with reports predominantly from patients with cervical dystonia (n = 1319) or blepharospasm/Meige syndrome (n = 704) were included in qualitative analysis. Five studies reporting remission in cervical dystonia were eligible for meta-analysis. Complete remission was reported in 11.8% and partial remission for 4.4% of cases. Remission rates were higher in cervical dystonia than in blepharospasm/Meige (e.g. complete remission 15.4% vs. 5.8% respectively). Remission occurred on average 4.5 years after onset of dystonic symptoms. However, the majority of patients (63.8%) relapsed. Meta-analysis for cervical dystonia showed that patients with remission were significantly younger at symptom onset than patients without remission (mean difference -7.13 years [95% CI: 10.58, -3.68], p < 0.0001). Based on our findings, we propose that the degree, the conditions associated with the onset, and the duration of remission are key factors to be considered in a unifying definition of dystonic remission.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
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30
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Berardelli I, Pasquini M, Conte A, Bologna M, Berardelli A, Fabbrini G. Treatment of psychiatric disturbances in common hyperkinetic movement disorders. Expert Rev Neurother 2018; 19:55-65. [DOI: 10.1080/14737175.2019.1555475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
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31
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Defazio G, Albanese A, Pellicciari R, Scaglione CL, Esposito M, Morgante F, Abbruzzese G, Bentivoglio AR, Bono F, Coletti Moja M, Fabbrini G, Girlanda P, Lopiano L, Pacchetti C, Romano M, Fadda L, Berardelli A. Expert recommendations for diagnosing cervical, oromandibular, and limb dystonia. Neurol Sci 2019; 40:89-95. [PMID: 30269178 DOI: 10.1007/s10072-018-3586-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Diagnosis of focal dystonia is based on clinical grounds and is therefore open to bias. To date, diagnostic guidelines have been only proposed for blepharospasm and laryngeal dystonia. To provide practical guidance for clinicians with less expertise in dystonia, a group of Italian Movement Disorder experts formulated clinical diagnostic recommendations for cervical, oromandibular, and limb dystonia. METHODS A panel of four neurologists generated a list of clinical items related to the motor phenomenology of the examined focal dystonias and a list of clinical features characterizing neurological/non-neurological conditions mimicking dystonia. Thereafter, ten additional expert neurologists assessed the diagnostic relevance of the selected features and the content validity ratio was calculated. The clinical features reaching a content validity ratio > 0.5 contributed to the final recommendations. RESULTS The recommendations retained patterned and repetitive movements/postures as the core feature of dystonia in different body parts. If present, a sensory trick confirmed diagnosis of dystonia. In the patients who did not manifest sensory trick, active exclusion of clinical features related to conditions mimicking dystonia (features that would be expected to be absent in dystonia) would be necessary for dystonia to be diagnosed. DISCUSSION Although reliability, sensitivity, and specificity of the recommendations are yet to be demonstrated, information from the present study would hopefully facilitate diagnostic approach to focal dystonias in the clinical practice and would be the basis for future validated diagnostic guidelines.
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32
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Esposito M, Fabbrini G, Ferrazzano G, Berardelli A, Peluso S, Cesari U, Gigante AF, Bentivoglio AR, Petracca M, Erro R, Barone P, Schirinzi T, Eleopra R, Avanzino L, Romano M, Scaglione CL, Cossu G, Morgante F, Minafra B, Zibetti M, Coletti Moja M, Turla M, Fadda L, Defazio G. Spread of dystonia in patients with idiopathic adult-onset laryngeal dystonia. Eur J Neurol 2018; 25:1341-1344. [DOI: 10.1111/ene.13731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - G. Fabbrini
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | | | - A. Berardelli
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | - S. Peluso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - U. Cesari
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - A. F. Gigante
- Department of Basic Science, Neuroscience and Sense Organs; Aldo Moro University of Bari; Bari Italy
| | - A. R. Bentivoglio
- Movement Disorders Unit; Center for Parkinson's Disease and Extrapyramidal Disorders; Institute of Neurology; Catholic University; Rome Italy
- Don Carlo Gnocchi Onlus Foundation; Milan Italy
| | - M. Petracca
- Movement Disorders Unit; Center for Parkinson's Disease and Extrapyramidal Disorders; Institute of Neurology; Catholic University; Rome Italy
| | - R. Erro
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; University of Salerno; Salerno Italy
| | - P. Barone
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; University of Salerno; Salerno Italy
| | - T. Schirinzi
- Department of Systems Medicine; University of Rome ‘Tor Vergata’; Rome Italy
| | - R. Eleopra
- IRCCS Foundation C. Besta Neurological Institute; Milan Italy
| | - L. Avanzino
- Section of Human Physiology; Department of Experimental Medicine; University of Genoa; Genoa Italy
| | - M. Romano
- Neurology Unit; Villa Sofia Hospital; Palermo Italy
| | | | - G. Cossu
- Department of Neurology; AOB ‘G. Brotzu’ General Hospital; Cagliari Italy
| | - F. Morgante
- Department of Neuroscience; University of Messina; Messina Italy
| | - B. Minafra
- Parkinson's Disease and Movement Disorders Unit; C. Mondino National Neurological Institute; IRCCS; Pavia Italy
| | - M. Zibetti
- Department of Neuroscience ‘Rita Levi Montalcini’; University of Turin; Turin Italy
| | | | - M. Turla
- Neurology Unit; Valle Camonica Hospital; Brescia Italy
| | - L. Fadda
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - G. Defazio
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
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