1
|
Sprenger GP, van Zwet EW, Bakels HS, Achterberg WP, Roos RA, de Bot ST. Prevalence and burden of pain across the entire spectrum of Huntington's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332992. [PMID: 38290837 DOI: 10.1136/jnnp-2023-332992] [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: 11/12/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Pain is an important symptom in Huntington's disease (HD), however, not systematically studied and understood. The objective of the current study is to assess the prevalence of pain, pain interference in daily activities, painful conditions, analgesic use and the severity of the pain burden across different disease stages and 'Age at symptom Onset' groups. Additionally, the association between pain and disease burden was investigated. METHODS A cross-sectional analysis was conducted within two large data sets, which included different types of pain scales. Multivariable logistic regression analyses and analyses of variance were performed to compare the pain levels with those in the general population. The analyses were adjusted for sex and age. Locally Estimated Scatterplot Smoothing was used to test the association between pain and the HD pathology score: a measure of disease burden. RESULTS The mean prevalence of pain in the HD population was 40% and for pain interference around 35% in both data sets. Patients in the early, middle and late stage of HD experience more pain burden compared with what is reported in patients with chronic pain (p<0.01). A positive and significant association was demonstrated between pain and disease burden. Patients in late stage HD with pain use significantly less analgesics compared with the general population (5% vs 13%, respectively (p<0.01)). CONCLUSIONS Pain is a prevalent and important symptom in HD. Severe pain burden in the HD population is present and positively associated with disease burden. Risk for undertreatment with analgesics is nevertheless present. Awareness of pain in HD needs to be increased, both clinically and scientifically.
Collapse
Affiliation(s)
- Gregory P Sprenger
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Huntington Center, Amstelring, Amsterdam, The Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Hannah S Bakels
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Huntington Center overduin, Topaz, Leiden, The Netherlands
| | - Raymund A Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Tramutola A, Bakels HS, Perrone F, Di Nottia M, Mazza T, Abruzzese MP, Zoccola M, Pagnotta S, Carrozzo R, de Bot ST, Perluigi M, van Roon-Mom WMC, Squitieri F. GLUT-1 changes in paediatric Huntington disease brain cortex and fibroblasts: an observational case-control study. EBioMedicine 2023; 97:104849. [PMID: 37898095 PMCID: PMC10630613 DOI: 10.1016/j.ebiom.2023.104849] [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: 03/23/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Paediatric Huntington disease with highly expanded mutations (HE-PHD; >80 CAG repeats) presents atypically, compared to adult-onset Huntington disease (AOHD), with neurodevelopmental delay, epilepsy, abnormal brain glucose metabolism, early striatal damage, and reduced lifespan. Since genetic GLUT-1 deficiency syndrome shows a symptom spectrum similar to HE-PHD, we investigated the potential role of the two main glucose transporters, GLUT-1 and GLUT-3, in HE-PHD. METHODS We compared GLUT-1 and GLUT-3 protein expression in HE-PHD, juvenile-onset (JOHD), and AOHD brains (n = 2; n = 3; n = 6) and periphery (n = 3; n = 2; n = 2) versus healthy adult controls (n = 6; n = 6). We also investigated mitochondrial complexes and hexokinase-II protein expression. FINDINGS GLUT-1 and GLUT-3 expression were significantly lower in HE-PHD frontal cortex (p = 0.009, 95% [CI 13.4, 14.7]; p = 0.017, 95% [CI 14.2, 14.5]) versus controls. In fibroblasts, GLUT-1 and GLUT-3 expression were lower compared to controls (p < 0.0001, 95% [CI 0.91, 1.09]; p = 0.046, 95% [CI 0.93, 1.07]). In the frontal cortex, this occurred without evidence of extensive neuronal degeneration. Patients with HE-PHD had deregulated mitochondrial complex expression, particularly complexes II-III, levels of which were lower in frontal cortex versus controls (p = 0.027, 95% [CI 17.1, 17.6]; p = 0.002, 95% CI [16.6, 16.9]) and patients with AOHD (p = 0.052, 95% [CI 17.0, 17.6]; p = 0.002, 95% [CI 16.6, 16.7]). Hexokinase-II expression was also lower in HE-PHD frontal cortex and striatum versus controls (p = 0.010, 95% [CI 17.8, 18.2]; p = 0.045, 95% [CI 18.6, 18.7]) and in frontal cortex versus patients with AOHD (p = 0.013, 95% [CI 17.7, 18.1]). Expression JOHD levels were consistently different to those of HE-PHD but similar to those of AOHD. INTERPRETATION Our data suggest a dysfunctional hypometabolic state occurring specifically in paediatric Huntington disease brains. FUNDING '5 × 1000' Personal Income Tax donation to LIRH Foundation; Italian Ministry of HealthRC2301MH04 and RF-2016-02364123 to CSS.
Collapse
Affiliation(s)
- Antonella Tramutola
- Department of Biochemical Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Hannah S Bakels
- Department of Neurology, Leiden University Medical Centre, ZA Leiden 2311, the Netherlands
| | - Federica Perrone
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza (CSS) Research Hospital, San Giovanni Rotondo 71013, Italy
| | - Michela Di Nottia
- Unit of Cellular Biology and Mitochondrial Diseases, IRCCS Bambino Gesú Children's Hospital, Rome 00146, Italy
| | - Tommaso Mazza
- Bioinformatics Unit, IRCCS Casa Sollievo della Sofferenza (CSS) Research Hospital, San Giovanni Rotondo 71013, Italy
| | - Maria Pia Abruzzese
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza (CSS) Research Hospital, San Giovanni Rotondo 71013, Italy
| | - Martina Zoccola
- Unit of Cellular Biology and Mitochondrial Diseases, IRCCS Bambino Gesú Children's Hospital, Rome 00146, Italy
| | - Sara Pagnotta
- Department of Biochemical Sciences, Sapienza University of Rome, Rome 00185, Italy
| | - Rosalba Carrozzo
- Unit of Cellular Biology and Mitochondrial Diseases, IRCCS Bambino Gesú Children's Hospital, Rome 00146, Italy
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Centre, ZA Leiden 2311, the Netherlands
| | - Marzia Perluigi
- Department of Biochemical Sciences, Sapienza University of Rome, Rome 00185, Italy
| | | | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, IRCCS Casa Sollievo della Sofferenza (CSS) Research Hospital, San Giovanni Rotondo 71013, Italy; Centre for Rare Neurological Diseases (CMRN), Italian League for Research on Huntington (LIRH) Foundation, Viale di Villa Massimo 4, Rome 00161, Italy.
| |
Collapse
|
3
|
Bakels HS, van Duinen SG, de Bresser J, van Roon-Mom WMC, van der Weerd L, de Bot ST. Post-mortem 7T MR imaging and neuropathology in middle stage juvenile-onset Huntington disease: A case report. Neuropathol Appl Neurobiol 2023; 49:e12858. [PMID: 36334065 PMCID: PMC10100344 DOI: 10.1111/nan.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/12/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Hannah S Bakels
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
4
|
Bakels HS, Roos RAC, van Roon-Mom WMC, de Bot ST. Juvenile-Onset Huntington Disease Pathophysiology and Neurodevelopment: A Review. Mov Disord 2021; 37:16-24. [PMID: 34636452 PMCID: PMC9291924 DOI: 10.1002/mds.28823] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/29/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
Huntington disease is an autosomal dominant inherited brain disorder that typically becomes manifest in adulthood. Juvenile-onset Huntington disease refers to approximately 5% of patients with symptom onset before the age of 21 years. The causal factor is a pathologically expanded CAG repeat in the Huntingtin gene. Age at onset is inversely correlated with CAG repeat length. Juvenile-onset patients have distinct symptoms and signs with more severe pathology of involved brain structures in comparison with disease onset in adulthood. The aim of this review is to compare clinical and pathological features in juvenile- and adult-onset Huntington disease and to explore which processes potentially contribute to the observed differences. A specific focus is placed on molecular mechanisms of mutant huntingtin in early neurodevelopment and the interaction of a neurodegenerative disease and postnatal brain maturation. The importance of a better understanding of pathophysiological differences between juvenile- and adult-onset Huntington disease lies in development and implementation of new therapeutic strategies. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Hannah S Bakels
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
Bugiani M, Kevelam SH, Bakels HS, Waisfisz Q, Ceuterick-de Groote C, Niessen HW, Abbink TE, Lesnik Oberstein SA, van der Knaap MS. Cathepsin A–related arteriopathy with strokes and leukoencephalopathy (CARASAL). Neurology 2016; 87:1777-1786. [DOI: 10.1212/wnl.0000000000003251] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/28/2016] [Indexed: 11/15/2022] Open
|
6
|
Arkink EB, Schoonman GG, van Vliet JA, Bakels HS, Sneeboer MA, Haan J, van Buchem MA, Ferrari MD, Kruit MC. The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study. Cephalalgia 2016; 37:208-213. [PMID: 27009562 DOI: 10.1177/0333102416640513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed. Methods In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls. Conclusion Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.
Collapse
Affiliation(s)
- Enrico B Arkink
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Guus G Schoonman
- 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,3 Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Jorine A van Vliet
- 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,4 Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Hannah S Bakels
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjolein Am Sneeboer
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost Haan
- 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,5 Department of Neurology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Mark A van Buchem
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michel D Ferrari
- 2 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark C Kruit
- 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
7
|
Klok MD, Bakels HS, Postma NL, van Spaendonk RML, van der Knaap MS, Bugiani M. Interferon-α and the calcifying microangiopathy in Aicardi-Goutières syndrome. Ann Clin Transl Neurol 2015; 2:774-9. [PMID: 26273690 PMCID: PMC4531060 DOI: 10.1002/acn3.213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 11/24/2022] Open
Abstract
Aicardi–Goutières syndrome is a leukoencephalopathy with calcifications and increased cerebrospinal fluid interferon-α. The relation between interferon-α and brain pathology is poorly understood. We report a patient with mutations in the disease-associated gene SAMHD1. Neuropathology showed an extensive microangiopathy with calcifications consistently associate with blood vessels. In an in vitro model of the microangiopathy, interferon-α enhanced vascular smooth muscle cell-derived calcifications. The noninfarcted white matter harbored apoptotic oligodendrocytes and increased numbers of oligodendrocyte progenitors. These findings better define the white matter pathology and provide evidence that interferon-α plays a direct pathogenetic role in the calcifying angiopathy typical of this disease.
Collapse
Affiliation(s)
- Melanie D Klok
- Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Hannah S Bakels
- Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Nienke L Postma
- Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Rosalina M L van Spaendonk
- Department of Clinical Genetics, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| | - Marjo S van der Knaap
- Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands ; Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands ; Department of Pathology, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands
| |
Collapse
|