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Nijenhuis B, van Zutphen T, Gul P, Otten E, Tijssen MAJ. Personality in speed skaters with skater's cramp: A preliminary cross-sectional study. J Psychosom Res 2023; 173:111440. [PMID: 37523930 DOI: 10.1016/j.jpsychores.2023.111440] [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: 05/04/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Skater's cramp is a debilitating disorder in expert speedskaters and recent evidence from muscle and movement studies nominate it is a task-specific dystonia (TSD). Building on these studies we investigated clinical features and personality in skater's cramp, hypothesizing that similar to other TSDs, trait emotionality would be higher in affected skaters. METHODS In a cross-sectional study we employed the HEXACO inventory to examine the personality of a cohort of skaters with skater's cramp (n = 26) compared to age, sex, and experience-matched controls (n = 28). Affected skaters were selected based on relevant clinical features important to the diagnosis of TSD. RESULTS Sentimentality (a sub-factor of emotionality) was higher in affected skaters, but only in the male population. Extraversion was lower in skaters with skater's cramp. Clinical findings resembled other forms of TSD. DISCUSSION Higher sentimentality is in line with previous studies in TSD. Lower Extraversion in affected skaters was an unexpected finding that may be a new feature of skater's cramp and TSD. Due to our small sample size and cross-sectional design, these findings are preliminary, but offer tentative evidence of personality differences in skater's cramp in line with TSD.
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Affiliation(s)
- B Nijenhuis
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB Groningen, the Netherlands; University of Groningen / Faculty Campus Fryslân, Wirdumerdijk 34, 8911 CE Leeuwarden, the Netherlands.
| | - T van Zutphen
- University of Groningen / Faculty Campus Fryslân, Wirdumerdijk 34, 8911 CE Leeuwarden, the Netherlands.
| | - P Gul
- University of Groningen / Faculty Campus Fryslân, Wirdumerdijk 34, 8911 CE Leeuwarden, the Netherlands.
| | - E Otten
- University Groningen, Department of Movement Sciences, NL-9713 AV Groningen, the Netherlands.
| | - M A J Tijssen
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB Groningen, the Netherlands.
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Nijenhuis B, Tijssen MAJ, van Zutphen T, van der Eb J, Otten E, Elting JW. Inter-muscular coherence in speed skaters with skater's cramp. Parkinsonism Relat Disord 2023; 107:105250. [PMID: 36563538 DOI: 10.1016/j.parkreldis.2022.105250] [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: 10/15/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Skater's cramp is a career-ending movement disorder in expert speed skaters noted to be a likely task-specific dystonia. In other movement disorders, including task-specific dystonia, studies have found evidence of central dysregulation expressed as higher inter-muscular coherence. We looked at whether inter-muscular coherence was higher in affected skaters as a possible indicator that it is centrally driven, and by extension further evidence it is a task-specific dystonia. METHODS In 14 affected and 14 control skaters we calculated inter-muscular coherence in the theta-band in a stationary task where tonic muscle activation was measured at 10%, 20% and 50% of maximum voluntary contraction. Additionally, we calculated wavelet coherence while skating at key moments in the stroke cycle. RESULTS Coherence did not differ in the stationary activation task. While skating, coherence was higher in the impacted leg of affected skaters compared to their non-impacted leg, p = .05, η2 = 0.031, and amplitude of electromyography correlated with coherence in the impacted leg, p = .009, R2adjusted = 0.41. A sub-group of severely affected skaters (n = 6) had higher coherence in the impacted leg compared to the left and right leg of controls, p = .02, Cohen's d = 1.59 and p = .01, Cohen's d = 1.63 respectively. Results were less clear across the entire affected cohort probably due to a diverse case-mix. CONCLUSION Our results of higher coherence in certain severe cases of skater's cramp is preliminary evidence of a central dysregulation, making the likelihood it is a task-specific dystonia higher.
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Affiliation(s)
- B Nijenhuis
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; University of Groningen, Faculty Campus Fryslân, Leeuwarden, the Netherlands.
| | - M A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T van Zutphen
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, the Netherlands
| | - J van der Eb
- Leiden Institute of Advanced Computer Science, Leiden, the Netherlands
| | - E Otten
- University of Groningen, Department of Movement Sciences, Groningen, the Netherlands
| | - J W Elting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Pollini L, Tijssen MAJ. A diagnosis of progressive myoclonic ataxia guided by blood biomarkers: Expert commentary. Parkinsonism Relat Disord 2021; 94:127-128. [PMID: 34896024 DOI: 10.1016/j.parkreldis.2021.12.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022]
Affiliation(s)
- L Pollini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M A J Tijssen
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands.
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Zutt R, Elting JW, Santens P, Luijckx GJR, Tijssen MAJ. Two cases with postural axial tremor: Consider a genetic origin. Parkinsonism Relat Disord 2021; 77:152-154. [PMID: 33023723 DOI: 10.1016/j.parkreldis.2020.04.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 03/30/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022]
Abstract
We present two cases with postural axial tremor predominantly involving the head, trunk, and shoulders. In the first patient, the postural tremor occurred in multiple attacks a day lasting approximately 10 min. The second patient developed a progressive tremor of his head and arms, worsened during sitting and standing. Electrophysiological supported the postural axial tremor in both patients with a varying 3-10 Hz tremor frequency between different muscles and within the same muscles at different times. Postural axial tremor is a rare and complex movement disorder. The majority of cases are caused by acquired cerebellar pathology. However, isolated cases with underlying genetic disorders are described in literature. Here, we illustrate how to differentiate paroxysmal axial tremor from other axial hyperkinetic movement disorders and extend the genetic heterogeneity of this intriguing movement disorder phenotype.
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Affiliation(s)
- R Zutt
- Department of Neurology, Haga Teaching Hospital, the Hague, the Netherlands.
| | - J W Elting
- Univ Groningen, Univ Med Ctr Groningen, Dept Neurol, 9713, Groningen, NL, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - P Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - G J R Luijckx
- Univ Groningen, Univ Med Ctr Groningen, Dept Neurol, 9713, Groningen, NL, the Netherlands
| | - M A J Tijssen
- Univ Groningen, Univ Med Ctr Groningen, Dept Neurol, 9713, Groningen, NL, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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Dreissen YEM, Koelman JHTM, Tijssen MAJ. The auditory startle response in relation to outcome in functional movement disorders. Parkinsonism Relat Disord 2021; 89:113-117. [PMID: 34274620 DOI: 10.1016/j.parkreldis.2021.07.012] [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: 03/06/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The auditory startle reflex (ASR) is enlarged in patients with functional movement disorders (FMD). OBJECTIVES To study whether the ASR relates to symptom reduction in FMD patients, who participated in a placebo controlled double blind treatment trial with Botulinum Neurotoxin (BoNT). METHODS Response to treatment in the BoNT study was assessed using the Clinical Global Impression - Improvement scale (CGI-I). The electromyography (EMG) muscle activity of 7 muscles following 110 dB tones was measured in 14 FMD patients before and after one-year treatment and compared to 11 matched controls. The early and a late (behaviorally affected) component of the ASR and the sympathetic skin response (SSR) were assessed. RESULTS 10 of 14 patients (71.4%) showed symptom improvement, which was believed to be mainly caused by placebo effects. The early total response probability of the ASR at baseline tended to be larger in patients compared to controls (p = 0.08), but normalized at follow-up (p = 0.84). The late total response probability was larger in patients vs. controls at baseline (p < 0.05), a trend that still was present at follow-up (p = 0.08). The SSR was higher in patients vs. controls at baseline (p < 0.01), and normalized at follow-up (p = 0.71). CONCLUSIONS On a group level 71.4% of the patients showed clinical symptom improvement after treatment. The early part of the ASR, most likely reflecting anxiety and hyperarousal, normalized in line with the clinical improvement. Interestingly, the augmented late component of the ASR remained enlarged suggesting persistent altered behavioral processing in functional patients despite motor improvement.
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Affiliation(s)
- Y E M Dreissen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - J H T M Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University Groningen, the Netherlands.
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Gannamani R, Timmers ER, Tijssen MAJ. The use of next-generation sequencing to unravel new genes: overcoming challenges posed by rare neurological disorders such as myoclonus-dystonia. Eur J Neurol 2020; 27:1459-1460. [PMID: 32365425 DOI: 10.1111/ene.14296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Gannamani
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Department of Genetics, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - E R Timmers
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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van den Dool J, Visser B, Huitema RB, Caljouw SR, Tijssen MAJ. Driving Performance in Patients With Idiopathic Cervical Dystonia; A Driving Simulator Pilot Study. Front Neurol 2020; 11:229. [PMID: 32308642 PMCID: PMC7145955 DOI: 10.3389/fneur.2020.00229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/06/2019] [Accepted: 03/10/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: To explore driving performance and driving safety in patients with cervical dystonia (CD) on a simulated lane tracking, intersections and highway ride and to compare it to healthy controls. Design: This study was performed as an explorative between groups comparison. Participants: Ten CD patients with idiopathic CD, 30 years or older, stable on botulinum toxin treatment for over a year, holding a valid driver's license and being an active driver were compared with 10 healthy controls, matched for age and gender. Main outcome measures: Driving performance and safety, measured by various outcomes from the simulator, such as the standard deviation of the lateral position on the road, rule violations, percentage of line crossings, gap distance, and number of collisions. Fatigue and driving effort were measured with the Borg CR-10 scale and self-perceived fitness to drive was assessed with Fitness to Drive Screening. Results: Except for a higher percentage of line crossings on the right side of the road by controls (median percentage 2.30, range 0.00–37.00 vs. 0.00, range 0.00–9.20, p = 0.043), no differences were found in driving performance and driving safety during the simulator rides. Fatigue levels were significantly higher in CD patients just before (p = 0.005) and after (p = 0.033) the lane tracking ride (patients median fatigue levels before 1.5 (range 0.00–6.00) and after 1.5 (range 0.00–7.00) vs. controls median fatigue levels before and after 0.00 (no range). No significant differences were found on self-perceived fitness to drive. Conclusion: In patients with CD there were no indications that driving performance or driving safety were significant different from healthy controls in a simulator. Patients reported higher levels of fatigue both before and after driving compared to controls in accordance with the non-motor symptoms known in CD.
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Affiliation(s)
- J van den Dool
- Faculty of Health, ACHIEVE Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - B Visser
- Faculty of Health, ACHIEVE Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - R B Huitema
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - S R Caljouw
- Centre for Human Movement Sciences, University of Groningen, Groningen, Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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Vochteloo M, Tijssen MAJ, Beudel M. A Clinical Applicable Smartwatch Application for Measuring Hyperkinetic Movement Disorder Severity. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5867-5870. [PMID: 31947185 DOI: 10.1109/embc.2019.8857869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Measuring the severity of hyperkinetic movement disorders like tremor and myoclonus is challenging. Although many accelerometers are available to quantify movements, the vast majority lacks real-time analysis and an interface that makes it possible to real-time adjust therapy like deep brain stimulation (DBS). Here, we developed a smartwatch/smartphone application that is capable of real-time analysing movement disorder severity. Movement analysis was realised by integrating acceleration values, to velocity and subsequently to distance. Measured distances were compared with a validated accelerometer already applied for quantifying movement disorders. Further validation was done by quantitative assessment of simulated movement disorders in 10 healthy volunteers. Finally, the approach was tested in two patients treated with DBS to quantify the effect of different DBS settings on myoclonus and tremor severity, respectively. The distance measured with the application had a 96% accuracy. This was non-inferior (p = 0.76) compared to accelerometers already clinically applied. Furthermore, (simulated) movement disorder severity could be classified correctly in 93% of the cases. Finally, the method was capable of distinguishing effective from non-effective DBS parameters in two patients. In summary, with our approach we realised an instantaneous and reliable estimation of the severity of movement disorders which can assist in real time titrating therapy like DBS.
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Abstract
Tremor and myoclonus are two common hyperkinetic movement disorders. Tremor is characterized by rhythmic oscillatory movements while myoclonic jerks are usually arrhythmic. Tremor can be classified into subtypes including the most common types: essential, enhanced physiological, and parkinsonian tremor. Myoclonus classification is based on its anatomic origin: cortical, subcortical, spinal, and peripheral myoclonus. The clinical presentations are unfortunately not always classic and electrophysiologic investigations can be helpful in making a phenotypic diagnosis. Video-polymyography is the main technique to (sub)classify the involuntary movements. In myoclonus, advanced electrophysiologic testing, such as back-averaging, coherence analysis, somatosensory-evoked potentials, and the C-reflex can be of additional value. Recent developments in tremor point toward a role for intermuscular coherence analysis to differentiate between tremor subtypes. Classification of the movement disorder based on clinical and electrophysiologic features is important, as it enables the search for an etiological diagnosis and guides tailored treatment.
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Affiliation(s)
- R Zutt
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - J W Elting
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
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Gelauff JM, Rosmalen JGM, Gardien J, Stone J, Tijssen MAJ. Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord 2019; 70:1-6. [PMID: 31785442 DOI: 10.1016/j.parkreldis.2019.11.018] [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: 04/29/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Functional motor disorders are often delineated according to the dominant motor symptom. In a large cohort, we aimed to find if there were differences in demographics, mode of onset, pain, fatigue, depression and anxiety and levels of physical functioning, quality of life and social adjustment between patients with different dominant motor symptoms. METHODS Baseline data from the Self-Help and Education on the Internet for Functional Motor Disorders Trial was used. Patients were divided into dominant motor symptom groups based on the diagnosis of the referring neurologist. Data on the above topics were collected by means of an online questionnaire and compared between groups using parametric and nonparametric statistics. RESULTS In 160 patients a dominant motor symptom could be determined, 31 had tremor, 45 myoclonus, 23 dystonia, 30 paresis, 31 gait disorder. No statistical differences between groups were detected for demographics, mode of onset and severity of pain, fatigue, depression and anxiety. Physical functioning was worse in the gait disorder group (median 20, IQR 25) compared to tremor (50 (55), p = 0.002) and myoclonus (50 (52), p = 0.001). Work and social adjustment was less impaired in the myoclonus group (median 20, IQR 18) compared to gait disorder (median 30, IQR18, p < 0.001) and paresis (28, IQR 10, p = 0.001). Self-report showed large overlap in motor symptoms. CONCLUSION No differences were detected between groups of functional motor symptoms, regarding demographics, mode of onset, depression, anxiety, pain and fatigue. The large overlap in symptoms contributes to the hypothesis of shared underlying mechanisms of functional motor disorders.
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Affiliation(s)
- J M Gelauff
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands
| | - J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, the Netherlands
| | - J Gardien
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands
| | - J Stone
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom
| | - M A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands.
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Brandsma R, Verschuuren-Bemelmans CC, Amrom D, Barisic N, Baxter P, Bertini E, Blumkin L, Brankovic-Sreckovic V, Brouwer OF, Bürk K, Catsman-Berrevoets CE, Craiu D, de Coo IFM, Gburek J, Kennedy C, de Koning TJ, Kremer HPH, Kumar R, Macaya A, Micalizzi A, Mirabelli-Badenier M, Nemeth A, Nuovo S, Poll-The B, Lerman-Sagie T, Steinlin M, Synofzik M, Tijssen MAJ, Vasco G, Willemsen MAAP, Zanni G, Valente EM, Boltshauser E, Sival DA. A clinical diagnostic algorithm for early onset cerebellar ataxia. Eur J Paediatr Neurol 2019; 23:692-706. [PMID: 31481303 DOI: 10.1016/j.ejpn.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/22/2019] [Revised: 05/25/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Early onset cerebellar Ataxia (EOAc) comprises a large group of rare heterogeneous disorders. Determination of the underlying etiology can be difficult given the broad differential diagnosis and the complexity of the genotype-phenotype relationships. This may change the diagnostic work-up into a time-consuming, costly and not always rewarding task. In this overview, the Childhood Ataxia and Cerebellar Group of the European Pediatric Neurology Society (CACG-EPNS) presents a diagnostic algorithm for EOAc patients. In seven consecutive steps, the algorithm leads the clinician through the diagnostic process, including EOA identification, application of the Inventory of Non-Ataxic Signs (INAS), consideration of the family history, neuro-imaging, laboratory investigations, genetic testing by array CGH and Next Generation Sequencing (NGS). In children with EOAc, this algorithm is intended to contribute to the diagnostic process and to allow uniform data entry in EOAc databases.
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Affiliation(s)
- R Brandsma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - C C Verschuuren-Bemelmans
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - D Amrom
- Department of Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Neurology Unit, Kannerklinik Centre Hospitalier de Luxembourg, Luxembourg, Grand Duchy of Luxembourg
| | - N Barisic
- Department of Pediatrics, Clinical Medical Centre Zagreb, University of Zagreb Medical School, Croatia
| | - P Baxter
- Department of Paediatric Neurology, Sheffield Children's Hospital, UK
| | - E Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - L Blumkin
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - V Brankovic-Sreckovic
- Clinic for Child Neurology and Psychiatry, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - O F Brouwer
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K Bürk
- Paracelsus-Elena-Klinik Kassel, University of Marburg, Germany
| | - C E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus University Hospital/Sophia Children's Hospital, Rotterdam, the Netherlands
| | - D Craiu
- Carol Davila University of Medicine Bucharest, Department of Clinical Neurosciences, Pediatric Neurology II Discipline, Alexandru Obregia Hospital, Bucharest, Romania
| | - I F M de Coo
- Department of Genetics and Cell Biology, University of Maastricht, Maastricht, the Netherlands
| | - J Gburek
- Centre for Paediatrics and Adolescent Medicine, Hannover Medical School, Hannover, Germany
| | - C Kennedy
- Clinical Neurosciences, Faculty of Medicine, University of Southampton, UK
| | - T J de Koning
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R Kumar
- Department of Pediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Macaya
- Grup de Recerca en Neurologia Pediàtrica, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Secció de Neurologia Pediàtrica, Hospital Universitari Vall d'Hebron, 08002, Barcelona, Spain
| | - A Micalizzi
- Laboratory of Medical Genetics, Bambino Gesu Children's Hospital, Rome, Italy
| | - M Mirabelli-Badenier
- DINOGMI Department-University of Genoa/Unit of Child Neuropsychiatry, G. Gaslini Institute, Genoa, Italy
| | - A Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - S Nuovo
- Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - B Poll-The
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Centre (AMC), University of Amsterdam, the Netherlands
| | - T Lerman-Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G Vasco
- Division of Neurorehabilitation, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - M A A P Willemsen
- Department of Pediatric Neurology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - G Zanni
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, Rome, Italy
| | - E M Valente
- Neurogenetics Unit, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - E Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
| | - D A Sival
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Doldersum E, van Zijl JC, Beudel M, Eggink H, Brandsma R, Piña-Fuentes D, van Egmond ME, Oterdoom DLM, van Dijk JMC, Elting JWJ, Tijssen MAJ. Intermuscular coherence as biomarker for pallidal deep brain stimulation efficacy in dystonia. Clin Neurophysiol 2019; 130:1351-1357. [PMID: 31207566 DOI: 10.1016/j.clinph.2019.04.717] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/07/2018] [Revised: 03/17/2019] [Accepted: 04/10/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Finding a non-invasive biomarker for Globus Pallidus interna Deep Brain Stimulation (GPi-DBS) efficacy. Dystonia heterogeneity leads to a wide variety of clinical response to GPi-DBS, making it hard to predict GPi-DBS efficacy for individual patients. METHODS EEG-EMG recordings of twelve dystonia patients who received bilateral GPi-DBS took place pre- and 1 year post-surgery ON and OFF stimulation, during a rest, pinch, and flexion task. Dystonia severity was assessed using the BFMDRS and TWSTRS (pre- and post-surgery ON stimulation). Intermuscular coherence (IMC) and motorcortex corticomuscular coherence (CMC) were calculated. Low frequency (4-12 Hz) and beta band (13-30 Hz) peak coherences were studied. RESULTS Dystonia severity improved after 1 year GPi-DBS therapy (BFMDRS: 30%, median 7.8 (IQR 3-10), TWSTRS: 22%, median 6.8 (IQR 4-9)). 86% of IMC were above the 95% confidence limit. The highest IMC peak decreased significantly with GPi-DBS in the low frequency and beta band. Low frequency and beta band IMC correlated partly with dystonia severity and severity improvement. CMC generally were below the 95% confidence limit. CONCLUSIONS Peak low frequency IMC functioned as biomarker for GPi-DBS efficacy, and partly correlated with dystonia severity. SIGNIFICANCE IMC can function as biomarker. Confirmation in a larger study is needed for use in clinical practice.
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Affiliation(s)
- E Doldersum
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - J C van Zijl
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - M Beudel
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - H Eggink
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - R Brandsma
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - D Piña-Fuentes
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands; Department of Neurosurgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - M E van Egmond
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - D L M Oterdoom
- Department of Neurosurgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - J M C van Dijk
- Department of Neurosurgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - J W J Elting
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands; Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
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Kuiper MJ, Brandsma R, Vrijenhoek L, Tijssen MAJ, Burger H, Dan B, Sival DA. Physiological movement disorder-like features during typical motor development. Eur J Paediatr Neurol 2018; 22:595-601. [PMID: 29680266 DOI: 10.1016/j.ejpn.2018.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/09/2017] [Revised: 03/01/2018] [Accepted: 03/25/2018] [Indexed: 11/25/2022]
Abstract
AIM To compare physiological age-relatedness between dyskinesia (dystonia/choreoathetosis), dystonia and ataxia rating scale scores in healthy children. METHOD Three movement disorders specialists quantified dyskinetic-like features in healthy children (n = 52; 4-16 years) using the Dyskinesia Impairment Scale (DIS = DIS-choreoathetosis (DIS-C) + DIS-dystonia (DIS-D)). We compared the age-related regression coefficients of the DIS with data processed from previous studies on dystonia and ataxia rating scales (Burke-Fahn-Marsden Movement and Disability Scales (BFMMS and BFMDS) and Scale for Assessment and Rating of Ataxia (SARA), International Cooperative Ataxia Rating Scale (ICARS) and Brief Ataxia Rating Scale (BARS)). RESULTS Dyskinetic scores were obtained in 79% (DIS); 65% (DIS-D) and 17% (DIS-C) versus dystonic and ataxic scores in 98% (BFMMS) and 89% (SARA/ICARS/BARS) of the children. Age-related DIS and DIS-D scores (B = -0.90 and 0.77; p < 0.001) were correlated with age-related BFMMS scores (B = -0.49; p < 0.001; r = 0.87; p < 0.001), whereas DIS-C scores were age-independent. Ataxic scores revealed stronger age-related regression coefficients than dyskinetic and dystonic scores (4-8 years; p < 0.05). INTERPRETATION In healthy children, comparison between physiological dyskinesia, dystonia and ataxia rating scale scores revealed: 1. inverse age-relatedness for dystonic and ataxic scores, but not for choreoathetotic scores, 2. interrelated dystonic DIS-D and BFMMS scores, 3. the strongest age-related expression by ataxic scores. In healthy children, these physiological movement disorder-like features are interpreted as an expression of the developing underlying motor centres.
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Affiliation(s)
- M J Kuiper
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Brandsma
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - L Vrijenhoek
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - H Burger
- Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands
| | - B Dan
- Université Libre de Bruxelles (ULB), Department of Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium; Revalidatieziekenhuis Inkendaal, Vlezenbeek, Belgium
| | - D A Sival
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, The Netherlands.
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14
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Beudel M, Zutt R, Meppelink AM, Little S, Elting JW, Stelten BML, Edwards M, Tijssen MAJ. Improving neurophysiological biomarkers for functional myoclonic movements. Parkinsonism Relat Disord 2018; 51:3-8. [PMID: 29653908 PMCID: PMC6022215 DOI: 10.1016/j.parkreldis.2018.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/08/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
Abstract
Introduction Differentiating between functional jerks (FJ) and organic myoclonus can be challenging. At present, the only advanced diagnostic biomarker to support FJ is the Bereitschaftspotential (BP). However, its sensitivity is limited and its evaluation subjective. Recently, event related desynchronisation in the broad beta range (13–45 Hz) prior to functional generalised axial (propriospinal) myoclonus was reported as a possible complementary diagnostic marker for FJ. Here we study the value of ERD together with a quantified BP in clinical practice. Methods Twenty-nine patients with FJ and 16 patients with cortical myoclonus (CM) were included. Jerk-locked back-averaging for determination of the ‘classical’ and quantified BP, and time-frequency decomposition for the event related desynchronisation (ERD) were performed. Diagnostic gain, sensitivity and specificity were obtained for individual and combined techniques. Results We detected a classical BP in 14/29, a quantitative BP in 15/29 and an ERD in 18/29 patients. At group level we demonstrate that ERD in the broad beta band preceding a jerk has significantly higher amplitude in FJ compared to CM (respectively −0.14 ± 0.13 and +0.04 ± 0.09 (p < 0.001)). Adding ERD to the classical BP achieved an additional diagnostic gain of 53%. Furthermore, when combining ERD with quantified and classical BP, an additional diagnostic gain of 71% was achieved without loss of specificity. Conclusion Based on the current findings we propose to the use of combined beta ERD assessment and quantitative BP analyses in patients with a clinical suspicion for all types of FJ with a negative classical BP. Differentiating between functional jerks and organic myoclonus is often difficult. The sensitivity of a positive bereitschaftspotential for diagnosing FJ is low. FJ are preceded by event related desynchronisation (ERD) in the beta band. Combining beta ERD and BP improves diagnosing FJ. The ERD method is of special relevance in possible FJ patients with a negative BP.
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Affiliation(s)
- M Beudel
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB, Groningen, The Netherlands
| | - R Zutt
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB, Groningen, The Netherlands; Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - A M Meppelink
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB, Groningen, The Netherlands
| | - S Little
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - J W Elting
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB, Groningen, The Netherlands
| | - B M L Stelten
- Canisius-Wilhelmina Hospital, Department of Neurology, Nijmegen, The Netherlands
| | - M Edwards
- Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | - M A J Tijssen
- University Groningen, University Medical Center Groningen, Department of Neurology, NL-9700 RB, Groningen, The Netherlands.
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15
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Tamás G, Abrantes C, Valadas A, Radics P, Albanese A, Tijssen MAJ, Ferreira JJ. Quality and reporting of guidelines on the diagnosis and management of dystonia. Eur J Neurol 2017; 25:275-283. [PMID: 29053896 DOI: 10.1111/ene.13488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/16/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The quality of clinical practice guidelines on dystonia has not yet been assessed. Our aim was to appraise the methodological quality of guidelines worldwide and to analyze the consistency of their recommendations. METHODS We searched for clinical practice guidelines on dystonia diagnosis/treatment in the National Guideline Clearinghouse, PubMed, National Institute for Health and Care Excellence, Guidelines International Network and Web of Science databases. We also searched for guidelines on homepages of international neurological societies. We asked for guidelines from every Management Committee member of the BM1101 Action of the Cooperation between Science and Technology European framework and every member of the International Parkinson and Movement Disorders Society with special interest in dystonia. RESULTS Fifteen guidelines were evaluated. Among guidelines on treatment, only one from the American Academy of Neurology could be considered as high quality. Among guidelines on diagnosis and therapy, the guideline from the European Federation of Neurological Societies was recommended by the appraisers. Clinical applicability and reports of editorial independence were the greatest shortcomings. The rigor of development was poor and stakeholder involvement was also incomplete in most guidelines. Discrepancies among recommendations may result from the weight given to consensus statements and expert opinions due to the lack of evidence, as well as inaccuracy of disease classification. CONCLUSIONS The quality of appraised guidelines was low. It is necessary to improve the quality of guidelines on dystonia, and the applied terminology of dystonia also needs to be standardized.
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Affiliation(s)
- G Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - C Abrantes
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon
| | - A Valadas
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon.,Neurology Service, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - P Radics
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - A Albanese
- Istituto Clinico Humanitas and Universita Cattolica del Sacro Cuore, Milan, Rozzano, Italy
| | - M A J Tijssen
- Department of Neurology, University of Groningen, Groningen, the Netherlands
| | - J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon.,Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon
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Peall KJ, Lorentzos MS, Heyman I, Tijssen MAJ, Owen MJ, Dale RC, Kurian MA. A review of psychiatric co-morbidity described in genetic and immune mediated movement disorders. Neurosci Biobehav Rev 2017; 80:23-35. [PMID: 28528196 DOI: 10.1016/j.neubiorev.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/21/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022]
Abstract
Psychiatric symptoms are an increasingly recognised feature of movement disorders. Recent identification of causative genes and autoantibodies has allowed detailed analysis of aetiologically homogenous subgroups, thereby enabling determination of the spectrum of psychiatric symptoms in these disorders. This review evaluates the incidence and type of psychiatric symptoms encountered in patients with movement disorders. A broad spectrum of psychiatric symptoms was identified across all subtypes of movement disorder, with depression, generalised anxiety disorder and obsessive-compulsive disorder being most common. Psychosis, schizophrenia and attention deficit hyperactivity disorder were also identified, with the psychiatric symptoms often predating onset of the motor disorder. The high incidence of psychiatric symptoms across such a wide range of movement disorders suggests a degree of common or overlapping pathogenic mechanisms. Our review demonstrates the need for increased clinical awareness of such co-morbidities, which should facilitate early neuropsychiatric intervention and allied specialist treatment for patients.
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Affiliation(s)
- K J Peall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK.
| | - M S Lorentzos
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - I Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital, London, UK; Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK
| | - M A J Tijssen
- Department of Neurology, University of Groningen, Groningen, The Netherlands
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK
| | - R C Dale
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - M A Kurian
- Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK.
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17
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van de Zande NA, Massey TH, McLauchlan D, Pryce Roberts A, Zutt R, Wardle M, Payne GC, Clenaghan C, Tijssen MAJ, Rosser AE, Peall KJ. Clinical characterization of dystonia in adult patients with Huntington's disease. Eur J Neurol 2017; 24:1140-1147. [PMID: 28661018 DOI: 10.1111/ene.13349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/03/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Huntington's disease (HD) is an autosomal dominant, neurodegenerative movement disorder, typically characterized by chorea. Dystonia is also recognized as part of the HD motor phenotype, although little work detailing its prevalence, distribution, severity and impact on functional capacity has been published to date. METHODS Patients (>18 years of age) were recruited from the Cardiff (UK) HD clinic, each undergoing a standardized videotaped clinical examination and series of functional assessment questionnaires (Unified Huntington's Disease Rating Scale, Burke-Fahn-Marsden Dystonia Rating Scale and modified version of the Toronto Western Spasmodic Torticollis Rating Scale). The presence and severity of dystonia were scored by four independent neurologists using the Burke-Fahn-Marsden Dystonia Rating Scale and Unified Huntington's Disease Rating Scale. Statistical analysis included Fisher's exact test, Wilcoxon test, anova and calculation of correlation coefficients where appropriate. RESULTS Forty-eight patients [91% (48/53)] demonstrated evidence of dystonia, with the highest prevalence in the left upper limb (n = 44, 83%), right upper limb most severely affected and eyes least affected. Statistically significant positive correlations (P < 0.05) were observed between dystonia severity and increasing HD disease stage and motor disease duration. Deterioration in functional capacity also correlated with increasing dystonia severity. No significant relationship was observed with age at motor symptom onset or CAG repeat length. CONCLUSIONS We report a high prevalence of dystonia in adult patients with HD, with worsening dystonia severity with increasing HD disease stage and motor disease duration. The recognition and management of dystonic symptoms in routine clinical practice will aid overall symptomatic treatment and functional improvement.
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Affiliation(s)
- N A van de Zande
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- Faculty of Medical Science, University of Groningen, Groningen, The Netherlands
| | - T H Massey
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - D McLauchlan
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - A Pryce Roberts
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - R Zutt
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - M Wardle
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
| | - G C Payne
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff
| | - C Clenaghan
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - M A J Tijssen
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - A E Rosser
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
- Cardiff University Brain Repair Group, School of Biosciences, Cardiff, UK
| | - K J Peall
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
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18
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Zoons E, Tijssen MAJ, Dreissen YEM, Speelman JD, Smit M, Booij J. The relationship between the dopaminergic system and depressive symptoms in cervical dystonia. Eur J Nucl Med Mol Imaging 2017; 44:1375-1382. [PMID: 28314910 PMCID: PMC5486819 DOI: 10.1007/s00259-017-3664-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/23/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Cervical dystonia (CD) is associated with tremor/jerks (50%) and psychiatric complaints (17-70%). The dopaminergic system has been implicated in the pathophysiology of CD in animal and imaging studies. Dopamine may be related to the motor as well as non-motor symptoms of CD. CD is associated with reduced striatal dopamine D2/3 (D2/3) receptor and increased dopamine transporter (DAT) binding. There are differences in the dopamine system between CD patients with and without jerks/tremor and psychiatric symptoms. METHODS Patients with CD and healthy controls underwent neurological and psychiatric examinations. Striatal DAT and D2/3 receptor binding were assessed using [123I]FP-CIT and [123I]IBZM SPECT, respectively. The ratio of specific striatal to non-specific binding (binding potential; BPND) was the outcome measure. RESULTS Twenty-seven patients with CD and 15 matched controls were included. Nineteen percent of patients fulfilled the criteria for a depression. Striatal DAT BPND was significantly lower in depressed versus non-depressed CD patients. Higher DAT BPND correlated significantly with higher scores on the Unified Myoclonus Rating Scale (UMRS). The striatal D2/3 receptor BPND in CD patients showed a trend towards lower binding compared to controls. The D2/3 BPND was significantly lower in depressed versus non-depressed CD patients. A significant correlation between DAT and D2/3R BPND was found in both in patients and controls. CONCLUSIONS Alterations of striatal DAT and D2/3 receptor binding in CD patients are related mainly to depression. DAT BPND correlates significantly with scores on the UMRS, suggesting a role for dopamine in the pathophysiology of tremor/jerks in CD.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre, Groningen, The Netherlands
| | - Y E M Dreissen
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J D Speelman
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Smit
- Department of Neurology, University Medical Centre, Groningen, The Netherlands
| | - J Booij
- Department of Nuclear Medicine, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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19
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Kuiper A, van Egmond ME, Harms MPM, Oosterhoff MD, van Harten B, Sival DA, de Koning TJ, Tijssen MAJ. Clinical Pearls - how my patients taught me: The fainting lark symptom. J Clin Mov Disord 2016; 3:16. [PMID: 27822381 PMCID: PMC5090888 DOI: 10.1186/s40734-016-0045-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Compulsive movements, complex tics and stereotypies are frequent, especially among patients with autism or psychomotor retardation. These movements can be difficult to characterize and can mimic other conditions like epileptic seizures or paroxysmal dystonia, particularly when abnormal breathing and cerebral hypoxia are induced. CASE PRESENTATION We describe an 18-year-old patient with Asperger syndrome who presented with attacks of tonic posturing of the trunk and neck. The attacks consisted of self-induced stereotypic stretching of the neck combined with a compulsive Valsalva-like maneuver. This induced cerebral hypoperfusion and subsequently dysautonomia and some involuntary movements of the arms. CONCLUSION This patient suffered from a complex tic with compulsive respiratory stereotypies. His symptoms contain aspects of a phenomenon described in early literature as 'the fainting lark'.
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Affiliation(s)
- A Kuiper
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands
| | - M E van Egmond
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands
| | - M P M Harms
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M D Oosterhoff
- Jonx Department of Youth Mental Health, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - B van Harten
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - D A Sival
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T J de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands ; Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands
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20
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Koens LH, Kuiper A, Coenen MA, Elting JWJ, de Vries JJ, Engelen M, Koelman JHTM, van Spronsen FJ, Spikman JM, de Koning TJ, Tijssen MAJ. Ataxia, dystonia and myoclonus in adult patients with Niemann-Pick type C. Orphanet J Rare Dis 2016; 11:121. [PMID: 27581084 PMCID: PMC5007743 DOI: 10.1186/s13023-016-0502-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 06/01/2016] [Accepted: 08/12/2016] [Indexed: 11/14/2022] Open
Abstract
Background Niemann-Pick type C (NP-C) is a rare autosomal recessive progressive neurodegenerative disorder caused by mutations in the NP-C 1 or 2 gene. Besides visceral symptoms, presentation in adolescent and adult onset variants is often with neurological symptoms. The most frequently reported presenting symptoms of NP-C in adulthood are psychiatric symptoms (38 %), cognitive decline (23 %) and ataxia (20 %). Myoclonus can be present, but its value in early diagnosis and the evolving clinical phenotype in NP-C is unclear. In this paper we present eight Dutch cases of NP-C of whom five with myoclonus. Methods Eight patients with genetically confirmed NP-C were recruited from two Dutch University Medical Centers. A structured interview and neuropsychological tests (for working and verbal memory, attention and emotion recognition) were performed. Movement disorders were assessed using a standardized video protocol. Quality of life was evaluated by questionnaires (Rand-36, SIP-68, HAQ). In four of the five patients with myoclonic jerks simultaneous EEG with EMG was performed. Results A movement disorder was the initial neurological symptom in six patients: three with myoclonus and three with ataxia. Two others presented with psychosis. Four experienced cognitive deficits early in the course of the disease. Patients showed cognitive deficits in all investigated domains. Five patients showed myoclonic jerks, including negative myoclonus. In all registered patients EEG-EMG coherence analysis and/or back-averaging proved a cortical origin of myoclonus. Patients with more severe movement disorders experienced significantly more physical disabilities. Conclusions Presenting neurological symptoms of NP-C include movement disorders, psychosis and cognitive deficits. At current neurological examination movement disorders were seen in all patients. The incidence of myoclonus in our cohort was considerably higher (63 %) than in previous publications and it was the presenting symptom in 38 %. A cortical origin of myoclonus was demonstrated. Our data suggest that myoclonus may be overlooked in patients with NP-C. All patients scored significantly lower on physical domains of HRQoL. Symptomatic treatment of movement disorders may improve physical functioning and subsequently HRQoL.
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Affiliation(s)
- L H Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - A Kuiper
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - M A Coenen
- Department of Clinical Neuropsychology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - J W J Elting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - J J de Vries
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - M Engelen
- Department of Neurology, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J H T M Koelman
- Department of Neurology, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - J M Spikman
- Department of Clinical Neuropsychology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Faculty of Behavioral and Social Sciences, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - T J de Koning
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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Kuiper A, Eggink H, Tijssen MAJ, de Koning TJ. Neurometabolic disorders are treatable causes of dystonia. Rev Neurol (Paris) 2016; 172:455-464. [PMID: 27561437 DOI: 10.1016/j.neurol.2016.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/08/2016] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 01/16/2023]
Abstract
A broad range of rare inherited metabolic disorders can present with dystonia. For clinicians, it is important to recognize dystonic features, but it can be complicated by the mixed and complex clinical picture seen in many neurometabolic patients. Careful phenotyping is the first step towards the diagnosis of the underlying condition and subsequent targeted treatment, further supported by imaging, biochemical diagnostics and the availability of modern diagnostic techniques such as next generation sequencing. As several neurometabolic disorders are treatable causes of dystonia, these should have priority in the diagnostic process. In the symptomatic treatment of dystonia, several therapeutic options are available. Awareness for the occurrence and optimal treatment of dystonia and other movement disorders in neurometabolic conditions is important because these symptoms can have a substantial impact on the quality of life and daily functioning; this effect is not only exerted by the dystonia itself, but also by the frequently associated non-motor features. In this paper, the highlights and key concepts of neurometabolic forms of dystonia are discussed, with a focus on phenomenology, the diagnostic approach, the most important neurometabolic aetiologies, co-occurring non-motor features and therapeutic options.
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Affiliation(s)
- A Kuiper
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Eggink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T J de Koning
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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van der Stouwe AMM, Elting JW, van der Hoeven JH, van Laar T, Leenders KL, Maurits NM, Tijssen MAJ. How typical are 'typical' tremor characteristics? Sensitivity and specificity of five tremor phenomena. Parkinsonism Relat Disord 2016; 30:23-8. [PMID: 27346607 DOI: 10.1016/j.parkreldis.2016.06.008] [Citation(s) in RCA: 36] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 05/25/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Distinguishing between different tremor disorders can be challenging. Some tremor disorders are thought to have typical tremor characteristics: the current study aims to provide sensitivity and specificity for five 'typical' tremor phenomena. METHODS Retrospectively, we examined 210 tremor patients referred for electrophysiological recordings between January 2008 and January 2014. The final clinical diagnosis was used as the gold standard. The first step was to determine whether patients met neurophysiological criteria for their type of tremor. Once established, we focused on 'typical' characteristics: tremor frequency decrease upon loading (enhanced physiological tremor (EPT)), amplitude increase upon loading, distractibility and entrainment (functional tremor (FT)), and intention tremor (essential tremor (ET)). The prevalence of these phenomena in the 'typical' group was compared to the whole group. RESULTS Most patients (87%) concurred with all core clinical neurophysiological criteria for their tremor type. We found a frequency decrease upon loading to be a specific (95%), but not a sensitive (42%) test for EPT. Distractibility and entrainment both scored high on sensitivity (92%, 91%) and specificity (94%, 91%) in FT, whereas a tremor amplitude increase was specific (92%), but not sensitive (22%). Intention tremor was a specific finding in ET (85%), but not a sensitive test (45%). Combination of characteristics improved sensitivity. CONCLUSION In this study, we retrospectively determined sensitivity and specificity for five 'typical' tremor characteristics. Characteristics proved specific, but few were sensitive. These data on tremor phenomenology will help practicing neurologists to improve distinction between different tremor disorders.
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Affiliation(s)
- A M M van der Stouwe
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Neurology, Isala Clinics, Zwolle, The Netherlands.
| | - J W Elting
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Neurophysiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J H van der Hoeven
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Neurophysiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K L Leenders
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N M Maurits
- Department of Clinical Neurophysiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
Functional jerks are among the most common functional movement disorders. The diagnosis of functional jerks is mainly based on neurologic examination revealing specific positive clinical signs. Differentiation from other jerky movements, such as tics, organic myoclonus, and primary paroxysmal dyskinesias, can be difficult. In support of a functional jerk are: acute onset in adulthood, precipitation by a physical event, variable, complex, and inconsistent phenomenology, suggestibility, distractibility, entrainment and a Bereitschaftspotential preceding the movement. Although functional jerks and tics share many similarities, characteristics differentiating tics from functional jerks are: urge preceding the tic, childhood onset, rostrocaudal development of the symptoms, a positive family history of tics, attention-deficit hyperactivity disorder or obsessive-compulsive symptoms, and response to dopamine antagonist medication. To differentiate functional jerks from organic myoclonus, localization of the movements can give direction. Further features in support of organic myoclonus include: insidious onset, simple and consistent phenomenology, and response to benzodiazepines or antiepileptic medication. Primary paroxysmal dyskinesias and functional jerks share a paroxysmal nature. Leading in the differentiation between the two are: a positive family history, in combination with video recordings revealing a consistent symptom pattern in primary paroxysmal dyskinesias. In this chapter functional jerks and their differential diagnoses will be discussed in terms of epidemiology, symptom characteristics, disease course, psychopathology, and supportive neurophysiologic tests.
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Affiliation(s)
- Y E M Dreissen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - D C Cath
- Department of Clinical and Health Psychology, Utrecht University/Altrecht, Utrecht, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands.
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Abstract
INTRODUCTION Dystonia is a movement disorder involving sustained or intermittent muscle contractions resulting in abnormal movements and postures. Identification of disease causing genes has allowed examination of genetically homogenous groups. Unlike the motor symptoms, non-motor characteristics are less clearly defined, despite their impact on a patient's quality of life. This review aims to examine the evidence for non-motor symptoms, addressing cohort size and methods of assessment in each study. METHODS A systematic and standardised search strategy was used to identify the published literature relating to psychiatric symptoms, cognition, sleep disorders, sensory abnormalities and pain in each of the genetically determined dystonias. Studies were divided according to cohort size, method of assessment and whether comparison was made to an appropriate control group. RESULTS Ninety-five articles were identified including reported clinical histories (n = 42), case reports and smaller case series (n = 12), larger case series (n = 23) and case-control cohorts (n = 18). Psychiatric symptoms were the most frequently investigated with anxiety, depression and Obsessive-Compulsive disorder being most common. Cognitive impairment involved either global deficits or isolated difficulties in specific domains. Disturbances to sleep were most common in the dopa-responsive dystonias. Sensory testing in DYT1 cases identified an intermediate subclinical phenotype. CONCLUSION Non-motor symptoms form an integral component of the dystonia phenotype. However, future studies should involve a complete assessment of all symptom subtypes in order to understand the frequency and gene-specificity of these symptoms. This will enable early symptom identification, appropriate clinical management, and provide additional outcome measures in future clinical trials.
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Affiliation(s)
- K J Peall
- Department of Neurology, University of Groningen, Groningen, The Netherlands; Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK.
| | - A Kuiper
- Department of Neurology, University of Groningen, Groningen, The Netherlands.
| | - T J de Koning
- Department of Neurology, University of Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands.
| | - M A J Tijssen
- Department of Neurology, University of Groningen, Groningen, The Netherlands.
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van Zijl JC, Beudel M, vd Hoeven HJ, Lange F, Tijssen MAJ, Elting JWJ. Electroencephalographic Findings in Posthypoxic Myoclonus. J Intensive Care Med 2015; 31:270-5. [PMID: 25670725 DOI: 10.1177/0885066615571533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 06/03/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
Abstract
The physical examination findings of early posthypoxic myoclonus (PHM) are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM. Generalized PHM, assumed to have a subcortical myoclonus origin, is still associated with a bad clinical outcome. It is not known whether the electroencephalographic (EEG) findings differ between the multifocal and generalized myoclonus groups nor is the clinical significance clearly defined. Forty-three patients with PHM were retrospectively derived from an EEG database. Patients were categorized as having multifocal (i), generalized (ii), or undetermined (iii) PHM. Outcome was expressed in cerebral performance category scores. The EEG background was categorized into isoelectric (I), low voltage (II), burst suppression (III), status epilepticus (SE; IV), diffuse slowing (V), and mild encephalopathic or normal (VI). 17 patients had generalized PHM and 23 had multifocal PHM (3 undetermined). The EEG showed more SE in generalized compared to multifocal PHM (64% vs 13%, P< .001). Diffuse slowing was more often present in multifocal PHM (52% vs 17%, P < .05). Early-onset myoclonus occurred significantly more often in generalized PHM, and early generalized PHM was invariantly associated with poor outcome. In conclusion, patients with generalized PHM showed more SE. These EEG findings might be either subcortical corollaries or primarily cortical phenomena. Our retrospective results conflict with currently used clinical criteria for myoclonus classification, and we suggest that more refined difference may be needed for accurate assessment of PHM. To better understand PHM, prospective research with standardized clinical assessment and quantitative EEG analysis is needed.
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Affiliation(s)
- J C van Zijl
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - M Beudel
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - H J vd Hoeven
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - F Lange
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
| | - J W J Elting
- Department of Neurology, University Medical Groningen, University of Groningen, Groningen, the Netherlands Department of Clinical Neurophysiology, University Medical Groningen, University of Groningen, Groningen, the Netherlands
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Mentzel CL, Tenback DE, Tijssen MAJ, van Harten PN. [Severe treatment-resistant tardive dystonia: is deep brain stimulation a treatment option]. Tijdschr Psychiatr 2015; 57:125-131. [PMID: 25669951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Severe tardive dyskinesia or dystonia (TD) are side-effects of dopamine-blocking agents, most of which are antipsychotics. A small subgroup of patients develop a severe debilitating treatment-resistant form of TD. AIM To assess the effects and side-effects of deep brain stimulation (DBS) in this subgroup of TD patients. METHOD We searched PubMed and Embase using the search terms 'tardive' and 'deep brain stimulation'. We found 19 articles containing data referring to 52 patients. Using the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS), the Abnormal Involuntary Movement Scale (AIMS) and the Extrapyramidal Symptoms Rating Scale (ESRS) we calculated the average improvement in the patients' condition. RESULTS On all the scales the improvement was statistically significant (p < 0.00001), the average improvement being 67% to 78%. In only 4% of the patients was there a deterioration in the psychiatric disorder. CONCLUSION DBS seems to be an effective treatment for treatment-resistant TD and the side-effects seem to be limited. However, the evidence is limited because our conclusion is based on case-reports and on small-scale trials without randomisation or blinding.
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Zoons E, Tijssen MAJ. Pathologic changes in the brain in cervical dystonia pre- and post-mortem - a commentary with a special focus on the cerebellum. Exp Neurol 2013; 247:130-3. [PMID: 23597638 DOI: 10.1016/j.expneurol.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 02/11/2013] [Revised: 03/28/2013] [Accepted: 04/07/2013] [Indexed: 10/27/2022]
Abstract
In a recent issue of Experimental Neurology, Prudente et al. (2012) investigated the neuropathology of cervical dystonia in six patients. Their most important finding was a patchy loss of cerebellar Purkinje cells in the cerebellum. In this article we discuss their findings in the context of a review including primary and secondary cervical dystonia. An update is given of the current knowledge on structural and functional brain abnormalities in idiopathic cervical dystonia with a special focus on the cerebellum.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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Nijmeijer SWR, Koelman JHTM, Standaar TSM, Postma M, Tijssen MAJ. Cervical dystonia: improved treatment response to botulinum toxin after referral to a tertiary centre and the use of polymyography. Parkinsonism Relat Disord 2013; 19:533-8. [PMID: 23466060 DOI: 10.1016/j.parkreldis.2013.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/15/2013] [Accepted: 01/21/2013] [Indexed: 12/19/2022]
Abstract
RATIONALE Cervical dystonia is the most common form of (primary) dystonia. The first line of treatment for cervical dystonia is intramuscular injections with botulinum toxin. To optimise the response to botulinum toxin proper muscles selection is required. Pre-treatment polymyographic EMG in addition to clinical evaluation is hypothesised to be a good tool to improve muscle selection and treatment outcome. OBJECTIVE To determine the efficacy of botulinum toxin treatment after adjacent polymyographic EMG in cervical dystonia patients referred to our tertiary referral centre with an unsatisfactory response to botulinum toxin treatment elsewhere. METHODS We performed a retrospective analysis of 40 consecutive second opinion cervical dystonia patients. Standard polymyographic EMG was performed before treatment. We retrieved the Tsui scores and subjective evaluations from the first visit, after 12 weeks and after one year of treatment. In addition, we assessed the final outcome of treatment in our centre based on the records and asked the patients for their personal opinion about the effect of referral to our centre on their treatment response. RESULTS After one year of treatment there was a significant improvement on both the Tsui scores (p < 0.01) and the subjective treatment evaluation (p < 0.001.) On their last visit 60% of the patients still continued treatment with a reasonable to good response. CONCLUSION A substantial amount of CD patients with an unsatisfactory response to botulinum toxin improved after polymyography and subsequent treatment with botulinum toxin in a tertiary referral centre.
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Affiliation(s)
- S W R Nijmeijer
- Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, Amsterdam, The Netherlands.
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Zoons E, Booij J, Nederveen AJ, Dijk JM, Tijssen MAJ. Structural, functional and molecular imaging of the brain in primary focal dystonia--a review. Neuroimage 2011; 56:1011-20. [PMID: 21349339 DOI: 10.1016/j.neuroimage.2011.02.045] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 12/31/2022] Open
Abstract
Primary focal dystonias form a group of neurological disorders characterized by involuntary, sustained muscle contractions causing twisting movements and abnormal postures. The estimated incidence is 12-25 per 100,000. The pathophysiology is largely unclear but genetic and environmental influences are suspected. Over the last decade neuroimaging techniques have been applied in patients with focal dystonia. Using structural, functional and molecular imaging techniques, abnormalities have been detected mainly in the sensorimotor cortex, basal ganglia and cerebellum. The shared anatomical localisations in different forms of focal dystonia support the hypothesis of a common causative mechanism. The primary defect in focal dystonia is hypothesised in the motor circuit connecting the cortex, basal ganglia, and cerebellum. Imaging techniques have clearly enhanced current knowledge on the pathophysiology of primary focal dystonia and will continue to do so in the future.
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Affiliation(s)
- E Zoons
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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Beukers RJ, van der Meer JN, van der Salm SM, Foncke EM, Veltman DJ, Tijssen MAJ. Severity of dystonia is correlated with putaminal gray matter changes in myoclonus-dystonia. Eur J Neurol 2011; 18:906-12. [PMID: 21219543 DOI: 10.1111/j.1468-1331.2010.03321.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Myoclonus-dystonia (M-D) is an autosomal dominantly inherited movement disorder characterized by myoclonic jerks and dystonic postures or movements. Morphometric studies have been performed in other, mainly heterogenous, types of dystonia producing conflicting results. However, all these studies agree on abnormalities in sensorimotor structures, mainly in the basal ganglia. We aimed to study gray matter (GM) volumes in sensorimotor brain structures with magnetic resonance imaging (MRI) in a genetically homogeneous form of dystonia, M-D. METHODS Twenty-five clinically affected DYT11 mutation carriers (MC) and 25 matched control subjects were studied using T1-weighted 3D anatomical images of the entire brain, obtained with a 3.0 Tesla MRI. MC were clinically scored using the Burke Fahn Marsden dsytonia rating scale (BFMDRS) and the unified myoclonus rating scale (UMRS). GM volumes in sensorimotor cortices and basal ganglia of patients and controls were compared, and multiple regression analyses were used to correlate the GM volumes of patients with the clinical rating scales BFMDRS and UMRS. RESULTS No significant differences were found between groups, but dystonia severity in MC was strongly correlated with increased GM volume in bilateral putamina. CONCLUSIONS This study provides further evidence for the involvement of putamina as important motor structures in the pathophysiology of (myoclonus-) dystonia. Changes in these structures are associated with the severity of dystonia.
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Affiliation(s)
- R J Beukers
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Abstract
In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For some secondary dystonias--like tardive dystonia, myoclonus-dystonia (M-D), NBIA (PANK2), the outcome was very good. Only for the primary generalized dystonias, the efficacy of GPi-DBS has been confirmed in randomised controlled trials. Predictors of outcome are the experience and dedication of the stereotactic team, the selection of patients--the diagnosis and pre-operative screening--and the quality of the post-operative care. Predictors of negative outcome are long duration of the disease--with contractures or scoliosis--and concomitant symptoms like spasticity and cerebellar dysfunction. More studies are required to establish the role of GPi-DBS in the treatment of secondary dystonias.
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Affiliation(s)
- J D Speelman
- Departments of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Verhagen MMM, Abdo WF, Willemsen MAAP, Hogervorst FBL, Smeets DFCM, Hiel JAP, Brunt ER, van Rijn MA, Majoor Krakauer D, Oldenburg RA, Broeks A, Last JI, van't Veer LJ, Tijssen MAJ, Dubois AMI, Kremer HPH, Weemaes CMR, Taylor AMR, van Deuren M. Clinical spectrum of ataxia-telangiectasia in adulthood. Neurology 2009; 73:430-7. [PMID: 19535770 DOI: 10.1212/wnl.0b013e3181af33bd] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the phenotype of adult patients with variant and classic ataxia-telangiectasia (A-T), to raise the degree of clinical suspicion for the diagnosis variant A-T, and to assess a genotype-phenotype relationship for mutations in the ATM gene. METHODS Retrospective analysis of the clinical characteristics and course of disease in 13 adult patients with variant A-T of 9 families and 6 unrelated adults with classic A-T and mutation analysis of the ATM gene and measurements of ATM protein expression and kinase activity. RESULTS Patients with variant A-T were only correctly diagnosed in adulthood. They often presented with extrapyramidal symptoms in childhood, whereas cerebellar ataxia appeared later. Four patients with variant A-T developed a malignancy. Patients with classic and variant A-T had elevated serum alpha-fetoprotein levels and chromosome 7/14 rearrangements. The mildest variant A-T phenotype was associated with missense mutations in the ATM gene that resulted in expression of some residual ATM protein with kinase activity. Two splicing mutations, c.331 + 5G>A and c.496 + 5G>A, caused a more severe variant A-T phenotype. The splicing mutation c.331 + 5G>A resulted in less ATM protein and kinase activity than the missense mutations. CONCLUSIONS Ataxia-telangiectasia (A-T) should be considered in patients with unexplained extrapyramidal symptoms. Early diagnosis is important given the increased risk of malignancies and the higher risk for side effects of subsequent cancer treatment. Measurement of serum alpha-fetoprotein and chromosomal instability precipitates the correct diagnosis. There is a clear genotype-phenotype relation for A-T, since the severity of the phenotype depends on the amount of residual kinase activity as determined by the genotype.
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Affiliation(s)
- M M M Verhagen
- Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Ritz K, Gerrits MCF, Foncke EMJ, van Ruissen F, van der Linden C, Vergouwen MDI, Bloem BR, Vandenberghe W, Crols R, Speelman JD, Baas F, Tijssen MAJ. Myoclonus-dystonia: clinical and genetic evaluation of a large cohort. J Neurol Neurosurg Psychiatry 2009; 80:653-8. [PMID: 19066193 DOI: 10.1136/jnnp.2008.162099] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Myoclonus-dystonia (M-D) is an autosomal dominant inherited movement disorder. Various mutations within the epsilon-sarcoglycan (SGCE) gene have been associated with M-D, but mutations are detected in only about 30% of patients. The lack of stringent clinical inclusion criteria and limitations of mutation screens by direct sequencing might explain this observation. METHODS Eighty-six M-D index patients from the Dutch national referral centre for M-D underwent neurological examination and were classified according to previously published criteria into definite, probable and possible M-D. Sequence analysis of the SGCE gene and screening for copy number variations were performed. In addition, screening was carried out for the 3 bp deletion in exon 5 of the DYT1 gene. RESULTS Based on clinical examination, 24 definite, 23 probable and 39 possible M-D patients were detected. Thirteen of the 86 M-D index patients carried a SGCE mutation: seven nonsense mutations, two splice site mutations, three missense mutations (two within one patient) and one multiexonic deletion. In the definite M-D group, 50% carried an SGCE mutation and one single patient in the probable group (4%). One possible M-D patient showed a 4 bp deletion in the DYT1 gene (c.934_937delAGAG). CONCLUSIONS Mutation carriers were mainly identified in the definite M-D group. However, in half of definite M-D cases, no mutation could be identified. Copy-number variations did not play a major role in the large cohort.
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Affiliation(s)
- K Ritz
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Extrapontine myelinolysis (EPM) is a rare cause of Parkinsonism. In this case report, we describe a 63-year-old woman with Parkinsonism due to EPM after correction of hyponatremia. During a 4-year follow-up, both the clinical features of Parkinsonism and the changes on magnetic resonance imaging resolved. Parkinsonism due to EPM should be recognized as it has a good prognosis.
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Affiliation(s)
- Bart Post
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.
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Gerrits MCF, Foncke EMJ, Koelman JHTM, Tijssen MAJ. Pediatric writer's cramp in myoclonus-dystonia: maternal imprinting hides positive family history. Eur J Paediatr Neurol 2009; 13:178-80. [PMID: 18571946 DOI: 10.1016/j.ejpn.2008.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 03/30/2008] [Indexed: 11/16/2022]
Abstract
Myoclonus-dystonia (M-D) is an autosomal dominantly inherited movement disorder with myoclonic jerks and dystonic contractions most frequently due to a mutation in the epsilon-sarcoglycan (SGCE, DYT11) gene. We describe two unrelated children with M-D (DYT11) who presented with writer's cramp. Due to maternal imprinting the family history appeared initially negative for M-D. In children with writer's cramp screening of the SGCE gene should be considered, even with a negative family history.
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Affiliation(s)
- M C F Gerrits
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Beukers RJ, Booij J, Weisscher N, Zijlstra F, van Amelsvoort TAMJ, Tijssen MAJ. Reduced striatal D2 receptor binding in myoclonus-dystonia. Eur J Nucl Med Mol Imaging 2008; 36:269-74. [PMID: 18719906 DOI: 10.1007/s00259-008-0924-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 07/28/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To study striatal dopamine D(2) receptor availability in DYT11 mutation carriers of the autosomal dominantly inherited disorder myoclonus-dystonia (M-D). METHODS Fifteen DYT11 mutation carriers (11 clinically affected) and 15 age- and sex-matched controls were studied using (123)I-IBZM SPECT. Specific striatal binding ratios were calculated using standard templates for striatum and occipital areas. RESULTS Multivariate analysis with corrections for ageing and smoking showed significantly lower specific striatal to occipital IBZM uptake ratios (SORs) both in the left and right striatum in clinically affected patients and also in all DYT11 mutation carriers compared to control subjects. CONCLUSIONS Our findings are consistent with the theory of reduced dopamine D(2) receptor (D2R) availability in dystonia, although the possibility of increased endogenous dopamine, and consequently, competitive D2R occupancy cannot be ruled out.
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Affiliation(s)
- R J Beukers
- Department of Neurology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Bour LJ, van Rootselaar AF, Koelman JHTM, Tijssen MAJ. Oculomotor abnormalities in myoclonic tremor: a comparison with spinocerebellar ataxia type 6. Brain 2008; 131:2295-303. [DOI: 10.1093/brain/awn177] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Maurits NM, Renken RJ, Hoogduin JM, van Duinen H, Zijdewind I, Tijssen MAJ, van Rootselaar AF. Making EMG recordings during fMRI work: experiences from fundamental and applied studies of the motor system. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1060345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Foncke EMJ, Gerrits MCF, van Ruissen F, Baas F, Hedrich K, Tijssen CC, Klein C, Tijssen MAJ. Distal myoclonus and late onset in a large Dutch family with myoclonus-dystonia. Neurology 2006; 67:1677-80. [PMID: 17101905 DOI: 10.1212/01.wnl.0000242880.49051.1f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a large myoclonus-dystonia (M-D) pedigree with a two-base pair deletion in Exon 5 of the epsilon-sarcoglycan gene. Three individuals had onset after age 40 years. Distal myoclonus of the arms was present in all 20 symptomatic mutation carriers. These findings expand the known phenotype of M-D and require revision of the current diagnostic criteria. Five of 14 asymptomatic mutation carriers who inherited the mutation from their mother showed minimal axial dystonia, arguing against a maternal imprinting mechanism.
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Affiliation(s)
- E M J Foncke
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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41
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Gerrits MCF, Foncke EMJ, de Haan R, Hedrich K, van de Leemput YLC, Baas F, Ozelius LJ, Speelman JD, Klein C, Tijssen MAJ. Phenotype-genotype correlation in Dutch patients with myoclonus-dystonia. Neurology 2006; 66:759-61. [PMID: 16534121 DOI: 10.1212/01.wnl.0000201192.66467.a3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The epsilon-sarcoglycan (SGCE) gene is an important cause of myoclonus-dystonia (M-D), although the majority of cases with an M-D phenotype test negative. Seven of 31 patients with the M-D phenotype carried a mutation in the SGCE gene. Positive family history and truncal myoclonus were independent prognostic factors. Early disease onset, onset with both myoclonus and dystonia, and axial dystonia were detected significantly more often in the mutation carriers.
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Affiliation(s)
- M C F Gerrits
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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42
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Siegelaar SE, Olff M, Bour LJ, Veelo D, Zwinderman AH, van Bruggen G, de Vries GJ, Raabe S, Cupido C, Koelman JHTM, Tijssen MAJ. The auditory startle response in post-traumatic stress disorder. Exp Brain Res 2006; 174:1-6. [PMID: 16525797 DOI: 10.1007/s00221-006-0413-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
Post-traumatic stress disorder (PTSD) patients are considered to have excessive EMG responses in the orbicularis oculi (OO) muscle and excessive autonomic responses to startling stimuli. The aim of the present study was to gain more insight into the pattern of the generalized auditory startle reflex (ASR). Reflex EMG responses to auditory startling stimuli in seven muscles rather than the EMG response of the OO alone as well as the psychogalvanic reflex (PGR) were studied in PTSD patients and healthy controls. Ten subjects with chronic PTSD (>3 months) and a history of excessive startling and 11 healthy controls were included. Latency, amplitude and duration of the EMG responses and the amplitude of the PGR to 10 auditory stimuli of 110 dB SPL were investigated in seven left-sided muscles. The size of the startle reflex, defined by the number of muscles activated by the acoustic stimulus and by the amplitude of the EMG response of the OO muscle as well, did not differ significantly between patients and controls. Median latencies of activity in the sternocleidomastoid (SC) (patients 80 ms; controls 54 ms) and the deltoid (DE) muscles (patients 113 ms; controls 69 ms) were prolonged significantly in PTSD compared to controls (P < 0.05). In the OO muscle, a late response (median latency in patients 308 ms; in controls 522 ms), probably the orienting reflex, was more frequently present in patients (56%) than in controls (12%). In patients, the mean PGR was enlarged compared to controls (P < 0.05). The size of the ASR response is not enlarged in PTSD patients. EMG latencies in the PTSD patients are prolonged in SC and DE muscles. The presence of a late response in the OO muscle discriminates between groups of PTSD patients with a history of startling and healthy controls. In addition, the autonomic response, i.e. the enlarged amplitude of the PGR can discriminate between these groups.
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Affiliation(s)
- S E Siegelaar
- Department of Neurology H2-222 and Clinical Neurophysiology, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Abstract
Dystonia of the limbs may be due to a wide range of aetiologies and may cause major functional limitation. We investigated whether the previously described pathological 4 to 7 Hz drive to muscles in cervical dystonia is present in patients with aetiologically different types of dystonia of the upper and lower limbs. To this end, we studied 12 symptomatic and 4 asymptomatic carriers of the DYT1 gene, 6 patients with symptomatic dystonia due to focal basal ganglia lesions, and 11 patients with fixed dystonia, a condition assumed to be mostly psychogenic in aetiology. We evaluated EMG-EMG coherence in the tibialis anterior (TA) of these and 15 healthy control subjects. Ten of 12 (83%) of symptomatic DYT1 patients had an excessive 4 to 7 Hz common drive to TA, evident as an inflated coherence in this band. This drive also involved the gastrocnemius, leading to co-contracting electromyographic bursts. In contrast, asymptomatic DYT1 carriers, patients with symptomatic dystonia, patients with fixed dystonia, and healthy subjects showed no evidence of such a drive or any other distinguishing electrophysiological feature. Moreover, the pathological 4 to 7 Hz drive in symptomatic DYT1 patients was much less common in the upper limb, where it was only present in 2 of 6 (33%) patients with clinical involvement of the arms. We conclude that the nature of the abnormal drive to dystonic muscles may vary according to the muscles under consideration and, particularly, with aetiology.
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Affiliation(s)
- Pascal Grosse
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
- Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - M Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
| | | | - A Schrag
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
| | - Andrew J Lees
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
| | - Peter Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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Hedrich K, Meyer EM, Schüle B, Kock N, de Carvalho Aguiar P, Wiegers K, Koelman JH, Garrels J, Dürr R, Liu L, Schwinger E, Ozelius LJ, Landwehrmeyer B, Stoessl AJ, Tijssen MAJ, Klein C. Myoclonus–dystonia: Detection of novel, recurrent, and de novoSGCEmutations. Neurology 2004; 62:1229-31. [PMID: 15079037 DOI: 10.1212/01.wnl.0000118286.75059.35] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Hedrich
- Department of Neurology, University of Lübeck, Germany
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Foncke EMJ, Klein C, Koelman JHTM, Kramer PL, Schilling K, Müller B, Garrels J, de Carvalho Aguiar P, Liu L, de Froe A, Speelman JD, Ozelius LJ, Tijssen MAJ. Hereditary myoclonus-dystonia associated with epilepsy. Neurology 2003; 60:1988-90. [PMID: 12821748 DOI: 10.1212/01.wnl.0000066020.99191.76] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A five-generation Dutch family with inherited myoclonus-dystonia (M-D) is described. Genetic analysis revealed a novel truncating mutation within the epsilon-sarcoglycan gene (SGCE). In three of five gene carriers, epilepsy and/or EEG abnormalities were associated with the symptoms of myoclonus and dystonia. The genetic and clinical heterogeneity of M-D is extended. EEG changes and epilepsy should not be considered exclusion criteria for the clinical diagnosis of M-D.
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Affiliation(s)
- E M J Foncke
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Doheny DO, Brin MF, Morrison CE, Smith CJ, Walker RH, Abbasi S, Müller B, Garrels J, Liu L, De Carvalho Aguiar P, Schilling K, Kramer P, De Leon D, Raymond D, Saunders-Pullman R, Klein C, Bressman SB, Schmand B, Tijssen MAJ, Ozelius LJ, Silverman JM. Phenotypic features of myoclonus-dystonia in three kindreds. Neurology 2002; 59:1187-96. [PMID: 12391346 DOI: 10.1212/wnl.59.8.1187] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Myoclonus-dystonia (M-D) is a movement disorder with involuntary jerks and dystonic contractions. Autosomal dominant alcohol-responsive M-D is associated with mutations in the epsilon-sarcoglycan gene (SGCE) (six families) and with a missense change in the D2 dopamine receptor (DRD2)gene (one family). OBJECTIVE To investigate the clinical phenotype associated with M-D including motor symptoms, psychiatric disorders, and neuropsychological deficits. METHODS Fifty individuals in three M-D families were evaluated and a standardized neurologic examination and DNA analysis were performed. Psychiatric profiles were established with the Diagnostic Interviews for Genetic Studies (DIGS) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Cognition was evaluated with standardized neuropsychological tests. RESULTS Distinct truncating mutations in the SGCE gene were identified in each family. Additionally, a missense alteration in the DRD2 gene was previously found in one family. Motor expression was variable, with onset of myoclonus or dystonia or both affecting the upper body and progression to myoclonus and dystonia in most cases. Psychiatric profiles revealed depression, obsessive-compulsive disorder, substance abuse, anxiety/panic/phobic disorders, and psychosis in two families, and depression only in the third family. Averaged scores from cognitive testing showed impaired verbal learning and memory in one family, impaired memory in the second family, and no cognitive deficits in the third family. CONCLUSIONS Cognitive deficits may be associated with M-D. Psychiatric abnormalities correlate with the motor symptoms in affected individuals. Assessment of additional M-D families with known mutations is needed to determine whether these are characteristic phenotypic manifestations of M-D.
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Affiliation(s)
- D O Doheny
- Department of Neurology, Mount Sinai School of Medicine, Annenberg 14-51A, Box 1052, New York, NY 10029, USA.
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Nielsen JB, Tijssen MAJ, Hansen NL, Crone C, Petersen NT, Brown P, Van Dijk JG, Rothwell JC. Corticospinal transmission to leg motoneurones in human subjects with deficient glycinergic inhibition. J Physiol 2002; 544:631-40. [PMID: 12381832 PMCID: PMC2290587 DOI: 10.1113/jphysiol.22.024091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Normal coordinated movement requires that the activity of antagonistic motoneurones may be depressed at appropriate times during the movement. Both glycinergic and GABAergic inhibitory mechanisms participate in this control. Patients with the major form of hyperekplexia (hereditary startle disease) have impaired inhibition of spinal motoneurones from local glycinergic interneurones and represent an ideal opportunity for studying the role of glycinergic inhibition in the control of antagonistic muscles. In the present study we investigated whether impaired glycinergic inhibition affects the corticospinal control of antagonistic spinal motoneurones in 10 patients with hyperekplexia and whether there are mechanisms that may compensate for the lack of glycinergic inhibition. In healthy subjects transcranial magnetic stimulation (TMS) produced a short-latency inhibition of the soleus H-reflex at rest and during tonic dorsiflexion. This inhibition, which has been shown to be mediated by spinal (glycinergic) inhibitory interneurones, was absent in all four patients in whom this experiment was performed. This confirms that glycinergic transmission is impaired in the patients. During voluntary dorsiflexion subthreshold TMS produced a depression of the ongoing EMG activity in the tibialis anterior (TA) muscle in both healthy subjects and all of the six tested patients. This is consistent with the idea that this EMG depression is caused by activation of cortical (GABAergic) inhibitory interneurones. Cross-correlation analysis revealed normal short-term synchronization of TA motor units accompanied by coherence in the 8-12 Hz and 18-35 Hz frequency bands in the 10 patients. As in healthy subjects, 8-12 Hz coherence accompanied by decreased tendency to discharge synchronously (de-synchronization) was found in recordings from the antagonistic TA and soleus muscles in 2 of the 10 patients. This suggests that glycinergic inhibition is not responsible for de-synchronization of antagonistic motor units, but that other GABAergic-inhibitory mechanisms must be involved. We propose that such mechanisms may compensate for the lack of glycinergic reciprocal inhibition in the hyperekplectic patients and explain why voluntary movements are not more severely affected.
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Affiliation(s)
- J B Nielsen
- Division of Neurophysiology, Department of Medical Physiology, The Panum Institute, University of Copenhagen, Denmark
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