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Iwasa S, Akaguchi R, Okuno H, Nakanishi K, Ueta K, Morioka S. Changes in Standing Postural Control Ability in a Case of Spinocerebellar Ataxia Type 31 With Physical Therapy Focusing on the Center of Gravity Sway Variables and Lower Leg Muscle Activity. Cureus 2023; 15:e51033. [PMID: 38264384 PMCID: PMC10805122 DOI: 10.7759/cureus.51033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
Spinocerebellar degeneration (SCD) is a progressive disease characterized by cerebellar ataxia or the posterior spinal cord. Among these, spinocerebellar ataxia type 31 (SCA31) is genetically more common in the Japanese population and is characterized by pure ataxia, resulting in severe disturbances in postural balance, with common falls. Therefore, rehabilitation is important to improve postural balance. Light touch is a known method of reducing postural sway, which acts with the light touching of an object with the body. We herein present a case of a patient with SCA31 who was trained in a standing position by lightly touching the back of the body to a wall surface. Dynamic interarticular coordination exercises were also performed as part of the rehabilitation program. As a result, even in the progressive SCA31, improvements in standing postural balance and activities of daily living contributed to improvements in the patient's postural balance. We followed the progress of postural control ability using the center of gravity sway measurement and electromyography and described some interesting characteristics of the patient's postural control ability in this report.
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Affiliation(s)
- Shiori Iwasa
- Physical Therapy, Faculty of Health Sciences, Kio University, Nara, JPN
| | - Ryo Akaguchi
- Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, JPN
- Rehabilitation, Setsunan General Hospital, Osaka, JPN
| | | | - Koji Nakanishi
- Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, JPN
| | - Kozo Ueta
- Physical Medicine and Rehabilitation, Neurorehabilitation Research Center, Kio University, Nara, JPN
| | - Shu Morioka
- Physical Medicine and Rehabilitation, Neurorehabilitation Research Center, Kio University, Nara, JPN
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Terao Y, Tokushige SI, Inomata-Terada S, Miyazaki T, Kotsuki N, Fisicaro F, Ugawa Y. How do patients with Parkinson's disease and cerebellar ataxia read aloud? -Eye-voice coordination in text reading. Front Neurosci 2023; 17:1202404. [PMID: 37638315 PMCID: PMC10452879 DOI: 10.3389/fnins.2023.1202404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The coordination between gaze and voice is closely linked when reading text aloud, with the gaze leading the reading position by a certain eye-voice lead (EVL). How this coordination is affected is unknown in patients with cerebellar ataxia and parkinsonism, who show oculomotor deficits possibly impacting coordination between different effectors. Objective To elucidate the role of the cerebellum and basal ganglia in eye-voice coordination during reading aloud, by studying patients with Parkinson's disease (PD) and spinocerebellar degeneration (SCD). Methods Participants were sixteen SCD patients, 18 PD patients, and 30 age-matched normal subjects, all native Japanese speakers without cognitive impairment. Subjects read aloud Japanese texts of varying readability displayed on a monitor in front of their eyes, consisting of Chinese characters and hiragana (Japanese phonograms). The gaze and voice reading the text was simultaneously recorded by video-oculography and a microphone. A custom program synchronized and aligned the gaze and audio data in time. Results Reading speed was significantly reduced in SCD patients (3.53 ± 1.81 letters/s), requiring frequent regressions to compensate for the slow reading speed. In contrast, PD patients read at a comparable speed to normal subjects (4.79 ± 3.13 letters/s vs. 4.71 ± 2.38 letters/s). The gaze scanning speed, excluding regressive saccades, was slower in PD patients (9.64 ± 4.26 letters/s) compared to both normal subjects (12.55 ± 5.42 letters/s) and SCD patients (10.81 ± 4.52 letters/s). PD patients' gaze could not far exceed that of the reading speed, with smaller allowance for the gaze to proceed ahead of the reading position. Spatial EVL was similar across the three groups for all texts (normal: 2.95 ± 1.17 letters/s, PD: 2.95 ± 1.51 letters/s, SCD: 3.21 ± 1.35 letters/s). The ratio of gaze duration to temporal EVL was lowest for SCD patients (normal: 0.73 ± 0.50, PD: 0.70 ± 0.37, SCD: 0.40 ± 0.15). Conclusion Although coordination between voice and eye movements and normal eye-voice span was observed in both PD and SCD, SCD patients made frequent regressions to manage the slowed vocal output, restricting the ability for advance processing of text ahead of the gaze. In contrast, PD patients experience restricted reading speed primarily due to slowed scanning, limiting their maximum reading speed but effectively utilizing advance processing of upcoming text.
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Affiliation(s)
- Yasuo Terao
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Medical Physiology, Kyorin University, Mitaka, Japan
| | - Tai Miyazaki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Naoki Kotsuki
- Department of Neurology, Kyorin University, Mitaka, Japan
| | - Francesco Fisicaro
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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Barbuto S, Martelli D, Isirame O, Lee N, Bishop L, Kuo SH, Agrawal S, Lee S, O’Dell M, Stein J. Phase I Single-Blinded Randomized Controlled Trial Comparing Balance and Aerobic Training in Degenerative Cerebellar Disease. PM R 2021; 13:364-371. [PMID: 32383352 PMCID: PMC7647960 DOI: 10.1002/pmrj.12401] [Citation(s) in RCA: 3] [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: 01/30/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Primary deficits in individuals with cerebellar degeneration include ataxia, unstable gait, and incoordination. Balance training is routinely recommended to improve function whereas little is known regarding aerobic training. OBJECTIVE To determine the feasibility of conducting a randomized trial comparing balance and aerobic training in individuals with cerebellar degeneration. DESIGN Assessor blinded randomized control phase I trial. SETTING Assessments in medical center, home training. PARTICIPANTS Twenty participants with cerebellar degeneration were randomized to home balance or aerobic training. INTERVENTION Aerobic training consisted of 4 weeks of stationary bicycle training, five times per week for 30-minute sessions. Home balance training consisted of performing the same duration of easy, moderate, and/or hard exercises. OUTCOME MEASURES Scale for the Assessment and Rating of Ataxia (SARA), maximal oxygen consumption (VO2 max), Dynamic Gait Index, Timed Up and Go, gait speed. RESULTS All 20 participants completed assigned training with no major adverse events. Seven of each group attained target training duration, frequency, and intensity. Although both groups had significant improvements in ataxia severity, balance, and gait measures, there were greater improvements in individuals who performed aerobic training in ataxia severity and maximal oxygen consumption when compared to balance training. The effect size for these outcome measures was determined to be large, indicating a phase II trial comparing the benefits of aerobic and balance training was feasible and required 26 participants per group. Improvements in SARA score and VO2 max remained in the aerobic training group at 3 months posttraining, but these improvements were trending back to baseline. In contrast, all balance group measures for pretraining and 3 months posttraining were statistically similar. CONCLUSIONS A phase II trial comparing balance and aerobic training in individuals with cerebellar degeneration is feasible. Benefits trended back toward baseline after training stopped, although benefits of longer duration exercise programs still need to be determined.
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Affiliation(s)
- Scott Barbuto
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Dario Martelli
- Department of Engineering, Columbia University, New York, NY, USA
| | - Omofuma Isirame
- Department of Engineering, Columbia University, New York, NY, USA
| | - Nancy Lee
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Laurie Bishop
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Sunil Agrawal
- Department of Engineering, Columbia University, New York, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Michael O’Dell
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
| | - Joel Stein
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
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Yahia A, Stevanin G. The History of Gene Hunting in Hereditary Spinocerebellar Degeneration: Lessons From the Past and Future Perspectives. Front Genet 2021; 12:638730. [PMID: 33833777 PMCID: PMC8021710 DOI: 10.3389/fgene.2021.638730] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/02/2021] [Indexed: 01/02/2023] Open
Abstract
Hereditary spinocerebellar degeneration (SCD) encompasses an expanding list of rare diseases with a broad clinical and genetic heterogeneity, complicating their diagnosis and management in daily clinical practice. Correct diagnosis is a pillar for precision medicine, a branch of medicine that promises to flourish with the progressive improvements in studying the human genome. Discovering the genes causing novel Mendelian phenotypes contributes to precision medicine by diagnosing subsets of patients with previously undiagnosed conditions, guiding the management of these patients and their families, and enabling the discovery of more causes of Mendelian diseases. This new knowledge provides insight into the biological processes involved in health and disease, including the more common complex disorders. This review discusses the evolution of the clinical and genetic approaches used to diagnose hereditary SCD and the potential of new tools for future discoveries.
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Affiliation(s)
- Ashraf Yahia
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Department of Biochemistry, Faculty of Medicine, National University, Khartoum, Sudan
- Institut du Cerveau, INSERM U1127, CNRS UMR7225, Sorbonne Université, Paris, France
- Ecole Pratique des Hautes Etudes, EPHE, PSL Research University, Paris, France
| | - Giovanni Stevanin
- Institut du Cerveau, INSERM U1127, CNRS UMR7225, Sorbonne Université, Paris, France
- Ecole Pratique des Hautes Etudes, EPHE, PSL Research University, Paris, France
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Barbuto S, Martelli D, Omofuma IB, Lee N, Kuo SH, Agrawal S, Lee S, O'Dell M, Stein J. Phase I randomized single-blinded controlled study investigating the potential benefit of aerobic exercise in degenerative cerebellar disease. Clin Rehabil 2020; 34:584-594. [PMID: 32037861 DOI: 10.1177/0269215520905073] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether people with cerebellar degeneration can perform rigorous aerobic exercise and to assess the clinical impact of training. DESIGN Randomized single-blinded controlled, feasibility study comparing aerobic training to no training. SETTING Home intervention, assessments conducted at an academic medical center. SUBJECTS Twenty individuals with cerebellar degeneration caused by a range of genetic disorders. INTERVENTION Aerobic training consisted of four weeks of stationary bicycle training, five times per week for 30-minute sessions. Intensity ranged from 65% to 80% of the participant's maximal heart rate determined during cardiopulmonary exercise testing. MAIN MEASURES Primary outcome measure was change in the Scale for the Assessment and Rating of Ataxia scores. Recruitment rate, adherence, drop-out, and adverse events were also determined. The treatment was considered technically feasible if participants achieved target training frequency, duration, and intensity. RESULTS The 20 participants mean age was 50 years (standard deviation 15.65 years) and average Scale for the Assessment and Rating of Ataxia score was 9.6 (standard deviation 3.13). Ten participants were randomized to aerobic training and 10 to no training. Seven participants in the aerobic group attained target training duration, frequency, and intensity. There was a mean reduction in ataxia severity of 2.1 points (standard deviation 1.26) with four weeks of aerobic training, whereas ataxia severity increased by 0.3 (standard deviation 0.62) in the control group over the same period. Walking speed, balance measures, and fitness also improved in individuals who performed aerobic exercise. CONCLUSIONS Rigorous aerobic training is feasible in people with cerebellar degeneration. Improvements in ataxia, balance, and gait are promising.
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Affiliation(s)
- Scott Barbuto
- Department of Physical Medicine and Rehabilitation, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Dario Martelli
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | | | - Nancy Lee
- Department of Physical Medicine and Rehabilitation, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Michael O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine, Vagelos College of Physicians and Surgeons, Columbia University.,NewYork-Presbyterian Hospital, New York, NY, USA
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Watanabe H, Makabe A, Hirai C, Takeda T, Honda K, Demura S, Tsutsumi T. Frequency analyses of posturography using logarithmic translation. Acta Otolaryngol 2020; 140:1-7. [PMID: 31709868 DOI: 10.1080/00016489.2019.1682660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Power-spectral analysis of the centre of pressure (CoP) frequencies of posturography provides exponentially approximated distributions, whereas logarithmic translation enables linear approximation.Objectives: Frequency analyses were adopted for posturography of healthy subjects and patients with spinocerebellar degeneration (SCD) using logarithmic translation to determine its clinical usefulness for managing the elderly and patients with disequilibrium.Material and methods: We included 172 healthy subjects and 47 SCD patients. Posturography was performed with the eyes fixated and closed, with and without foam rubber. The power-spectral data of the CoP were obtained with the maximum entropy method. Power-spectral data were logarithmically translated for quantitative evaluation.Results: For teenagers, high-frequency fluctuations were dominant and attributable to proprioceptive compensation due to immature postural control. In elderly populations, the increased frequency in the lateral direction was characterised by three peaks indicating postural disturbances attributed to three sensory inputs. The disappearance of one peak in the anteroposterior fluctuation indicates a decrease in vestibular contribution. The foam rubber and the closed-eye condition enhanced fluctuations in two peaks. There were differences in power-spectral distributions of two peaks between the healthy subjects and SCD patients.Conclusions: Logarithmic power-spectral data distribution could provide an age- and disease-specific novel and visually-comprehensible parameter.
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Affiliation(s)
- Hiroki Watanabe
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayane Makabe
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chiaki Hirai
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takamori Takeda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Honda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Demura
- College of Human and Social Sciences, Kanazawa University, Kanazawa, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Bando K, Honda T, Ishikawa K, Takahashi Y, Mizusawa H, Hanakawa T. Impaired Adaptive Motor Learning Is Correlated With Cerebellar Hemispheric Gray Matter Atrophy in Spinocerebellar Ataxia Patients: A Voxel-Based Morphometry Study. Front Neurol 2019; 10:1183. [PMID: 31803128 PMCID: PMC6871609 DOI: 10.3389/fneur.2019.01183] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/24/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the degree to which recently proposed parameters measured via a prism adaptation task are correlated with changes in cerebellar structure, specifically gray matter volume (GMV), in patients with spinocerebellar degeneration (SCD). Methods: We performed whole-brain voxel-based morphometry (VBM) analysis on 3-dimensional T1-weighted images obtained from 23 patients with SCD [Spinocerebellar ataxia type 6 (SCA6), 31 (SCA31), 3/Machado-Joseph disease (SCA3/MJD), and sporadic cortical cerebellar atrophy (CCA)] and 21 sex- and age-matched healthy controls (HC group). We quantified a composite index representing adaptive motor learning abilities in a hand-reaching task with prism adaptation. After controlling for age, sex, and total intracranial volume, we analyzed group-wise differences in GMV and regional GMV correlations with the adaptive learning index. Results: Compared with the HC group, the SCD group showed reduced adaptive learning abilities and smaller GMV widely in the lobules IV-VIII in the bilateral cerebellar hemispheres. In the SCD group, the adaptive learning index was correlated with cerebellar hemispheric atrophy in the right lobule VI, the left Crus I. Additionally, GMV of the left supramarginal gyrus showed a correlation with the adaptive learning index in the SCD group, while the supramarginal region did not accompany reduction of GMV. Conclusions: This study indicated that a composite index derived from a prism adaptation task was correlated with GMV of the lateral cerebellum and the supramarginal gyrus in patients with SCD. This study should contribute to the development of objective biomarkers for disease severity and progression in SCD.
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Affiliation(s)
- Kyota Bando
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of NCNP Brain Physiology and Pathology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.,National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takeru Honda
- Motor Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kinya Ishikawa
- Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Takahashi
- National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hidehiro Mizusawa
- National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of NCNP Brain Physiology and Pathology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Namikawa K, Dorigo A, Köster RW. Neurological Disease Modelling for Spinocerebellar Ataxia Using Zebrafish. J Exp Neurosci 2019; 13:1179069519880515. [PMID: 31666796 PMCID: PMC6798160 DOI: 10.1177/1179069519880515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 01/02/2023] Open
Abstract
The cerebellum integrates sensory information and motor actions. Increasing
experimental evidence has revealed that these functions as well as the
cerebellar cytoarchitecture are highly conserved in zebrafish compared with
mammals. However, the potential of zebrafish for modelling human cerebellar
diseases remains to be addressed. Spinocerebellar ataxias (SCAs) represent a
group of genetically inherited cerebellar diseases leading to motor
discoordination that is most often caused by affected cerebellar Purkinje cells
(PCs). Towards modelling SCAs in zebrafish we identified a small-sized
PC-specific regulatory element that was used to develop coexpression vectors
with tunable expression strength. These vectors allow for in vivo imaging of
SCA-affected PCs by high-resolution fluorescence imaging. Next, zebrafish with
SCA type 13 (SCA13) transgene expression were established, revealing that
SCA13-induced cell-autonomous PC degeneration results in eye movement deficits.
Thus, SCA13 zebrafish mimic the neuropathology of an SCA-affected brain as well
as the involved loss of motor control and hence provide a powerful approach to
unravel SCA13-induced cell biological pathogenic and cytotoxic mechanisms.
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Affiliation(s)
- Kazuhiko Namikawa
- Cellular and Molecular Neurobiology, Zoological Institute, Technische Universität Braunschweig, Braunschweig, Germany
| | - Alessandro Dorigo
- Cellular and Molecular Neurobiology, Zoological Institute, Technische Universität Braunschweig, Braunschweig, Germany
| | - Reinhard W Köster
- Cellular and Molecular Neurobiology, Zoological Institute, Technische Universität Braunschweig, Braunschweig, Germany
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Takeda T, Ikeda T, Tsutsumi T. The evaluation of gravitational recognition in patients with spinocerebellar degeneration using Listing's plane. Acta Otolaryngol 2019; 139:581-587. [PMID: 31107126 DOI: 10.1080/00016489.2019.1607975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The thickness of Listing's plane accurately reflects gravitational recognition, constructed through the integration of visual, vestibular, and proprioceptive sensory input in the neural integrator of the central nervous system. Spinocerebellar degeneration (SCD) is a progressive degenerative disease mainly involving the cerebellum and brainstem that leads to destabilize the gravitational recognition, and may thicken thickening of Listing's plane. Objective: The aim of this study is to evaluate the gravitational recognition in response to positional change in patients with SCD, using the thickness of Listing's plane as a parameter. Materials and methods: In this prospective study, we evaluated the thickness of Listing's plane in 21 consecutive patients with SCD and 32 healthy subjects in the seated and supine positions, and investigated the association with other neuro-otological examinations (electronystagmography including caloric test and posturography). Results: We detected significant thickening of Listing's plane in SCD patients only when they were in the seated position. The thickness of Listing's plane correlated with neither the caloric response nor Romberg's ratio or the total center of the pressure path length. Conclusions and significance: The thickness of Listing's plane could be a useful parameter for assessing a gravity-oriented internal model in SCD patients.
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Affiliation(s)
- Takamori Takeda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuo Ikeda
- Department of Otolaryngology, Tsudumigaura Medical Center for Children with Disabilities, Yamaguchi, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Kanazawa Y, Funabiki K, Taura A, Imai T, Torii H, Ogita H, Okano T, Ito J, Omori K. An attempt to measure the diametric relationship between slow and quick phases of nystagmus. Acta Otolaryngol 2018; 138:633-638. [PMID: 29355067 DOI: 10.1080/00016489.2018.1425903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate whether our original method can precisely evaluate the angle between slow and quick phases of nystagmus (vector angle) and to determine whether vector angle analysis is helpful in differentiating between horizontal nystagmus and mixed nystagmus with horizontal and vertical components. METHODS We included 20 healthy volunteers, 17 patients with horizontal nystagmus, and 15 patients with mixed nystagmus. Caloric nystagmus was recorded in healthy volunteers; positional nystagmus was recorded in each patient. We extracted the velocity of nystagmus from eye movement of each subject and analysed the vector angle. RESULTS In caloric nystagmus, the vector angle approached 180 degrees as slow-phase velocity increased, suggesting that our vector angle measurement is more reliable with faster nystagmus. Importantly, in horizontal nystagmus from peripheral vestibular disease, the vector angle similarly approached 180 degrees as slow-phase velocity increased; in contrast, the vector angle in cases of mixed nystagmus from vertebrobasilar insufficiency or spinocerebellar degeneration significantly differed from the angle of caloric nystagmus. CONCLUSIONS Vector angle analysis using our original algorithm can precisely evaluate the diametric relationship in vestibular nystagmus; it may be helpful in diagnosis of non-peripheral vestibular disorders.
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Affiliation(s)
- Yuji Kanazawa
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto City, Japan
| | - Kazuo Funabiki
- Institute for Biomedical Research and Innovation, Kobe City, Japan
| | - Akiko Taura
- Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto City, Japan
| | - Takumi Imai
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Hiroko Torii
- Department of Otolaryngology-Head and Neck Surgery, Shizuoka General Hospital, Aoi-ku, Shizuoka City, Japan
| | - Hideaki Ogita
- Department of Otolaryngology, Shiga Medical Center for Children, Moriyama City, Japan
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto City, Japan
| | - Juichi Ito
- Department of Otolaryngology, Shiga Medical Center Research Institute, Moriyama City, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto City, Japan
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Takeda T, Makabe A, Hirai C, Tsutsumi T. Determination of the time course of caloric nystagmus in patients with spinocerebellar degeneration using caloric step stimulus procedure. Acta Otolaryngol 2018; 138:41-45. [PMID: 28949274 DOI: 10.1080/00016489.2017.1378434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CONCLUSIONS The step stimulus procedure can provide information on the time course of the vestibulo-ocular reflex. Spinocerebellar degeneration and aging seem to shorten the time constant of the onset of the vestibulo-ocular reflex, causing a rapid rise up. Failure of the central processing of velocity storage might contribute to this rapid rise up. OBJECTIVES The aim of this study is to evaluate the time course characteristics of the vestibulo-ocular reflex in patients with spinocerebellar degeneration. METHODS Ten patients (20 ears) and 22 healthy subjects (30 ears) underwent caloric test using the step stimulus procedure. We evaluated the time course of caloric VOR and calculated the parameters of the time constant of an activation and adaptation response. We compared between the control and SCD groups to elucidate the time course characteristics of caloric VOR in patients with SCD. RESULTS Spinocerebellar degeneration seems to shorten the time constant of the activation response by caloric irrigation with 20 °C, 7l/min air. However, aging also possibly contributes to this shortening. No change was observed in the time constant of the adaptation response.
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Affiliation(s)
- Takamori Takeda
- Department of Oto-Rhino-Laryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayane Makabe
- Department of Oto-Rhino-Laryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chiaki Hirai
- Department of Oto-Rhino-Laryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Tsutsumi
- Department of Oto-Rhino-Laryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Yamada M, Toyoshima Y, Makifuchi T, Kakita A, Takahashi H. Spinocerebellar degeneration: Discrepancies between clinical and pathological diagnoses. Neuropathology 2015; 36:405-10. [PMID: 26556659 DOI: 10.1111/neup.12278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/19/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 11/29/2022]
Abstract
To improve the diagnostic accuracy of sporadic spinocerebellar degeneration (SCD), we assessed the clinical and pathological data of 1494 consecutive autopsy cases. The number of patients who received a diagnosis of sporadic SCD (including multiple system atrophy) either clinically or pathologically was 19 (1.3%). We identified six cases with clinical misdiagnoses of SCD that were confirmed pathologically as progressive supranuclear palsy (PSP, four cases), basilar artery thrombosis (one case) and unclassified tauopathy (one case). The total number of patients who received a clinical diagnosis of sporadic SCD was 93 and the positive predictive value was 93.5%. We also identified 13 autopsy cases that were pathologically confirmed as SCD, but had been clinically misdiagnosed as having other disorders. Their clinical diagnoses comprised progressive supranuclear palsy (five cases) and Parkinson's disease (PD, four cases), as well as parkinsonism with dementia, amyotrophic lateral sclerosis, paraneoplastic syndrome and multiple cerebral infarction (one case each). The results indicate that it is often difficult to distinguish PSP and PD from SCD, because of the atypical combination of symptoms or atypical timing of the appearance of symptoms, such as severe autonomic failure, cognitive impairment, poor L-dopa responsiveness, early cerebellar signs and obvious vertical gaze palsy.
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Affiliation(s)
- Mitsunori Yamada
- Department of Brain Disease Research, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Division of Neuropathology, Department of Clinical Research, National Saigata Medical Center, Joetsu, Niigata, Japan
| | - Yasuko Toyoshima
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Takao Makifuchi
- Division of Neuropathology, Department of Clinical Research, National Saigata Medical Center, Joetsu, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
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Omichi R, Maeda Y, Sugaya A, Kataoka Y, Kariya S, Nagayasu R, Nakagawa A, Yamashita T, Abe K, Nishizaki K. Characteristics of audiogram configuration in multiple-system atrophy C and cortical cerebellar atrophy. Acta Otolaryngol 2015; 136:266-70. [PMID: 26549828 DOI: 10.3109/00016489.2015.1104722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The prevalence of low-tone hearing loss (LTHL) is significantly high in spinocerebellar degeneration (SCD) with cerebellar predominance, including multiple-system atrophy C (MSA-C) and cortical cerebellar atrophy (CCA). OBJECTIVE This study aimed to test the hypothesis that SCD with cerebellar predominance, MSA-C and CCA may cause auditory symptoms. METHODS The shape and threshold of pure-tone audiograms were evaluated for MSA-C (n = 47; mean (± SD) age, 61.6 ± 8.9 years), CCA (n = 16; 62.8 ± 9.5 years), and age-matched controls (n = 169; 62.5 ± 10.7 years). To differentiate specific hearing loss for MSA-C and CCA from presbycusis, the shape of audiograms was examined based on previously established audiological criteria. RESULTS When audiogram shape was defined according to audiological criteria, the odds ratio for LTHL in SCD compared to controls was 2.492 (95% confidence interval (CI) = 1.208-5.139; p < 0.05, Pearson's Chi-square test) in MSA-C and 2.194 (95% CI = 0.709-6.795) in CCA. When the selection of audiogram shape according to these criteria was verified by three certified audiologists, odds ratios for LTHL in MSA-C and CCA were 3.243 (95% CI = 1.320-7.969) and 3.692 (95% CI = 1.052-12.957), respectively, significantly higher than in controls.
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Affiliation(s)
- Ryotaro Omichi
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yukihide Maeda
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akiko Sugaya
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuko Kataoka
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Kariya
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nagayasu
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuko Nakagawa
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Yamashita
- b Department of Neurology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Koji Abe
- b Department of Neurology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Kazunori Nishizaki
- a Department of Otolaryngology - Head and Neck Surgery , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Stefanescu MR, Dohnalek M, Maderwald S, Thürling M, Minnerop M, Beck A, Schlamann M, Diedrichsen J, Ladd ME, Timmann D. Structural and functional MRI abnormalities of cerebellar cortex and nuclei in SCA3, SCA6 and Friedreich's ataxia. Brain 2015; 138:1182-97. [PMID: 25818870 DOI: 10.1093/brain/awv064] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [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: 09/17/2014] [Accepted: 01/21/2015] [Indexed: 02/07/2023] Open
Abstract
Spinocerebellar ataxia type 3, spinocerebellar ataxia type 6 and Friedreich's ataxia are common hereditary ataxias. Different patterns of atrophy of the cerebellar cortex are well known. Data on cerebellar nuclei are sparse. Whereas cerebellar nuclei have long been thought to be preserved in spinocerebellar ataxia type 6, histology shows marked atrophy of the nuclei in Friedreich's ataxia and spinocerebellar ataxia type 3. In the present study susceptibility weighted imaging was used to assess atrophy of the cerebellar nuclei in patients with spinocerebellar ataxia type 6 (n = 12, age range 41-76 years, five female), Friedreich's ataxia (n = 12, age range 21-55 years, seven female), spinocerebellar ataxia type 3 (n = 10, age range 34-67 years, three female), and age- and gender-matched controls (total n = 23, age range 22-75 years, 10 female). T1-weighted magnetic resonance images were used to calculate the volume of the cerebellum. In addition, ultra-high field functional magnetic resonance imaging was performed with optimized normalization methods to assess function of the cerebellar cortex and nuclei during simple hand movements. As expected, the volume of the cerebellum was markedly reduced in spinocerebellar ataxia type 6, preserved in Friedreich's ataxia, and mildy reduced in spinocerebellar ataxia type 3. The volume of the cerebellar nuclei was reduced in the three patient groups compared to matched controls (P-values < 0.05; two-sample t-tests). Atrophy of the cerebellar nuclei was most pronounced in spinocerebellar ataxia type 6. On a functional level, hand-movement-related cerebellar activation was altered in all three disorders. Within the cerebellar cortex, functional magnetic resonance imaging signal was significantly reduced in spinocerebellar ataxia type 6 and Friedreich's ataxia compared to matched controls (P-values < 0.001, bootstrap-corrected cluster-size threshold; two-sample t-tests). The difference missed significance in spinocerebellar ataxia type 3. Within the cerebellar nuclei, reductions were significant when comparing spinocerebellar ataxia type 6 and Friedreich's ataxia to matched controls (P < 0.01, bootstrap-corrected cluster-size threshold; two-sample t-tests). Susceptibility weighted imaging allowed depiction of atrophy of the cerebellar nuclei in patients with Friedreich's ataxia and spinocerebellar ataxia type 3. In spinocerebellar ataxia type 6, pathology was not restricted to the cerebellar cortex but also involved the cerebellar nuclei. Functional magnetic resonance imaging data, on the other hand, revealed that pathology in Friedreich's ataxia and spinocerebellar ataxia type 3 is not restricted to the cerebellar nuclei. There was functional involvement of the cerebellar cortex despite no or little structural changes.
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Affiliation(s)
- Maria R Stefanescu
- 1 Department of Neurology, University of Duisburg-Essen, Essen, Germany 2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Moritz Dohnalek
- 1 Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- 2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Markus Thürling
- 1 Department of Neurology, University of Duisburg-Essen, Essen, Germany 2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Martina Minnerop
- 3 Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany 4 Department of Neurology, University of Bonn, Bonn, Germany
| | - Andreas Beck
- 5 Department of Computer Sciences, University of Düsseldorf, Düsseldorf, Germany
| | - Marc Schlamann
- 6 Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
| | - Joern Diedrichsen
- 7 Institute of Cognitive Neuroscience, University College London, London, UK
| | - Mark E Ladd
- 2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany 6 Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany 8 Division of Medical Physics in Radiology, University of Heidelberg and German Cancer Research Centre, Heidelberg, Germany
| | - Dagmar Timmann
- 1 Department of Neurology, University of Duisburg-Essen, Essen, Germany
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15
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Pope PA, Miall RC. Restoring cognitive functions using non-invasive brain stimulation techniques in patients with cerebellar disorders. Front Psychiatry 2014; 5:33. [PMID: 24765079 PMCID: PMC3980102 DOI: 10.3389/fpsyt.2014.00033] [Citation(s) in RCA: 30] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/17/2014] [Indexed: 11/13/2022] Open
Abstract
Numerous studies have highlighted the possibility of modulating the excitability of cerebro-cerebellar circuits bi-directionally using transcranial electrical brain stimulation, in a manner akin to that observed using magnetic stimulation protocols. It has been proposed that cerebellar stimulation activates Purkinje cells in the cerebellar cortex, leading to inhibition of the dentate nucleus, which exerts a tonic facilitatory drive onto motor and cognitive regions of cortex through a synaptic relay in the ventral-lateral thalamus. Some cerebellar deficits present with cognitive impairments if damage to non-motor regions of the cerebellum disrupts the coupling with cerebral cortical areas for thinking and reasoning. Indeed, white matter changes in the dentato-rubral tract correlate with cognitive assessments in patients with Friedreich ataxia, suggesting that this pathway is one component of the anatomical substrate supporting a cerebellar contribution to cognition. An understanding of the physiology of the cerebro-cerebellar pathway previously helped us to constrain our interpretation of results from two recent studies in which we showed cognitive enhancements in healthy participants during tests of arithmetic after electrical stimulation of the cerebellum, but only when task demands were high. Others studies have also shown how excitation of the prefrontal cortex can enhance performance in a variety of working memory tasks. Thus, future efforts might be guided toward neuro-enhancement in certain patient populations, using what is commonly termed "non-invasive brain stimulation" as a cognitive rehabilitation tool to modulate cerebro-cerebellar circuits, or for stimulation over the cerebral cortex to compensate for decreased cerebellar drive to this region. This article will address these possibilities with a review of the relevant literature covering ataxias and cerebellar cognitive affective disorders, which are characterized by thalamo-cortical disturbances.
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Affiliation(s)
- Paul A Pope
- School of Psychology, University of Birmingham , Birmingham , UK
| | - R Chris Miall
- School of Psychology, University of Birmingham , Birmingham , UK
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16
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Abstract
Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anesthetic management of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the level of L2-L3. The anesthetic implications of the various aspects of spinocerebellar degeneration are discussed.
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Affiliation(s)
- Prasanna Vadhanan
- Department of Anesthesia, Vinayaka Missions Medical College, Karaikal, India
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17
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Iwasaki Y, Mori K, Ito M, Tatsumi S, Mimuro M, Yoshida M. An autopsied case of progressive supranuclear palsy presenting with cerebellar ataxia and severe cerebellar involvement. Neuropathology 2013; 33:561-7. [PMID: 23320789 DOI: 10.1111/neup.12012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/27/2012] [Indexed: 11/28/2022]
Abstract
A Japanese male patient presented with gait disturbance at the age of 69 years. His principal symptom was cerebellar ataxia for several years. He was initially diagnosed as having olivopontocerebellar atrophy because dysarthria and ataxia gradually developed, and head CT scan showed apparent atrophy of the cerebellum and brainstem and dilatation of the fourth ventricle. Later, he showed vertical gaze palsy, dysphagia, retrocollis, parkinsonism, axial dominant rigidity and grasp reflex, and therefore, the diagnosis was modified to progressive supranuclear palsy (PSP). Progressive atrophy of the frontotemporal lobe, cerebellum and brainstem, and dilatation of the lateral, third and fourth ventricles were evident on MRI. Gastrostomy and tracheotomy were performed 9 and 10 years after onset, respectively, and the patient died after 11 years disease duration. At autopsy the brain weighed 1000 g and showed atrophy of the frontotemporal lobe, cerebellum and brainstem. Neurofibrillary tangles, mainly globose-type revealed by Gallyas-Braak silver staining, were extensively observed in the cerebral cortex and subcortical grey matter. Numerous glial fibrillary tangles, including tuft-shaped astrocytes and coiled bodies, and extensive argyrophilic threads were also recognized, particularly in the frontal lobe, basal ganglia, cerebellar white matter, brainstem and spinal cord. The Purkinje cell layer showed severe neuron loss with Bergmann's gliosis, and the dentate nucleus showed severe neuron loss with grumose degeneration. Tau-positive/Gallyas-positive inclusions in the Purkinje cells and the glial cells of the Purkinje cell layer were observed. Pathological findings of the present patient were consistent with the diagnosis of PSP, but the olivopontocerebellar involvement, particularly in the cerebellum, was generally more severe, and the quantity of tau-positive/Gallyas-positive structures were more abundant than in typical PSP cases. The existence of a distinct, rare PSP subtype with severe olivopontocerebellar involvement, "PSP-C", which tends to be clinically misdiagnosed as spinocerebellar degeneration in the early disease stage, is noteworthy. The present case corresponded to this rare subtype of PSP.
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Affiliation(s)
- Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute
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18
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Abstract
Hereditary ataxias (HA) encompass an increasing number of degenerative disorders characterized by progressive cerebellar ataxia usually accompanied by extracerebellar semeiology including peripheral nerve involvement. Classically, HA were classified according to their pathological hallmark comprising three main forms: (1) spinal form predominantly with degeneration of spinocerebellar tracts, posterior columns, and pyramidal tracts (Friedreich's ataxia, FA); (2) olivopontocerebellar atrophy (OPCA); and (3) cortical cerebellar atrophy (CCA). In the 1980s Harding proposed a clinico-genetic classification based upon age of onset, modality of transmission, and clinical semeiology. The main categories in this classification were as follows: (1) early onset cerebellar ataxia (EOCA) with age of onset below 25 years and usually with autosomal recessive (AR) transmission (this group encompasses FA and syndromes different from FA); (2) autosomal dominant cerebellar ataxia (ADCA) with adult onset and with either cerebellar-plus syndrome or pure cerebellar semeiology; and (3) idiopathic late onset onset cerebellar ataxia (ILOCA). With the advent of molecular genetics, the nosology of HA has been in a state of constant flux. At present EOCA comprises at least 17 genotypes (designated with the acronym of ARCA derived from AR cerebellar ataxia), whereas under the umbrella of ADCA 30 genotypes have been reported. In this chapter we will review peripheral nerve involvement in classical pathological entities (OPCA and CCA), ARCA, ADCA, and ILOCA paying special attention to the most prevalent syndromes in each category. As a general rule, nerve involvement is relatively common in any form of ataxia except ILOCA, the most common pattern being either sensory or sensorimotor neuronopathy with a dying-back process. An exception to this rule is AR spastic ataxia of Charlevoix-Saguenay where nerve conduction studies show the characteristic pattern of intermediate neuropathy implying that sacsin mutation causes both axonal and Schwann cell dysfunction.
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Affiliation(s)
- José Berciano
- Department of Neurology and Clinical Neurophysiology, University Hospital "Marqués de Valdecilla (IFIMAV)", University of Cantabria and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Santander, Spain.
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19
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Brega AG, Goodrich G, Bennett RE, Hessl D, Engle K, Leehey MA, Bounds LS, Paulich MJ, Hagerman RJ, Hagerman PJ, Cogswell JB, Tassone F, Reynolds A, Kooken R, Kenny M, Grigsby J. The primary cognitive deficit among males with fragile X-associated tremor/ataxia syndrome (FXTAS) is a dysexecutive syndrome. J Clin Exp Neuropsychol 2008; 30:853-69. [PMID: 18608667 PMCID: PMC4098148 DOI: 10.1080/13803390701819044] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [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] [Indexed: 10/22/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder associated with a premutation trinucleotide repeat expansion in the fragile X mental retardation 1 gene. Symptoms include gait ataxia, action tremor, and cognitive impairment. The objectives of the study were to clarify the nature of the dysexecutive syndrome observed in FXTAS and to assess the contribution of executive impairment to deficits in nonexecutive cognitive functions. Compared to controls, men with FXTAS demonstrated significant executive impairment, which was found to mediate group differences in most other cognitive abilities. Asymptomatic premutation carriers performed similarly to controls on all but two measures of executive functioning. These findings suggest that the impairment of nonexecutive cognitive skills in FXTAS is in large part secondary to executive dysfunction.
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Affiliation(s)
- Angela G. Brega
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - Glenn Goodrich
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - Rachael E. Bennett
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - David Hessl
- M.I.N.D. Institute, University of California, Davis, Medical Center, Sacramento, CA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Medical Center, Sacramento, CA
| | - Karen Engle
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - Maureen A. Leehey
- Department of Neurology, University of Colorado at Denver and Health Sciences Center, Denver, CO
| | - Lanee S. Bounds
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - Marsha J. Paulich
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
| | - Randi J. Hagerman
- M.I.N.D. Institute, University of California, Davis, Medical Center, Sacramento, CA
- Department of Pediatrics, University of California, Davis, Medical Center, Sacramento, CA
| | - Paul J. Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, CA
| | - Jennifer B. Cogswell
- M.I.N.D. Institute, University of California, Davis, Medical Center, Sacramento, CA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, CA
| | | | | | - Michael Kenny
- C.U. Aging Center, University of Colorado at Colorado Springs, Colorado Springs, CO
| | - Jim Grigsby
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO
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