Ataxic Disorders
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Multiplex Families with Multiple System Atrophy
ORIGINAL CONTRIBUTION Multiplex Families With Multiple System Atrophy Kenju Hara, MD, PhD; Yoshio Momose, MD, PhD; Susumu Tokiguchi, MD, PhD; Mitsuteru Shimohata, MD, PhD; Kenshi Terajima, MD, PhD; Osamu Onodera, MD, PhD; Akiyoshi Kakita, MD, PhD; Mitsunori Yamada, MD, PhD; Hitoshi Takahashi, MD, PhD; Motoyuki Hirasawa, MD, PhD; Yoshikuni Mizuno, MD, PhD; Katsuhisa Ogata, MD, PhD; Jun Goto, MD, PhD; Ichiro Kanazawa, MD, PhD; Masatoyo Nishizawa, MD, PhD; Shoji Tsuji, MD, PhD Background: Multiple system atrophy (MSA) has Results: Consanguineous marriage was observed in 1 been considered a sporadic disease, without patterns of of 4 families. Among 8 patients, 1 had definite MSA, 5 inheritance. had probable MSA, and 2 had possible MSA. The most frequent phenotype was MSA with predominant parkin- Objective: To describe the clinical features of 4 multi- sonism, observed in 5 patients. Six patients showed pon- plex families with MSA, including clinical genetic tine atrophy with cross sign or slitlike signal change at aspects. the posterolateral putaminal margin or both on brain mag- netic resonance imaging. Possibilities of hereditary atax- Design: Clinical and genetic study. ias, including SCA1 (ataxin 1, ATXN1), SCA2 (ATXN2), Machado-Joseph disease/SCA3 (ATXN1), SCA6 (ATXN1), Setting: Four departments of neurology in Japan. SCA7 (ATXN7), SCA12 (protein phosphatase 2, regula- tory subunit B,  isoform; PP2R2B), SCA17 (TATA box Patients: Eight patients in 4 families with parkinson- binding protein, TBP) and DRPLA (atrophin 1; ATN1), ism, cerebellar ataxia, and autonomic failure with age at ␣ onset ranging from 58 to 72 years. Two siblings in each were excluded, and no mutations in the -synuclein gene family were affected with these conditions. -
Friedreich Ataxia Mouse Models with Progressive Cerebellar and Sensory Ataxia Reveal Autophagic Neurodegeneration in Dorsal Root Ganglia
The Journal of Neuroscience, February 25, 2004 • 24(8):1987–1995 • 1987 Neurobiology of Disease Friedreich Ataxia Mouse Models with Progressive Cerebellar and Sensory Ataxia Reveal Autophagic Neurodegeneration in Dorsal Root Ganglia Delphine Simon,1 Herve´ Seznec,1 Anne Gansmuller,1 Nade`ge Carelle,1 Philipp Weber,1 Daniel Metzger,1 Pierre Rustin,2 Michel Koenig,1 and He´le`ne Puccio1 1Institut de Ge´ne´tique et de Biologie Mole´culaire et Cellulaire, Centre National de la Recherche Scientifique/Institut National de la Sante´ et de la Recherche Me´dicale (INSERM)/Universite´ Louis Pasteur, 67404 Illkirch cedex, CU de Strasbourg, France, and 2Unite´ de Recherches sur les Handicaps Ge´ne´tiques de l’Enfant, INSERM U393, Hoˆpital Necker-Enfants Malades, 75015 Paris, France Friedreich ataxia (FRDA), the most common recessive ataxia, is characterized by degeneration of the large sensory neurons of the spinal cord and cardiomyopathy. It is caused by severely reduced levels of frataxin, a mitochondrial protein involved in iron–sulfur cluster (ISC) biosynthesis. Through a spatiotemporally controlled conditional gene-targeting approach, we have generated two mouse models for FRDA that specifically develop progressive mixed cerebellar and sensory ataxia, the most prominent neurological features of FRDA. Histological studies showed both spinal cord and dorsal root ganglia (DRG) anomalies with absence of motor neuropathy, a hallmark of the human disease. In addition, one line revealed a cerebellar granule cell loss, whereas both lines had Purkinje cell arborization defects. These lines represent the first FRDA models with a slowly progressive neurological degeneration. We identified an autophagic process as the causative pathological mechanism in the DRG, leading to removal of mitochondrial debris and apparition of lipofuscin deposits. -
Non-Progressive Congenital Ataxia with Cerebellar Hypoplasia in Three Families
248 Non-progressive congenital ataxia with cerebellar hypoplasia in three families . No 1.6 Z. YAPICI & M. ERAKSOY . .. I.Y.. \ .~ ---················ No of Neurology, of Child Neuro/ogy, Facu/ty of Turkey Abstract Non-progressive with cerebellar hypoplasia are a rarely seen heterogeneous group ofhereditary cerebellar ataxias. Three sib pairs from three different families with this entity have been reviewed, and differential diagnosis has been di sc ussed. in two of the families, the parents were consanguineous. Walking was delayed in ali the children. Truncal and extremiry were then noticed. Ataxia was severe in one child, moderate in two children, and mild in the remaining revealed horizontal, horizonto-rotatory and/or vertical variable degrees ofmental and pvramidal signs besides truncal and extremity ataxia. In ali the cases, cerebellar hemisphere and vermis were in MRI . During the follow-up period, a gradual clinical improvement was achieved in ali the Condusion: he cu nsidered as recessive in some of the non-progressive ataxic syndromes. are being due to the rarity oflarge pedigrees for genetic studies. Iffurther on and clini cal progression of childhood associated with cerebellar hypoplasia is be a cu mbined of metabolic screening, long-term follow-up and radiological analyses is essential. Key Words: Cerebella r hy poplasia, ataxic syndromes are common during Patients 1 and 2 (first family) childhood. Friedreich 's ataxia and ataxia-telangiectasia Two brothers aged 5 and 7 of unrelated parents arc two best-known examples of such rare syn- presented with a history of slurred speech and diffi- dromes characterized both by their progressive nature culty of gait. -
Movement Disorders in the Elderly
MOVEMENT DISORDERS IN THE ELDERLY Eugene C. Lai, M.D., Ph.D. Michael E. DeBakey VA Medical Center Baylor College of Medicine Houston, Texas MOVEMENT DISORDERS Neurologic dysfunctions in which there is either a paucity of voluntary and automatic movements (HYPOKINESIA) or an excess of movement (HYPERKINESIA) or uncontrolled movements (DYSKINESIA) typically unassociated with weakness or spasticity HYPOKINESIAS • Parkinson‟s disease • Secondary Parkinsonism • Parkinson‟s plus syndromes HYPERKINESIAS • Akathisia • Hemifacial spasm • Athetosis • Myoclonus • Ballism • Restless leg syndrome • Chorea • Tics • Dystonia • Tremor COMMON MOVEMENT DISORDERS IN THE ELDERLY • Parkinsonism • Tremor • Gait disorder • Restless leg syndrome • Drug-induced syndrome PARKINSONISM • Parkinson‟s disease • Secondary parkinsonism • Drug-induced parkinsonism • Vascular parkinsonism • Parkinson‟s plus syndromes • Multiple system atrophy • Progressive supranuclear palsy PARKINSON’S DISEASE PARKINSON’S DISEASE Classical Clinical Features • Resting Tremor • Cogwheel Rigidity • Bradykinesia • Postural Instability PARKINSON’S DISEASE Associated Clinical Features • Micrographia • Hypophonia • Hypomimia • Shuffling gait / festination • Drooling • Dysphagia NON-MOTOR COMPLICATIONS IN PARKINSON’S DISEASE • Sleep disturbances • Autonomic dysfunctions • Sensory phenomena • Neuropsychiatric manifestations • Cognitive impairment PARKINSON’S DISEASE General Considerations • The second most common progressive neurodegenerative disorder • The most common neurodegenerative movement -
Comprehensive Systematic Review: Treatment of Cerebellar Motor Dysfunction and Ataxia
Comprehensive systematic review: Treatment of cerebellar motor dysfunction and ataxia Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Theresa A. Zesiewicz, MD1; George Wilmot, MD2; Sheng-Han Kuo, MD3; Susan Perlman, MD4; Patricia E. Greenstein, MB, BCh5; Sarah H. Ying, MD6; Tetsuo Ashizawa, MD7; S.H. Subramony, MD8; Jeremy D. Schmahmann, MD9; K.P. Figueroa10; Hidehiro Mizusawa, MD11; Ludger Schöls, MD12; Jessica D. Shaw, MPH1; Richard M. Dubinsky, MD, MPH13; Melissa J. Armstrong, MD, MSc8; Gary S. Gronseth, MD13; Kelly L. Sullivan, PhD14 1) Department of Neurology, University of South Florida, Tampa 2) Department of Neurology, Emory University, Atlanta, GA 3) Department of Neurology, Columbia University, New York, NY 4) Department of Neurology, University of California, Los Angeles 5) Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 6) Shire, Lexington, MA, and the Johns Hopkins University School of Medicine, Baltimore, MD 7) Department of Neurology, Houston Methodist Research Institute, TX 8) Department of Neurology, University of Florida College of Medicine, Gainesville 9) Department of Neurology, Massachusetts General Hospital, and Department of Neurology, Harvard Medical School, Boston, MA 10) Department of Neurology, University of Utah, Salt Lake City 11) National Center of Neurology and Psychiatry, Tokyo, Japan 12) Department of Neurology and Hertie-Institute for Clinical Brain Research, Tübingen, Germany 13) Department of Neurology, University of Kansas Medical Center, Kansas City 14) Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro Address correspondence and reprint requests to American Academy of Neurology: [email protected] Title character count: 71 Abstract word count: 254 Manuscript word count: 7,891 Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on October 22, 2016; by the Practice Committee on October 2, 2017; and by the AAN Institute Board of Directors on December 5, 2017. -
The Clinical Approach to Movement Disorders Wilson F
REVIEWS The clinical approach to movement disorders Wilson F. Abdo, Bart P. C. van de Warrenburg, David J. Burn, Niall P. Quinn and Bastiaan R. Bloem Abstract | Movement disorders are commonly encountered in the clinic. In this Review, aimed at trainees and general neurologists, we provide a practical step-by-step approach to help clinicians in their ‘pattern recognition’ of movement disorders, as part of a process that ultimately leads to the diagnosis. The key to success is establishing the phenomenology of the clinical syndrome, which is determined from the specific combination of the dominant movement disorder, other abnormal movements in patients presenting with a mixed movement disorder, and a set of associated neurological and non-neurological abnormalities. Definition of the clinical syndrome in this manner should, in turn, result in a differential diagnosis. Sometimes, simple pattern recognition will suffice and lead directly to the diagnosis, but often ancillary investigations, guided by the dominant movement disorder, are required. We illustrate this diagnostic process for the most common types of movement disorder, namely, akinetic –rigid syndromes and the various types of hyperkinetic disorders (myoclonus, chorea, tics, dystonia and tremor). Abdo, W. F. et al. Nat. Rev. Neurol. 6, 29–37 (2010); doi:10.1038/nrneurol.2009.196 1 Continuing Medical Education online 85 years. The prevalence of essential tremor—the most common form of tremor—is 4% in people aged over This activity has been planned and implemented in accordance 40 years, increasing to 14% in people over 65 years of with the Essential Areas and policies of the Accreditation Council age.2,3 The prevalence of tics in school-age children and for Continuing Medical Education through the joint sponsorship of 4 MedscapeCME and Nature Publishing Group. -
Ataxia in Children: Early Recognition and Clinical Evaluation Piero Pavone1,6*, Andrea D
Pavone et al. Italian Journal of Pediatrics (2017) 43:6 DOI 10.1186/s13052-016-0325-9 REVIEW Open Access Ataxia in children: early recognition and clinical evaluation Piero Pavone1,6*, Andrea D. Praticò2,3, Vito Pavone4, Riccardo Lubrano5, Raffaele Falsaperla1, Renata Rizzo2 and Martino Ruggieri2 Abstract Background: Ataxia is a sign of different disorders involving any level of the nervous system and consisting of impaired coordination of movement and balance. It is mainly caused by dysfunction of the complex circuitry connecting the basal ganglia, cerebellum and cerebral cortex. A careful history, physical examination and some characteristic maneuvers are useful for the diagnosis of ataxia. Some of the causes of ataxia point toward a benign course, but some cases of ataxia can be severe and particularly frightening. Methods: Here, we describe the primary clinical ways of detecting ataxia, a sign not easily recognizable in children. We also report on the main disorders that cause ataxia in children. Results: The causal events are distinguished and reported according to the course of the disorder: acute, intermittent, chronic-non-progressive and chronic-progressive. Conclusions: Molecular research in the field of ataxia in children is rapidly expanding; on the contrary no similar results have been attained in the field of the treatment since most of the congenital forms remain fully untreatable. Rapid recognition and clinical evaluation of ataxia in children remains of great relevance for therapeutic results and prognostic counseling. Keywords: Ataxia, Diagnostic maneuvers, Acute cerebellitis, Cerebellar syndrome, Cerebellar malformations Background Clinical signs in cerebellar ataxic patients are related to Ataxia in children is a common clinical sign of various impaired localization. -
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RESIDENT & FELLOW SECTION Clinical Reasoning: Section Editor An 82-year-old man with worsening gait John J. Millichap, MD Sheena Chew, MD SECTION 1 neck and left leg cramps. He denied bowel or bladder Ivana Vodopivec, MD, An 82-year-old man with hypothyroidism presented symptoms. PhD with difficulty walking. The patient was previously healthy, playing com- Aaron L. Berkowitz, MD, One year prior to presentation, he noticed that his petitive sports at the national level into his late 70s. PhD legs occasionally “froze” when initiating walking. His His only medication was levothyroxine. gait progressively worsened over the year. He devel- oped balance difficulty, tripping and falling twice Question for consideration: Correspondence to without loss of consciousness. In the 4 months prior Dr. Chew: to presentation, he started using a cane, a rolling 1. What examination findings would help to localize [email protected] walker, then a wheelchair. He reported occasional the etiology of his abnormal gait? GO TO SECTION 2 From the Department of Neurology, Brigham and Women’s Hospital (S.C., I.V., A.L.B.), and Department of Neurology, Massachusetts General Hospital (S.C.), Harvard Medical School, Boston. Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. e246 © 2017 American Academy of Neurology ª 2017 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. SECTION 2 arm dysdiadochokinesia and right leg dysmetria, but The neurologic basis of gait spans the entire neuraxis, no left-sided or truncal ataxia. -
Ataxia and Tremor in People with Multiple Sclerosis (MS)
for health professionals Ataxia and tremor in people with multiple sclerosis (MS) Freecall: 1800 042 138 www.msaustralia.org.au MS PRACTICE // ATAXIA AND TREMOR IN PEOPLE WITH MULTIPLE SCLEROSIS Ataxia and tremor in people with multiple sclerosis (MS) Ataxia and tremor are common yet difficult symptoms to manage in people with MS ― often requiring the involvement of a multidisciplinary team. Early intervention is important in order to address both the functional and psychological issues associated with these symptoms. Freecall: 1800 042 138 www.msaustralia.org.au MS PRACTICE // ATAXIA AND TREMOR IN PEOPLE WITH MULTIPLE SCLEROSIS 01 Contents Page 1.0 Definitions 02 2.0 Incidence and impact 3.0 Pathophysiology and clinical characteristics 3.1 Ataxia 3.2 Tremor 03 4.0 Assessment 5.0 Management 04 5.1 Physiotherapy 5.2 Pharmacotherapy 05 5.3 Surgical intervention 06 6.0 Summary Freecall: 1800 042 138 www.msaustralia.org.au MS PRACTICE // AtaXIA AND TREMOR IN PEOPLE WITH MULTIPLE SCLEROSIS 02 1.0 Definitions Ataxia Tremor Ataxia is a term used to describe a number of Tremor is defined as a rhythmic, involuntary, oscillating abnormal movements that may occur during the movement of a body part. There are two main execution of voluntary movements. They include, but classifications of tremor ― resting tremor and action are not limited to, incoordination, delay in movement, tremor. Resting tremor is present in a body part that dysmetria (inaccuracy in achieving a target), is completely supported against gravity and is not dysdiadochokinesia (inability -
GAIT DISORDERS, FALLS, IMMOBILITY Mov7 (1)
GAIT DISORDERS, FALLS, IMMOBILITY Mov7 (1) Gait Disorders, Falls, Immobility Last updated: April 17, 2019 GAIT DISORDERS ..................................................................................................................................... 1 CLINICAL FEATURES .............................................................................................................................. 1 CLINICO-ANATOMICAL SYNDROMES .............................................................................................. 1 CLINICO-PHYSIOLOGICAL SYNDROMES ......................................................................................... 1 Dyssynergy Syndromes .................................................................................................................... 1 Frontal gait ............................................................................................................................ 2 Sensory Gait Syndromes .................................................................................................................. 2 Sensory ataxia ........................................................................................................................ 2 Vestibular ataxia .................................................................................................................... 2 Visual ataxia .......................................................................................................................... 2 Multisensory disequilibrium ................................................................................................. -
ATAXIA TELANGIECTASIA Recommendations for Diagnosis and Treatment
STRATEGIC COMMITTEE AND STUDY GROUP ON IMMUNODEFICIENCIES ITALIAN ASSOCIATION OF PAEDIATRIC HAEMATOLOGY AND ONCOLOGY ATAXIA TELANGIECTASIA Recommendations for diagnosis and treatment Final version June 2007 Coordinator AIEOP Strategic Committee and A. Plebani Study Group on Immunodeficiencies: Paediatric Clinic Brescia Scientific Committee: A.G. Ugazio (Rome) I. Quinti (Rome) D. De Mattia (Bari) F. Locatelli (Pavia) L.D. Notarangelo (Brescia) A. Pession (Bologna) MC. Pietrogrande (Milan) C. Pignata (Naples) P. Rossi (Rome) PA. Tovo (Turin) C. Azzari (Florence) M. Aricò (Palermo) Head: M. Fiorilli (Rome) Document preparation: M. Fiorilli (Rome) L. Chessa (Rome) V. Leuzzi (Rome) M. Duse (Rome) A. Plebani (Brescia) A. Soresina (Brescia) Data Review Committee: M. Fiorilli (Rome) A. Soresina (Brescia) R. Rondelli (Bologna) Data Collection-Management-Statistical AIEOP-FONOP Operative Centre Analysis: c/o Sant’Orsola-Malpighi Hospital Via Massarenti 11 (pad. 13) 40138 Bologna 2 AIEOP SCSGI PARTICIPATING CENTRES 0901 ANCONA Clinica Pediatrica Prof. Coppa Ospedale dei Bambini “G. Salesi” Prof. P.Pierani Via F. Corridoni 11 60123 ANCONA Tel.071/5962360 Fax 071/36363 e-mail: [email protected] 1308 BARI Dipart. Biomedicina dell’Età Prof. D. De Mattia Evolutiva Dr. B. Martire Clinica Pediatrica I P.zza G. Cesare 11 70124 BARI Tel. 080/5478973 - 5542867 Fax 080/5592290 e-mail: [email protected] [email protected] 1307 BARI Clinica Pediatrica III Prof. L. Armenio Università di Bari Dr. F. Cardinale P.zza Giulio Cesare 11 70124 BARI Tel. 080/5426802 Fax 080/5478911 e-mail: [email protected] 1306 BARI Dip.di Scienze Biomediche e Prof. F. Dammacco Oncologia umana Prof. -
Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias
International Journal of Molecular Sciences Review Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias Giacomo Garone 1,2 , Alessandro Capuano 2 , Lorena Travaglini 3,4 , Federica Graziola 2,5 , Fabrizia Stregapede 4,6, Ginevra Zanni 3,4, Federico Vigevano 7, Enrico Bertini 3,4 and Francesco Nicita 3,4,* 1 University Hospital Pediatric Department, IRCCS Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, 00165 Rome, Italy; [email protected] 2 Movement Disorders Clinic, Neurology Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] (A.C.); [email protected] (F.G.) 3 Unit of Neuromuscular and Neurodegenerative Diseases, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] (L.T.); [email protected] (G.Z.); [email protected] (E.B.) 4 Laboratory of Molecular Medicine, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] 5 Department of Neuroscience, University of Rome Tor Vergata, 00133 Rome, Italy 6 Department of Sciences, University of Roma Tre, 00146 Rome, Italy 7 Neurology Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; [email protected] * Correspondence: [email protected]; Tel.: +0039-06-68592105 Received: 30 April 2020; Accepted: 13 May 2020; Published: 20 May 2020 Abstract: Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main categories of PMDs are recognized based on the phenomenology: Paroxysmal dyskinesias (PxDs) are characterized by transient episodes hyperkinetic movement disorders, while attacks of cerebellar dysfunction are the hallmark of episodic ataxias (EAs).