Dystonia in Machado-Joseph disease: Clinical profile, therapy and anatomical basis.

INTRODUCTION: Dystonia is frequent in Machado-Joseph disease, but several important aspects are not yet defined, such as the detailed clinical profile, response to treatment and anatomical substrate. METHODS: We screened 75 consecutive patients and identified those with dystonia. The Burke-Marsden-Fahn Dystonia Rating Scale was employed to quantify dystonia severity. Patients with dystonia received levodopa 600 mg/day for 2 months and were videotaped before and after treatment. A blinded evaluator rated dystonia in the videos. Patients with disabling dystonia who failed to respond to levodopa treatment received botulinum toxin. Finally, volumetric T1 and diffusion tensor imaging sequences were obtained in the dystonic group using a 3T-MRI scanner to identify areas of gray and white matter that were selectively damaged. RESULTS: There were 21 patients with dystonia (28%): 9 classified as generalized and 12 as focal/segmental. Patients with dystonia had earlier onset and larger (CAG) expansions (28.9 ± 11.7 vs 40.6 ± 11.4; p < 0.001 and 75 vs 70; p < 0.001, respectively). Although group analyses failed to show benefit on levodopa (p = 0.07), some patients had objective improvement. In addition, ten patients received botulinum toxin resulting in a significant change in dystonia scores after 4 weeks (p = 0.03). Patients with dystonia had atrophy at pre- and paracentral cortices; whereas, non-dystonic patients had occipital atrophy. Basal ganglia volume was reduced in both groups, but atrophy at the thalami, cerebellar white matter and ventral diencephali was disproportionately higher in the dystonic group. CONCLUSION: Dystonia in Machado-Joseph disease is frequent and often disabling, but may respond to levodopa. It is associated predominantly with structural abnormalities around the motor cortices and in the thalami.

White and grey matter abnormalities in patients with SPG11 mutations.

BACKGROUND: Mutations in SPG11 are the most frequent known cause of autosomal recessive hereditary spastic paraplegia. Corpus callosum thinning is a hallmark of the condition but little is known about damage to other structures in the CNS. OBJECTIVE: To evaluate in vivo cerebral damage in patients with SPG11 mutations. METHODS: 5 patients and 15 age and sex matched healthy controls underwent high resolution diffusion tensor imaging (32 directions) and a T1 volumetric (1 mm slices) acquisition protocol in a 3 T scanner (Philips Achieva). These sequences were then analysed through voxel based morphometry (VBM) and tract based spatial statistics (TBSS). RESULTS: Mean age of the patients was 23.6±4.5 years (range 14-45) and mean duration of disease was 12 years (range 5-15). All patients presented with progressive spastic paraplegia and three were already wheelchair bound when first evaluated. Mutations found were: c.529_533delATATT, c.704_705delAT, c.733_734delAT, c.118C>T and c.7256A>G. VBM identified significant grey matter atrophy in both the thalamus and lentiform nuclei. TBSS analyses revealed reduced fractional anisotropy involving symmetrically subcortical white matter of the temporal and frontal lobes, the cingulated gyrus, cuneus, striatum, corpus callosum and brainstem. CONCLUSIONS: Widespread white matter damage in patients with SPG11 mutations has been demonstrated. Grey matter atrophy was prominent in both the thalamus and basal ganglia but not in the cerebral cortex. These findings suggest that neuronal damage/dysfunction is more widespread than previously recognised in this condition.

Thalamic volume and dystonia in Machado-Joseph disease.

BACKGROUND AND PURPOSE: Neuropathological studies and one positron emission tomography study demonstrated involvement of the thalamus in Machado-Joseph disease (MJD), but a large series of patients has not been studied. Our objective was to perform an automated and a manual segmentation of the thalamus in patients with MJD. METHODS: We used the MarsBar volume of interest analysis toolbox to SPM2 and selected thalamic region of interests and we performed a t-test with Bonferroni's correction using SPM2 to compare patients to control. Next, we performed manual segmentation of the thalamus using the display software. Differences between patients and controls were analyzed by t-test. We also correlated manual thalamic volumes with clinical and genetic markers of the disease. RESULTS: We observed decreased thalamic volumes in MJD when compared to controls using both methods of volumetric measurement. MJD patients with dystonia had smaller volumes than patients without dystonia. CONCLUSIONS: We confirmed thalamic involvement in MJD patients. Patients with dystonia had smaller thalamic volumes than patients without dystonia. We observed a clinical-anatomical correlation, which suggests that different phenotypes of the disease present different primary or secondary targets of the disease.