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[A challenge for revealing common molecular mechanisms underlying neurodegenerative disorders].

Many neuodegenerative disorders manifest disease-specific phenotypes, and thus it was thought impossible to deduce a common molecular mechanism underlying many, if not all, neurodegenerative disorders. However, protein aggregates and vacuoles are almost universally found in degenerating neurons, suggesting the existence of similar molecular processes in neuronal cell death. In 1994, we identified the gene responsible for Machado-Joseph disease (MJD). Not only MJD but also another 8 inherited neurodegenerative diseases, including Huntington's disease are caused by the expansion of CAG repeats encoding polyglutamines. Indeed, we have shown that polyglutamines have the ability to self-aggregate and induce neurodegeneration and neuronal cell death, leading to a proposal of 'polyglutamine disease'. Furthermore, we have identified ter94/VCP, a member of the AAAAT-Pase, as a key molecule in neurodegeneration. VCP co-localizes not only with polyglutamine aggregates but also other protein aggregates and Lewy bodies. Moreover, profound deficits in its ATPase activity are found to severely affect ER quality control, leading to abnormal ER expansion and cell death. These lines of evidence indicate that VCP functions not only as a common sensor for abnormal protein accumulations but also as a mediator of neurodegenerative phenotypes; excessive accumulation of abnormal proteins may inactivate VCP's ATPase in several neurodegenerative disorders, eventually leading to the neurodegenerations. A proper regulation of VCP function is thus proposed to lead to novel treatments that are effective in a broad spectrum of neurodegenerative diseases.

Adenosine Triphosphatases↗

[Glycosaminoglycans and their fractions in patients with hereditary neuromuscular disorders].

Hereditary neuromuscular disorders (HNMD), with population incidence 1:3000, are characterized in most cases by progressive course and treatment resistance and patient's disabling. To study the involvement of the tissue-connecting structures in the pathogenesis, glycosaminoglycans and their fractions were determined in blood serum. The test group involved 40 patients with hereditary myotonia, myodystrophy, neuropathy and spinal muscular atrophy and control one consisted of 27 healthy age- and sex-matched subjects. The study was conducted using anion exchange chromatography on DEAE-cellulose. Comparing to controls, significant increase of total glycosaminoglycans and decrease of gilauronic acid fraction (p < 0.05) were found in HNMD patients, with no differences being detected between nosologic entities. Reverse correlation (r = -0.46) was revealed between patient's age and glycosaminoglycans concentration in blood serum. We concluded on intracellular and intercellular matrix heteropolyglycans metabolism dysregulation in the patients and suggested a part of HNMD pathogenesis scheme.

Adult↗

Abiotrophy.

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Heredodegenerative Disorders, Nervous System↗

[Treatment of patients with neuromuscular disease in a warm climate].

BACKGROUND: Several patient groups request treatment in a warm climate, in spite of the fact that the effects of such treatment are undocumented. MATERIAL AND METHODS: 47 children and 40 adults with neuromuscular diseases were recruited, stratified according to sex, use or non-use of electric wheelchair, primary myopathy or hereditary neuropathy, and randomised into two adult and two children groups. The patients were treated in a rehabilitation centre, either on Lanzarote or in Norway. All patients were monitored with physical tests and questionnaires at the start of the study, at the end of the treatment period, after three months (all groups) and after six months (adults only). RESULTS: No significant differences in effect between the groups were found. In the warm climate, the adult patient group showed a statistically significant improvement regarding pain, quality of life, depression, and results of physical tests at the end of treatment. After three months, the improvement in physical tests was still present. Among adult patients treated in Norway, improvement in physical tests was statistically significant after three months, but not at the end of the treatment period. INTERPRETATION: This study did not show a statistically significant difference between patients with various neuromuscular diseases treated in a warm climate compared to similar patients treated in Norway.

Adult↗

Inborn errors of metabolism (IEM) -- an Indian perspective.

The inborn errors of metabolism (IEM) constitute a diverse heterogeneous group of disorders with protean clinical manifestations presenting mainly in the pediatric population. Though individually rare, together they constitute a significant percentage of children seen in genetic and neurology clinics. This review focuses on selected IEMs and highlights those seen in the neonatal period. Data from Indian centers are presented. It also emphasizes principles of management in these difficult disorders in the context of a developing country.

Brain Diseases, Metabolic↗

Hereditary neurodegenerative disorders in Nigerian Africans.

Of 2.1 million patients seen in 25 years at the University College Hospital, Ibadan, Nigeria, only 25 suffered from heredodegenerative disorders of the nervous system. Six patients had hereditary ataxia, 10 essential tremor, 4 Huntington's chorea, 2 ataxia telangiectasia, and 3 Charcot-Marie-Tooth disease.

Adolescent↗

[Pathophysiology of sulfatide metabolism in metachromatic leukodystrophy].

Metachromatic leucodystrophies (MLD) comprise a small group of heredodegenerative disorders of the nervous system. Deficiency of sulfatide-sulfatase or arylsulfatase A is the common defect in all forms of MLD leading to lysosomal sulfatide storage in the nervous tissue and in the kidney. On the basis of animal experiments, experiments with cultured fibroblasts of the patients as well as ultrastructural studies in a case of prenatal MLD, the following pathomechanism is proposed: 1. Lysosomal degradation of a large portion newly synthetised sulfatide normally regulating the net synthesis and incorporation of sulfatide into myelin, causes early accumulation of sulfatide in lysosomes of myelinating cells and in neurons in the genetic deficiency of arylsulfatase A. 2. Early accumulation of sulfatide does not lead to disturbance in myelination. Demyelination occurs possibly by storage of a cytotoxic compound, psychosin sulfate, also a substrate for the missing enzyme. Prevention of MLD is possible by prenatal diagnosis of arylsulfatase A deficiency in cultured amniotic cells. Enzyme substitution of the missing arylsulfatase A is possible by exogenous uptake of the enzyme in cultured fibroblasts. Thereby the defect of sulfatide degradation can be corrected. Although principles of enzyme substitution have been demonstrated, the problems of treating patients with MLD with arylsulfatase A infusions have yet to be overcome.

Animals↗

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗

Neuropsychiatric disorders in Nigerians: 1914 consecutive new patients seen in 1 year.

The socio-demographic attributes and the different diagnostic categories of patients attending Aro Neuropsychiatric Hospital for the first time over a 1-year period are presented. There was an overall preponderance of males but more females than males suffered from depression. Factors which distinguished patients with anxiety neurosis from those with neurotic and endogenous depression are identified. Two patients who suffered from obsessional neurosis, commonly regarded as rare in the black Africans, are described. Heredodegenerative diseases of the nervous system are rare in the Africans and one patient with hereditary spinocerebellar degeneration is described. Eclampsia was a probable predisposing factor for epilepsy in four women.

Adolescent↗

The nosology of genetic peripheral neuropathies in Swedish children.

103 consecutive childhood cases of genetic peripheral neuropathies of heredodegenerative background were collected from Gothenburg from 1973 to 1980. From this series, 63 hereditary motor and sensory neuropathies (HMSN) were distinguished: 31 cases of demyelinating and remyelinating HMSN (HMSN I), 21 (18 families) with an autosomal dominant and 10 with sporadic mode of inheritance and unaffected parents; and 32 cases of neuronal-axonal types (HMSN II), 27 of whom (25 families) had at least one affected, if asymptomatic, parent. In one family, both parents were neurologically and neurophysiologically completely normal. Three cases of uncharacteristic HSN were diagnosed. Among 37 cases with a combined degenerative encephalopathy/myelopathy and a peripheral neuropathy, nine had hereditary spastic paraplegia, six had heredoataxias (three of the Friedreich type), nine had lysosomal storage diseases (five of the Krabbe type), seven had other known inborn metabolic errors and six had biochemically undefined disorders. Progressive neuropathies are important manifestations of a large variety of genetically determined heredodegenerative neurological disorders of infancy and childhood. For classification of HMSN, clinical and neurophysiological examinations are necessary for the index case and for both parents as well.

Biopsy↗

Polyneuropathies in paediatrics.

Non-acute polyneuropathies (PNPs) encountered in paediatrics are reviewed. Emphasis is placed on three main groups of conditions: the relatively rare but treatable dysimmune PNP (chronic relapsing dysimmune polyneuropathies, CRDP); the more common hereditary motor/sensory neuropathies (HMSN and HSN); and the often missed symptomatic neuropathies of some heredodegenerative and neurometabolic disorders. Diagnostic procedures are discussed. One conclusion drawn is that so far metabolic screening procedures do not give any diagnostic or aetiological information in HMSN or in HSN, nor in heredoataxias or heredoparaplegias. When a specific neurometabolic disease is suspected from the clinical symptomatology, individually structured investigations are necessary.

Adolescent↗

[Diagnostic focus on the child with epilepsy and neuropsychological deterioration].

Symptomatic epilepsy secondary to hereditary metabolic or degenerative disorders, is usually associated to neurological deterioration. Though epilepsy by itself does not induce neurological deterioration, we should remind that some epileptics encephalopathies, such as the West or Lennox-Gastaut syndromes, do actually induce limited neurological deterioration. Furthermore, in some forms of complex partial epilepsy, motor problems and behavior disorders can be observed, specially in adolescents with temporary lobe epilepsy. Other forms of epilepsy, such as the atypical benign partial epilepsy or the Landau-Kleffner syndrome, can present a certain degree of cognitive deterioration in the evolution, although they can recover later lost functions, totally or partially. The evolution of some refractory epilepsy, as patients are submitted to a multiple treatments, can make us suspect a degenerative disease. In some cases, the diagnosis of the hereditary metabolic and heredodegeneratives diseases can be made by the characteristics of the seizures but in most cases the diagnosis will be established by the symptoms of the basic disease and the lab data.

Adolescent↗

[Contribution of visual evoked potentials (VEP) to neurology].

It is widely admitted that visual evoked potentials (VEPs) are clinically useful for diagnostic purposes in multiple sclerosis (MS). Delayed P100 component to pattern shift stimulation indicates a dissemination of the demyelinating process when routine ophthalmological investigations are normal. The delay of P100 may be observed early in the course of the disease following an attack of optic neuritis (ON); in the absence of previous ON the P100 latency may appear later after the onset. The P100 latency exceptionally returns to normal values. Compared with somatosensory or brain-stem auditory evoked potentials VEPs are the most efficient for the detection of silent lesions in MS. Longitudinal studies demonstrate that the percentage of MS patients with abnormal VEPs increases with time during the course of the disease. Delayed P100 component may also be recorded in patients with heredodegenerative or toxic optic neuropathies, but the clinical context is very different. The detection of bitemporal visual field defects with VEPs is more uncertain. In patients with cortical blindness VEPs may persist. When compared with usual campimetric investigations, VEPs do not represent a simple and reliable means of investigating lateral homonymous hemianopsia.

Epilepsy↗

Pigmentary degeneration of the retina in heredodegenerative neurological diseases.

Frequency of pigmentary degeneration of the retina (PDR) among patients with degenerative and heredodegenerative neurological diseases (HDNDs) was estimated based on the hospital statistics. PDR was detected in 3% of 176 inpatients with HDNDs by careful ophthalmologic examination. On the other hand, out of 30 consecutive cases of PDR seen in our Department of Neurology, 15 patients were associated with some form of HDNDs. Atypical PDR were more frequently associated with HDNDs than typical PDR. Among neurological manifestations in those 15 cases of PDR associated with HDNDs, mental deficiency, hearing disturbance, spasticity, progressive ophthalmoplegia and ataxia were most frequently encountered. Four cases with unusual symptomatology were presented. Clinical analysis of cases of PDR associated with HDNDs in the present series as well as in the relevant literature revealed an extreme variety of clinical manifestations and underlying metabolic disorders, suggesting a possible participation of multiple factors in the pathogenesis of PDR. Importance of careful ophthalmologic examination in HDNDs was stressed from the prognostic point of view.

Adolescent↗