[Show abstract][Hide abstract] ABSTRACT: Background and aims:
Impaired emotional facial expressiveness is an important feature in Parkinson's disease (PD). Although there is evidence of a possible relationship between reduced facial expressiveness and altered emotion recognition or imagery in PD, it is unknown whether other aspects of the emotional processing, such as subjective emotional experience (alexithymia), might influence hypomimia in this condition. In this study wee aimed to investigate possible relationship between reduced facial expressiveness and altered emotion processing (including facial recognition and alexithymia) in patients with PD.
Forty PD patients and seventeen healthy controls were evaluated. Facial expressiveness was rated on video recordings, according to the UPDRS-III item 19 and using an ad hoc scale assessing static and dynamic facial expression and posed emotions. Six blind raters evaluated the patients' videos. Emotion facial recognition was tested using the Ekman Test; alexithymia was assessed using Toronto Alexithymia Scale (TAS-20).
PD patients had a significantly reduced static and dynamic facial expressiveness and a deficit in posing happiness and surprise. They performed significantly worse than healthy controls in recognizing surprise (p=0.03). The Ekman total score positively correlated with the global expressiveness (R^2=0.39, p=0.01) and with the expressiveness of disgust (R^2=0.32, p=0.01). The occurrence of alexithymia was not different between PD patients and HC; however, a significant negative correlation between the expressiveness of disgust was found for a subscore of TAS (R^2=-.447, p=0.007).
Reduced facial expressiveness in PD may be in part related to difficulties with emotional recognition in a context of an unimpaired subjective emotional experience.
Journal of the neurological sciences 09/2015; DOI:10.1016/j.jns.2015.08.1516 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: sec> Objective In Tourette syndrome (TS), multiple motor and vocal tics are frequently accompanied by complex tics with social significance, including imitation (echophenomena), and urges to perform socially inappropriate behaviours. Furthermore, previous studies have highlighted differences in the way individuals with TS reason about social and emotional information. In this study we explored whether TS may be characterised by differences in the tendency to adopt alternative perspectives and to relate emotionally to others in everyday life. Method We administered the Interpersonal Reactivity Index to a total of 155 adults, of whom 95 had TS and the remainder were healthy controls. Between-group comparisons were conducted separately for males and females, and within-group analyses explored whether any clinical features (tics, premonitory urges, symptoms of common co-morbid disorders) were linked to scale ratings. Results Both males and females with TS were found to exhibit a different Interpersonal Reactivity Profile to healthy gender-matched controls, which consisted of a reduced tendency to take the perspective of others, and elevated personal distress when faced with other people in crises. There were no group differences for the fantasy or empathic concern subscales. Personal distress ratings were strongly associated with tic severity and weakly related to attention problems. Conclusion The pattern of interpersonal reactivity ratings suggests that an elevated distress response to witnessing highly emotive situations may encourage a defensive strategy of reduced perspective taking in TS. These findings provide further evidence that TS is associated with changes in social cognition, as reflected in patients' self-reported everyday behaviour. </sec
[Show abstract][Hide abstract] ABSTRACT: Background
A contribution of aberrant interoceptive awareness to the perception of premonitory urges in Gilles de la Tourette syndrome (GTS) has been hypothesized.
We assessed interoceptive awareness in 19 adults with GTS and 25 age-matched healthy controls using the heartbeat counting task. We also used multiple regression to explore whether the severity of premonitory urges was predicted by interoceptive awareness or severity of tics and obsessive-compulsive symptoms.
We observed lower interoceptive awareness in GTS compared with controls. Interoceptive awareness was the strongest predictor of premonitory urges in GTS, with greater interoceptive awareness being associated with more urges. Greater tic severity was also associated with higher rates of premonitory urges.
The observed relationship between severity of premonitory urges and interoceptive awareness suggests that interoception might be involved in self-reported premonitory urges in GTS. High levels of interoceptive awareness might reflect a self-attentive capacity to perceive urges.
Movement Disorders 04/2015; 30(9). DOI:10.1002/mds.26228 · 5.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Guanfacine is an α2A-adrenoreceptor agonist currently indicated for the treatment of attention deficit hyperactivity disorder (ADHD). This article reviews the chemistry, pharmacodynamics and pharmacokinetics of guanfacine, as well as the clinical trial literature on guanfacine for the treatment of ADHD in children and adolescents, mainly focusing on the use of guanfacine extended-release (GXR). Six already published prospective randomized controlled trials (RCTs) and one unpublished RCT study were identified for GXR in the treatment of ADHD. All RCTs trials showed superiority over placebo on the primary outcome measure. Guanfacine, especially XR, seems to be an effective and safe treatment option for ADHD in children and adolescents.
[Show abstract][Hide abstract] ABSTRACT: It is increasingly clear that we extract patterns of temporal regularity between events to optimize information processing. The ability to extract temporal patterns and regularity of events is referred as temporal expectation. Temporal expectation activates the same cerebral network usually engaged in action selection, comprising cerebellum. However, it is unclear whether the cerebellum is directly involved in temporal expectation, when timing information is processed to make predictions on the outcome of a motor act. Healthy volunteers received one session of either active (inhibitory, 1Hz) or sham repetitive transcranial magnetic stimulation covering the right lateral cerebellum prior the execution of a temporal expectation task. Subjects were asked to predict the end of a visually perceived human body motion (right hand handwriting) and of an inanimate object motion (a moving circle reaching a target). Videos representing movements were shown in full; the actual tasks consisted of watching the same videos, but interrupted after a variable interval from its onset by a dark interval of variable duration. During the 'dark' interval, subjects were asked to indicate when the movement represented in the video reached its end by clicking on the spacebar of the keyboard. Performance on the timing task was analyzed measuring the absolute value of timing error, the coefficient of variability and the percentage of anticipation responses. The active group exhibited greater absolute timing error compared with the sham group only in the human body motion task. Our findings suggest that the cerebellum is engaged in cognitive and perceptual domains that are strictly connected to motor control.
PLoS ONE 02/2015; 10(2):e0116607. DOI:10.1371/journal.pone.0116607 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and aims: It is recognized that emotional deficits are part of the non-motor features of Parkinson's disease but scant attention has been paid to specific aspects such as emotional facial expression, subjective emotional experience (alexithymia) and recognition of facial emotion expressions. This study aimed to investigate the relationship between alexithymia, emotion facial recognition, and emotion facial expression in PD patients.
[Show abstract][Hide abstract] ABSTRACT: Tourette syndrome (TS) is a childhood-onset tic disorder associated with abnormal development of brain networks involved in the sensory and motor processing. An involvement of immune mechanisms in its pathophysiology has been proposed. Animal models based on active immunization with bacterial or viral mimics, direct injection of cytokines or patients' serum anti-neuronal antibodies, and transgenic approaches replicated stereotyped behaviors observed in human TS. A crucial role of microglia in the neural-immune crosstalk within TS and related disorders has been proposed by animal models and confirmed by recent post mortem studies. With analogy to autism, genetic and early life environmental factors could foster the involvement of immune mechanisms to the abnormal developmental trajectories postulated in TS, as well as lead to systemic immune dysregulation in this condition. Clinical studies demonstrate an association between TS and immune responses to pathogens like group A Streptococcus (GAS), although their role as risk-modifiers is still undefined. Overactivity of immune responses at a systemic level is suggested by clinical studies exploring cytokine and immunoglobulin levels, immune cell subpopulations, and gene expression profiling of peripheral lymphocytes. The involvement of autoantibodies, on the other hand, remains uncertain and warrants more work using live cell-based approaches. Overall, a body of evidence supports the hypothesis that disease mechanisms in TS, like other neurodevelopmental illnesses (e.g. autism), may involve dysfunctional neural-immune cross-talk, ultimately leading to altered maturation of brain pathways controlling different behavioral domains and, possibly, differences in organising immune and stress responses.
Brain Research 05/2014; 1617. DOI:10.1016/j.brainres.2014.04.027 · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Based on their phenomenology, tics can be classified as clonic, dystonic, and tonic. Although tic syndromes are considered to be childhood disorders, there are reports on (clonic) tics developing late in life. Literature on dystonic tics is sparse, and it is unclear whether adult-onset dystonic tics are part of the same disorder spectrum that includes Tourette's syndrome or represent a discrete entity. We describe here 11 patients with adult-onset primary dystonic tics. Ten patients (90.1%) were males. Mean age at onset was 42.2 ± 14.9 years. More than 60% had both motor clonic and dystonic tics. Dystonic tics most frequently involved the cranial-cervical region and the shoulders and, less frequently, the limbs. Psychiatric comorbidities were present in 5 patients. Family history for any movement disorder or for psychiatric disorders was present in 2 cases. One patient showed a sensory geste, which allowed him to partially control his tics, whereas another developed overt dystonia 3 years after his first assessment. The hyperkinesias exhibited by these patients were likely consistent with tics. However, other clinical features would allow us to argue that adult-onset dystonic tics may represent a discrete entity, which is intermediate between tics and dystonia.