Introdução: A doença de Huntington (HD) é uma doença neurodegenerativa, autossômica dominante, causada pela expansão CAG que resulta em distúrbios do movimento, prejuízo cognitivo e alterações de personalidade. Muito pouco se sabe sobre a qualidade de vida de pacientes com HD e fatores associados e a influência dos mesmos nos sintomas depressivos dos cuidadores. Objetivo: Avaliar a qualidade de vida de indivíduos portadores da HD bem como suas implicações e, além disso, avaliar presença de sintomas depressivos no seu cuidador de convívio diário. Investigar os fatores que possam estar relacionados com o prejuízo da qualidade de vida do paciente tais como grau de comprometimento funcional, distúrbio motor, cognitivo e comportamental, sintomas de depressão, prejuízo no sono. Metodologia: Trata-se de um estudo quantitativo transversal. A população foi composta por pacientes com HD em acompanhamento no ambulatório de Distúrbios do Movimento e Neurogenética, que possuíam diagnóstico de HD confirmado por teste molecular. As entrevistas foram realizadas com auxilio de ferramentas estruturadas, as quais seguem: SF-36 e HQoLI, para qualidade de vida; UHDRS para avaliação funcional; MoCA para avaliação cognitiva; PSQI para avaliação do sono e BDI para avaliação de sintomas depressivos do paciente e cuidador. Resultados: Foram avaliados 28 pacientes com HD com idade média de 41 ± 9.5 e expansão CAG média de 45 ± 6. A duração da doença apresentou associação com os aspectos físicos da escala SF-36 (p<0.01). AUHDRS apresentou impacto em vários domínios da qualidade de vida, tais como domínios de saúde física e mental. A má qualidade do sono avaliada através da escala PSQI influenciou na QV do paciente nos dois grandes domínios de saúde física e saúde mental com (p<0.05) e (p<0.01) respectivamente. O nível cognitivo apresentado pelos pacientes avaliados pela escala MoCA apresentaram associação com domínio de funcionamento físico da escala SF-36 (p<0.01) Conclusão: As análises dos dados coletados permitem afirmar que se trata de uma doença que impacta de maneira significativa na QV das famílias. O apoio multidisciplinar a família afetada e o tratamento das comorbidades associadas se faz fundamental para amenizar os impactos da doença e melhorar a QV. / Background: The Huntington Disease (HD) is a neurodegenerative autosomal dominant disorder caused by the CAG expansion resulting in movement disorders, cognitive impairment and personality changes. Very little is known about the quality of life in HD patients associated factors and influence on depressive symptoms of caregivers. Objective: To evaluate the quality of life in individuals with HD, as well as its implications, and evaluate their daily caregiver for depressive symptoms. Factors that may be related to harm of patient's quality of life, such as functional impairment; motor, cognitive and behavioral disorder; symptoms of depression; and sleep loss were investigated. Methods: It is a quantitative cross-sectional study. The population was composed of patients with HD from Movement Disorders and Neurogenetics Clinic, who had positive molecular test. The interviews were carried out with support of the structured tools as follow: SF-36 and HQoLI for quality of life, UHDRS for functional evaluation, MoCA for cognitive evaluation, PSQI for sleep evaluation, and BDI for evaluation of depression of patient and caregiver. Results: Twenty-eight HD patients were evaluated with an average age of 41 ± 9.5 and an average CAG expansion of 45 ± 6. The duration of the disease was associated with the physical aspects of the SF-36 scale (p<0.01). UHDRS was associated with impairment in several domains of quality of life including mental and physical domains. It was identified that the bad sleep quality evaluated through the PSQI scale was associated with patient's QL (quality of life). The cognitive level evaluated by the MoCA scale presented association with the Physical functioning domain of SF-36 scale (p<0.01). Conclusion: The analysis of the collected data allows to affirm that HD impacts significantly on the families quality of life. The multidisciplinary support to the affected family is critical to mitigate the impacts of the disease and improve the QL.

Introdução: A doença de Huntington (HD) é uma doença neurodegenerativa, autossômica dominante, causada pela expansão CAG que resulta em distúrbios do movimento, prejuízo cognitivo e alterações de personalidade. Muito pouco se sabe sobre a qualidade de vida de pacientes com HD e fatores associados e a influência dos mesmos nos sintomas depressivos dos cuidadores. Objetivo: Avaliar a qualidade de vida de indivíduos portadores da HD bem como suas implicações e, além disso, avaliar presença de sintomas depressivos no seu cuidador de convívio diário. Investigar os fatores que possam estar relacionados com o prejuízo da qualidade de vida do paciente tais como grau de comprometimento funcional, distúrbio motor, cognitivo e comportamental, sintomas de depressão, prejuízo no sono. Metodologia: Trata-se de um estudo quantitativo transversal. A população foi composta por pacientes com HD em acompanhamento no ambulatório de Distúrbios do Movimento e Neurogenética, que possuíam diagnóstico de HD confirmado por teste molecular. As entrevistas foram realizadas com auxilio de ferramentas estruturadas, as quais seguem: SF-36 e HQoLI, para qualidade de vida; UHDRS para avaliação funcional; MoCA para avaliação cognitiva; PSQI para avaliação do sono e BDI para avaliação de sintomas depressivos do paciente e cuidador. Resultados: Foram avaliados 28 pacientes com HD com idade média de 41 ± 9.5 e expansão CAG média de 45 ± 6. A duração da doença apresentou associação com os aspectos físicos da escala SF-36 (p<0.01). AUHDRS apresentou impacto em vários domínios da qualidade de vida, tais como domínios de saúde física e mental. A má qualidade do sono avaliada através da escala PSQI influenciou na QV do paciente nos dois grandes domínios de saúde física e saúde mental com (p<0.05) e (p<0.01) respectivamente. O nível cognitivo apresentado pelos pacientes avaliados pela escala MoCA apresentaram associação com domínio de funcionamento físico da escala SF-36 (p<0.01) Conclusão: As análises dos dados coletados permitem afirmar que se trata de uma doença que impacta de maneira significativa na QV das famílias. O apoio multidisciplinar a família afetada e o tratamento das comorbidades associadas se faz fundamental para amenizar os impactos da doença e melhorar a QV. / Background: The Huntington Disease (HD) is a neurodegenerative autosomal dominant disorder caused by the CAG expansion resulting in movement disorders, cognitive impairment and personality changes. Very little is known about the quality of life in HD patients associated factors and influence on depressive symptoms of caregivers. Objective: To evaluate the quality of life in individuals with HD, as well as its implications, and evaluate their daily caregiver for depressive symptoms. Factors that may be related to harm of patient's quality of life, such as functional impairment; motor, cognitive and behavioral disorder; symptoms of depression; and sleep loss were investigated. Methods: It is a quantitative cross-sectional study. The population was composed of patients with HD from Movement Disorders and Neurogenetics Clinic, who had positive molecular test. The interviews were carried out with support of the structured tools as follow: SF-36 and HQoLI for quality of life, UHDRS for functional evaluation, MoCA for cognitive evaluation, PSQI for sleep evaluation, and BDI for evaluation of depression of patient and caregiver. Results: Twenty-eight HD patients were evaluated with an average age of 41 ± 9.5 and an average CAG expansion of 45 ± 6. The duration of the disease was associated with the physical aspects of the SF-36 scale (p<0.01). UHDRS was associated with impairment in several domains of quality of life including mental and physical domains. It was identified that the bad sleep quality evaluated through the PSQI scale was associated with patient's QL (quality of life). The cognitive level evaluated by the MoCA scale presented association with the Physical functioning domain of SF-36 scale (p<0.01). Conclusion: The analysis of the collected data allows to affirm that HD impacts significantly on the families quality of life. The multidisciplinary support to the affected family is critical to mitigate the impacts of the disease and improve the QL.

Adolescence is a time when individuals begin to explore and examine psychological characteristics of the self in order to discover who they really are and how they fit in the social world in which they live. It is during this time of self-exploration that adolescents at risk for Huntington's Disease often learn of their risk status and witness the debilitating symptoms of the disease in their parents. Huntington Disease (HD) is an autosomal dominant neuropsychiatric disorder characterized by mid-life onset, involuntary movements, cognitive impairment, and depression. This dissertation investigated how adolescents experience living in a family with Huntington's Disease and therefore at risk for Huntington's Disease, and how this impacts their self-understanding and self-identity. The method of inquiry was based on a phenomenological approach. In-depth interviews were conducted with each of the adolescents. The data were analyzed using Van Manen's (1980) and Cochran and Claspell's (1987) format, resulting in an extraction of three themes. These themes are: (1) Naming the Legacy: Understanding and Misunderstanding; (2) Experiencing the Legacy: Huntington's Disease in Relation to Relationships; and (3) Integrating the Legacy: At the Crossroads of Self and Future Self. The analysis emphasizes that the at-risk adolescents' exploration of self-identity and future self was an individual process influenced by the cognitive, developmental, and socio-cultural contexts of the adolescents' lives. The process of learning about Huntington's Disease occurred through intuition and practical and experiential learning. The adolescents found support outside their family through friends and adult mentors. They engaged in complicated coping strategies and demonstrated a capacity for decision-making that displayed maturity beyond what would be expected for their age group. These findings led to specific recommendations for theory, research, and clinical practice in the area of the adolescent experience of HD. The research underscores the need for healthcare professionals to re-evaluate their view of adolescent autonomy and capacity for decision-making. / Graduate and Postdoctoral Studies / Graduate

This study is a multi-method, two-city, intensive, in-depth qualitative study of Huntington's disease (HD) caregivers (HDCs) in Colombia. I explored the Colombia HDCs' experience through the Hispanic culture of caring. I develop the theory of the subrogate agency based on 5 functional stages of HD from Shoulson and Fanh (1979). This study was conducted in two different regions of Colombia, Medellin and Juan de Acosta, in which high rates of HD cases have been identified. The data were collected through three methods: (a) 56 interviews with HDCs and 8 with physicians; (b) 28 participant observations of Huntington's disease sufferers (HDSs); (c) 4 interviews and 8 focus groups of 6 members each with HDCs of late HDSs. Human agency is the ability to monitor one's own action. This study showed that the gradual and serious loss of all capabilities in HDSs has a social effect on the HDSs' agency. HDSs' survival depends on the subrogation that the HDC offers to the HDS. The HDS retains self-hood, i.e. agency, through the HDC's action. This subrogation causes a paradoxical consequence, resulting in both negative and positive effects on the caregiver. The theory of surrogate agency is supported by the data. Through the progressive phases, the capacity of the sufferer for expressing suffering, and social embarrassment, as well as the capacity to fight against the illness and provide reciprocity to their caregivers, deceases. The reason is that physical and cognitive impairments, as well as depression and anger, continue to increase. The study also documented important socio-cultural differences among the study regions. For instance, HDC's solidarity was based on blood and friendship; in larger cities, HD fragmented families. The study also found that HD is taking an immense toll on caregivers, sufferers and families because they are excluded from the Colombia's Basic Health Plan.

Ceftriaxone is the most used third-generation cephalosporin anti-microbial agent in treating infections caused by gram-positive and gram-negative organisms. Chorea is a movement disorder characterized by involuntary and hyperkinetic movements of the affected body parts due to rapid and unpredictable contractions. We report an uncommon case of ceftriaxone-induced acute reversible chorea. 84-year-old male with a medical history of diabetes mellitus, hypertension, previous myocardial infarction, and gouty arthritis was admitted to the hospital with complaints of altered mental status (AMS) and right 1st metacarpal-phalangeal joint (MTP) swelling, erythema and ruptured wound draining pus-like fluid. The patient was febrile with a temperature of 101.3 F. The rest of the vitals were normal. The patient had an initial workup and was empirically started on ceftriaxone and vancomycin for skin and soft tissue infection. His wound cultures and blood cultures grew pan-sensitive streptococcus agalactiae. His antibiotics were de-escalated to ceftriaxone. X-ray showed severe soft tissue swelling and erosive changes at the base of the proximal phalanx of the first digit secondary to gout or osteomyelitis. MRI of the right foot was attempted, but the patient could not tolerate it. TTE was negative for Endocarditis. The patient had initial improvement in his AMS, but 72 hours later, he became increasingly confused with choreiform movements. Ceftriaxone was discontinued, and Ertapenem was started. Patient’s confusion and choreiform movements improved after the discontinuation of ceftriaxone. Patient was discharged to a rehabilitation facility with four weeks of IV Ertapenem. Ceftriaxone is a third-generation cephalosporin that inhibits mucopeptide synthesis in the bacterial cell wall. Ceftriaxone is a well-tolerated anti-microbial agent with a low toxicity profile. Common adverse effects include gastrointestinal disturbances, skin rashes, and hematological disorders. Neurological symptoms like encephalopathy is an uncommon adverse effect. Chorea is a movement disorder due to hereditary or acquired causes. Drug-induced chorea is one of the rare causes of acquired chorea. History and physical examination are essential in diagnosing acquired causes of chorea. Further workup with laboratory tests and neuroimaging are required to evaluate secondary causes. Chorea due to ceftriaxone is described in a patient with end-stage renal disease on hemodialysis in a case report previously, but our patient did not have any chronic kidney disease [1]. It is postulated that beta-lactam antibiotics increase neurological hyperexcitability by increased glutamate release in the striatum and cerebral cortex, causing movement disorders [2]. It is noted that pre-existing neurological conditions and excessive dosage are shown to be significant risk factors for cephalosporin neurotoxicity. Our patient, however, did not have any neurological condition but was treated with 2 grams of ceftriaxone daily before he had choreiform movements. Upon removal, the patient improved significantly within 36-48 hours. Ceftriaxone is a widely used anti-microbial with broad coverage. Although uncommon, recognizing that neurotoxicity due to third generation cephalosporins is essential. Prompt diagnosis and withdrawal of the offending agent is critical in improving the patient’s symptoms. Age, prior neurological conditions, kidney disease, and dosage must be carefully evaluated before administration.

Indiana University-Purdue University Indianapolis (IUPUI) / Huntington disease (HD) is an autosomal dominant disorder characterized by progressive decline of motor, cognitive, and behavioral function. Saccades (rapid, gaze-shifting eye movements) are affected before a clinical diagnosis of HD is certain (i.e. during the premanifest period of the disease). Fundamental questions remain regarding the neural substrates of abnormal saccades and the course of premanifest disease. This work addressed these questions using magnetic resonance imaging (MRI) and a longitudinal study of premanifest disease progression. Gray matter atrophy is a characteristic of HD that can be reliably detected during the premanifest period, but it is not known how such changes influence saccadic behavior. We evaluated antisaccades (AS) and memory guided saccades (MG) in premanifest and manifest HD, then tested for associations between impaired saccadic measures and gray matter atrophy in brain regions involved in these saccadic tasks. The results suggest that slowed vertical AS responses indicate cortical and subcortical atrophy and may be a noninvasive marker of atrophic changes in the brain. We also investigated the brain changes that underlie AS impairment using an event-related AS design with functional MRI (fMRI). We found that, in premanifest and manifest HD, blood oxygenation level dependent (BOLD) response was abnormally absent in the pre-supplementary motor area and dorsal anterior cingulate cortex following incorrect AS responses. These results are the first to suggest that abnormalities in an error-related response network underlie early disease-related saccadic changes, and they emphasize the important influence of regions outside the striatum and frontal cortex in disease manifestations. Though saccadic abnormalities have been repeatedly observed cross sectionally, they have not yet been studied longitudinally in premanifest HD. We found different patterns of decline; for some measures the rate of decline increased as individuals approached onset, while for others the rate was constant throughout the premanifest period. These results establish the effectiveness of saccadic measures in tracking premanifest disease progression, and argue for their use in clinical trials. Together, these studies establish the utility of saccade measures as a marker of HD neurodegeneration and suggest that they would be a valuable component of batteries evaluating the efficacy of neuroprotective therapies.

No description available.

Thesis (Ph. D.)--University of Lund, 1994. / Published dissertation. Includes bibliographical references.

Thesis (Ph. D.)--University of Lund, 1994. / Published dissertation. Includes bibliographical references.

EcoP15I ist ein Vertreter der multifunktionalen, heterooligomeren Typ III Restriktionsendonukleasen. Typ III Restriktionsendonukleasen sind wegen der Lage ihres Spaltortes, ca. 25 bp vom Erkennungsort entfernt, von besonderem Interesse für Anwendungen in der Medizin und funktionellen Genomanalyse. EcoP15I erkennt die DNA-Sequenz 5''-CAGCAG und benötigt für eine effektive DNA-Spaltung zwei invers orientierte Erkennungsorte auf einem DNA-Molekül. Nach dem bisherigen DNA-Translokations-Modell bindet je ein EcoP15I-Protein an je einen Erkennungsort und startet dann durch ATP-Hydrolyse vermittelte DNA-Translokation. Die Kollision der beiden EcoP15I-DNA-Komplexe initiiert die DNA-Doppelstrang-Spaltung. Experimente zur Erkennungsort-Suche von EcoP15I zeigen, dass über längere Distanzen offenbar nicht das "Sliding", sondern ein dreidimensionaler Prozess die bevorzugte Bewegung von EcoP15I an der DNA ist. Eine erhöhte Anzahl von Wiederholungen von CAG-Trinukleotiden (CAG-Repeats) im Exon 1 des Gens für Chorea Huntington (Huntington Disease - HD) führt zur Manifestation dieser neurodegenerativen Erkrankung. Für die Diagnostik der Erkrankung ist die exakte Bestimmung der Anzahl der CAG-Repeats von Bedeutung. Diese Arbeit zeigt die Spaltung von HD Gen Exon 1 DNA durch EcoP15I. Die halbautomatische, hoch-sensitive Analyse dieses Spaltmusters ermöglicht die exakte Bestimmung der Anzahl der CAG-Repeats. Diese Arbeit liefert den ersten Nachweis für die DNA-Translokation durch eine Typ III-Restriktionsendonuklease. Die postulierten EcoP15I-DNA-Schlaufen wurden mit Hilfe der Rasterkraftmikroskopie (SFM) abgebildet. Dadurch wird das DNA-Translokations-Modell der DNA-Spaltung durch EcoP15I bestätigt. Es werden Gemeinsamkeiten und Unterschiede des gesamten DNA-Spaltvorganges der Typ III Restriktionsendonuklease EcoP15I in bezug auf andere Restriktionsendonukleasen diskutiert. / EcoP15I is a multifunctional, hetero-oligomeric Type III restriction enzyme. Type III restriction enzymes are of general interest in medicine and functional genome analysis because they cut DNA 25 bp downstream of their recognition site. EcoP15I recognises the DNA sequence 5`-CAGCAG and needs two inverse oriented recognition sites for effective DNA cleavage. According to the present translocation collision model DNA cleavage was proposed to result from ATP dependent DNA translocation, which is expected to induce DNA loop formation, and collision of two enzyme-DNA complexes. Experiments show that EcoP15 moves rather in a three-dimensional than in a "sliding" process in search for its recognition site. Huntington''s disease (HD) is a progressive neurodegenerative disorder with autosomal-dominant inheritance. The disease is caused by a CAG trinucleotide repeat expansion located in the first exon of the HD gene. To diagnose the illness the exact determination of the number of CAG repeats is necessary. This study shows that the number of CAG repeats in the HD gene can be determined by restriction of the DNA with the endonuclease EcoP15I and subsequent high-resolution analysis of the restriction fragment pattern using the ALFexpress DNA Analysis System. Here, for the first time DNA translocation by the Type III restriction enzyme EcoP15I is demonstrated. The postulated EcoP15-DNA loops are visualised using scanning force microscopy. This confirms the translocation-collision model for DNA cleavage by EcoP15. Similarities and differences between the DNA cleavage processes of the Type III restriction enzyme EcoP15I and other restriction enzymes are discussed.