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. 2019 Apr 23;92(17):e1939-e1947.
doi: 10.1212/WNL.0000000000007355. Epub 2019 Apr 10.

Brain structure in juvenile-onset Huntington disease

Alexander Tereshchenko  1 , Vincent Magnotta  1 , Eric Epping  1 , Katherine Mathews  1 , Patricia Espe-Pfeifer  1 , Erin Martin  1 , Jeffrey Dawson  1 , Wenzhen Duan  1 , Peg Nopoulos  2
Affiliations

Brain structure in juvenile-onset Huntington disease

Alexander Tereshchenko et al. Neurology. .

Abstract

Objective: To assess brain morphometry in a sample of patients with juvenile-onset Huntington disease (JOHD) and several mouse models of Huntington disease (HD) that likely represent the human JOHD phenotype.

Methods: Despite sharing the mutation in the Huntingtin gene, adult-onset HD characteristically presents as a hyperkinetic motor disorder, while JOHD typically presents as a hypokinetic motor disease. The University of Iowa Kids-JHD program enrolls individuals 5 to 25 years of age who have already received the clinical diagnosis. A total of 19 children with juvenile HD (JHD) (mean CAG = 72) were studied. Patients with JHD were compared to healthy controls (n = 234) using a cross-sectional study design. Volumetric data from structural MRI was compared between groups. In addition, we used the same procedure to evaluate brain morphology of R6/2, zQ175, HdhQ250 HD mice models.

Results: Participants with JHD had substantially reduced intracranial volumes. After controlling for the small intracranial volume size, the volumes of subcortical regions (caudate, putamen, globus pallidus, and thalamus) and of cortical white matter were significantly decreased in patients with JHD. However, the cerebellum was proportionately enlarged in the JHD sample. The cerebral cortex was largely unaffected. Likewise, HD mice had a lower volume of striatum and a higher volume of cerebellum, mirroring the human MRI results.

Conclusions: The primary pathology of JOHD extends beyond changes in the striatal volume. Brain morphology in both mice and human patients with JHD shows proportional cerebellar enlargement. This pattern of brain changes may explain the unique picture of hypokinetic motor symptoms in JHD, which is not seen in the hyperkinetic chorea-like phenotype of adult-onset HD.

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Figures

Figure 1
Figure 1. Cortical thickness changes observed in the juvenile-onset Huntington disease group do not involve motor cortex
JHD = juvenile Huntington disease.
Figure 2
Figure 2. Cerebellar enlargement and striatal degeneration is present in (A) R6/2, (B) zQ175, and (C) HdhQ250 mouse models
Cerebellar changes are significant in 2 of 3 models. Significance: ***<0.001, **<0.01, *<0.05.
See this image and copyright information in PMC

Comment in

References

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