Advertisement

Effects of Physical Rehabilitation in Patients with Spinocerebellar Ataxia Type 7

  • Karla Tercero-Pérez
  • Hernán Cortés
  • Yessica Torres-Ramos
  • Roberto Rodríguez-Labrada
  • César M. Cerecedo-Zapata
  • Oscar Hernández-Hernández
  • Nelson Pérez-González
  • Rigoberto González-Piña
  • Norberto Leyva-García
  • Bulmaro Cisneros
  • Luis Velázquez-PérezEmail author
  • Jonathan J. MagañaEmail author
Original Paper

Abstract

Today, neurorehabilitation has become in a widely used therapeutic approach in spinocerebellar ataxias; however, there are scarce powerful clinical studies supporting this notion, and these studies require extension to other specific SCA subtypes in order to be able to form conclusions concerning its beneficial effects. Therefore, in this study, we perform for the first time a case-control pilot randomized, single-blinded, cross-sectional, and observational study to evaluate the effects of physical neurorehabilitation on the clinical and biochemical features of patients with spinocerebellar ataxia type 7 (SCA7) in 18 patients diagnosed with SCA7. In agreement with the exercise regimen, the participants were assigned to groups as follows: (a) the intensive training group, (b) the moderate training group, and (c) the non-training group (control group).

We found that both moderate and intensive training groups showed a reduction in SARA scores but not INAS scores, compared with the control group (p < 0.05). Furthermore, trained patients exhibited improvement in the SARA sub-scores in stance, gait, dysarthria, dysmetria, and tremor, as compared with the control group (p < 0.05). No significant improvements were found in daily living activities, as revealed by Barthel and Lawton scales (p > 0.05). Patients under physical training exhibited significantly decreased levels in lipid-damage biomarkers and malondialdehyde, as well as a significant increase in the activity of the antioxidant enzyme PON-1, compared with the control group (p < 0.05). Physical exercise improved some cerebellar characteristics and the oxidative state of patients with SCA7, which suggest a beneficial effect on the general health condition of patients.

Keywords

Spinocerebellar ataxia type 7 Physical rehabilitation Neurorehabilitation Cerebellar features Oxidative stress markers 

Notes

Acknowledgments

This paper is dedicated to the patients and members of SCA7-affected families. We also thank Julio C. Rodríguez-Díaz PhD and Emilio Martínez-Cruz MD for technical assistance.

Funding Information

This study was supported by a grant from CONACyT to JJ-M (CB-2015-01-258043).

Compliance with Ethical Standards

The study was approved by the Ethical and Research Committee of the INR-LGII and signed informed consent was obtained from all patients prior to participation. All procedures were carried out according to the Code of Ethics of the Helsinki Declaration.

Informed Consent

An informed consent form was signed by all subjects prior to examination and the research protocol was approved by the National Rehabilitation Institute (INR, Mexico City) Research and Ethical Committee.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

12311_2019_1006_Fig4_ESM.png (172 kb)
Supplemental Figure.

Effect of exercise training on extracerebellar features in patients with SCA7. Patients subjected to no training, moderate training, or intensive training were evaluated by INAS at baseline, at 12 weeks, and at 24 weeks of treatment. Black, white, and gray columns represent the no training, moderate training, and intensive training groups, respectively. (PNG 171 kb)

12311_2019_1006_MOESM1_ESM.tif (221 kb)
High Resolution Image (TIF 221 kb)

References

  1. 1.
    David G, Abbas N, Stevanin G, et al. Cloning of the SCA7 gene reveals a highly unstable CAG repeat expansion. Nat Genet. 1997;17:65–70.CrossRefGoogle Scholar
  2. 2.
    Horton LC, Frosch MP, Vangel MG, Weigel-Difranco C, Berson EL, Schmahmann JD. Spinocerebellar ataxia type 7: clinical course, phenotype-genotype correlations, and neuropathology. Cerebellum. 2013;12:176–93.CrossRefGoogle Scholar
  3. 3.
    Velazquez-Perez L, Cerecedo-Zapata CM, Hernandez-Hernandez O, et al. A comprehensive clinical and genetic study of a large Mexican population with spinocerebellar ataxia type 7. Neurogenetics. 2015;16(1):11–21.CrossRefGoogle Scholar
  4. 4.
    Fonteyn EM, Keus SH, Verstappen CC, Schols L, de Groot IJ, Van deWarrenburg BP. The effectiveness of allied health care in patients with ataxia: a systematic review. J Neurol 2013; 261(2):251–258.Google Scholar
  5. 5.
    Cup EH, Pieterse AJ, Ten Broek-Pastoor JM, et al. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review. Arch Phys Med Rehabil. 2007;88(11):1452–64.CrossRefGoogle Scholar
  6. 6.
    Busse M, Quin L, Debono K, et al. A randomized feasibility study of a 12-week community-based exercise program for people with Huntington’s disease. JNPT. 2013;37:149–58.PubMedGoogle Scholar
  7. 7.
    Ørngreen MC, Olsen DB. Vissing. Aerobic training in patients with myotonic dystrophy type 1. Ann Neurol. 2005;57:754–7.CrossRefGoogle Scholar
  8. 8.
    Perez-Avila I, Fernández JA, Martinez-Gongora E, Ochoa-Mastrapa R, Velazquez-Manresa MG. Effects of a physical training program on quantitative neurological indices in mild stage type 2 spinocerebellar ataxia patients. Rev Neurol. 2004;39:907–10.PubMedGoogle Scholar
  9. 9.
    Rodríguez JC, Velázquez L, Sánchez G, et al. Evaluación de la restauración neurológica en pacientes con ataxia SCA2 cubana. Plast Rest Neurol. 2008;7(1):13–8.Google Scholar
  10. 10.
    Rodríguez-Díaz JC, Velázquez-Pérez L, Rodríguez-Labrada R, et al. Neurorehabilitation therapy in SCA2: a 24-week, rater blinded, randomized, controlled trial. Mov Disord. 2018;33(9):1481–7.CrossRefGoogle Scholar
  11. 11.
    Miyai I, Ito M, Hattori N, et al. Cerebellar Ataxia rehabilitation Trialists collaboration. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair. 2012;26(5):515–22.CrossRefGoogle Scholar
  12. 12.
    Keller JL, Bastian AJ. A home balance exercise program improves walking in people with cerebellar Ataxia. Neurorehabil Neural Repair. 2014;28(8):770–8.CrossRefGoogle Scholar
  13. 13.
    Schatton C, Synofzik M, Fleszar Z, Giese MA, Schols L, Ilg W. Individualized exergame training improves postural control in advanced degenerative spinocerebellar ataxia: a rater-blinded, intraindividually controlled trial. Parkinsonism Relat Disord. 2017;39:80–4.CrossRefGoogle Scholar
  14. 14.
    Ilg W, Timmann D. General management of cerebellar disorders: an overview. In: Manto M, Schmahmann J, Rossi F, Gruol D, Koibuchi N, eds. Handbook of the Cerebellum and Cerebellar Disorders. Amsterdam, the Netherlands: Springer; 2013:2349–2368.Google Scholar
  15. 15.
    Bilney B, Morris ME, Perry A. Effectiveness of physiotherapy, occupational therapy, and speech pathology for people with Huntington's disease: a systematic review. Neurorehabil Neural Repair. 2003;17(1):12–24.CrossRefGoogle Scholar
  16. 16.
    Voet NB, van der Kooi EL, Riphagen II, Lindeman E, van Engelen BG, Geurts AC. Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst Rev 2013; (7):CD003907.Google Scholar
  17. 17.
    Benton CS, de Silva R, Rutledge SL, Bohlega S, Ashizawa T, Zoghbi HY. Molecular and clinical studies in SCA-7 define a broad clinical spectrum and the infantile phenotype. Neurology 1998; 51(4):1081–1086.Google Scholar
  18. 18.
    Magaña JJ, Tapia-Guerrero YS, Velázquez-Pérez L, et al. Analysis of CAG repeats in five SCA loci in Mexican population: epidemiological evidence of a SCA7 founder effect. Clin Genet. 2014;85(2):159–65.CrossRefGoogle Scholar
  19. 19.
    Klockgether T, Lüdtke R, Kramer B, et al. The natural history of degenerative ataxia: a retrospective study in 466 patients. Brain. 1998;1(4):589–600.CrossRefGoogle Scholar
  20. 20.
    Denny-Brown D, David MD, Tyler HR. Handbook of Neurological Examination and Case Recording. Cambridge, MA, USA: Harvard University Press; 1982; viii, 87 p. p.Google Scholar
  21. 21.
    Schmitz-Hubsch T. duMontcel ST, Baliko L et al. scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006;66(11):1717–20.CrossRefGoogle Scholar
  22. 22.
    Schmitz-Hubsch T, Coudert M, Bauer P, et al. Spinocerebellar ataxia types 1, 2, 3, and 6: disease severity and non-ataxia symptoms. Neurology. 2008;71(13):982–9.CrossRefGoogle Scholar
  23. 23.
    Wade DT, Collin C. The Barthel ADL index: a standard measure of physical disability? Int Disabil Stud. 1988;10:64–7.CrossRefGoogle Scholar
  24. 24.
    Torres-Ramos Y, Montoya-Estrada A, Cisneros B, et al. Oxidative stress in spinocerebellar Ataxia type 7 is associated with disease severity. Cerebellum. 2018;17(5):601–9.Google Scholar
  25. 25.
    Silva RC, Saute JA, Silva AC, Coutinho AC, Saraiva-Pereira ML, Jardim LB. Occupational therapy in spinocerebellar ataxia type 3: an open-label trial. Braz J Med Biol Res. 2010;43(6):537–42.CrossRefGoogle Scholar
  26. 26.
    Burciu RG, Fritsche N, Granert O, et al. Brain changes associated with postural training in patients with cerebellar degeneration: a voxel-based morphometry study. J Neurosci. 2013;33(10):4594–604.CrossRefGoogle Scholar
  27. 27.
    Azimi M, Gharakhanlou R, Naghdi N, Khodadadi D, Heysieattalab S. Moderate treadmill exercise ameliorates amyloid-β-induced learning and memory impairment, possibly via increasing AMPK activity and up-regulation of the PGC-1α/FNDC5/BDNF pathway. Peptides. 2018;102:78–88.CrossRefGoogle Scholar
  28. 28.
    Klintsova AY, Dickson E, Yoshida R, Greenough WT. Altered expression of BDNF and its high-affinity receptor TrkB in response to complex motor learning and moderate exercise. Brain Res. 2004;1028(1):92–104.CrossRefGoogle Scholar
  29. 29.
    Vaynman S, Ying Z, Gómez-Pinilla F. Exercise induces BDNF and synapsin I to specific hippocampal subfields. J Neurosci Res. 2004;76(3):356–62.CrossRefGoogle Scholar
  30. 30.
    Ajayi A, Yu X, Lindberg S, Langel U, Ström AL. Expanded ataxin-7 cause toxicity by inducing ROS production from NADPH oxidase complexes in a stable inducible spinocerebellar ataxia type 7 (SCA7) model. BMC Neurosci. 2012;13:86.CrossRefGoogle Scholar
  31. 31.
    Cui L, Hofer T, Rani A, Leeuwenburgh C, Foster TC. Comparison of lifelong and late life exercise on oxidative stress in the cerebellum. Neurobiol Aging. 2009;30:903–9.CrossRefGoogle Scholar
  32. 32.
    Yin H, Xu L, Porter N. Free radical lipid peroxidation: mechanisms and analysis. Chem Rev. 2011;111(10):5944–72.CrossRefGoogle Scholar
  33. 33.
    León-Reyes G, Maida-Claros RF, Urrutia-Medina AX, et al. Oxidative profiles of LDL and HDL isolated from women with preeclamsia. Lipids Health Dis. 2017;16:90.CrossRefGoogle Scholar
  34. 34.
    Hauser DN, Hastings TG. Mitochondrial dysfunction and oxidative stress in Parkinson's disease and monogenic parkinsonism. Neurobiol Dis. 2013;51:35–42.CrossRefGoogle Scholar
  35. 35.
    Dasuri K, Zhang L, Keller JN. Oxidative stress, neurodegeneration, and the balance of protein degradation and protein synthesis. Free Radic Biol Med. 2013;62:170–85.CrossRefGoogle Scholar
  36. 36.
    Almaguer-Gotay D, Almaguer-Mederos LE, Aguilera-Rodríguez R, et al. Role of glutathione S-transferases in the spinocerebellar ataxia type 2 clinical phenotype. J Neurol Sci. 2014;341(1–2):41–5.CrossRefGoogle Scholar
  37. 37.
    Kharchenko EP, Tel’nova MN. Brain plasticity: limitations and possibilities. Neurosci Behav Physiol. 2018;48(5):603–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Karla Tercero-Pérez
    • 1
  • Hernán Cortés
    • 2
  • Yessica Torres-Ramos
    • 3
  • Roberto Rodríguez-Labrada
    • 4
  • César M. Cerecedo-Zapata
    • 1
  • Oscar Hernández-Hernández
    • 2
  • Nelson Pérez-González
    • 1
  • Rigoberto González-Piña
    • 2
  • Norberto Leyva-García
    • 2
  • Bulmaro Cisneros
    • 5
  • Luis Velázquez-Pérez
    • 4
    • 6
    Email author
  • Jonathan J. Magaña
    • 2
    Email author
  1. 1.Rehabilitation and Social Inclusion Center of Veracruz (CRIS-DIF)VeracruzMexico
  2. 2.Laboratory of Genomic Medicine, Department of GeneticsNational Rehabilitation Institute- Luis Guillermo Ibarra Ibarra (INR-LGII)Ciudad de México (CDMX)Mexico
  3. 3.Department of ImmunobiochemistryNational Perinatology Institute (INPer)Mexico CityMexico
  4. 4.Center for Research and Rehabilitation of the Hereditary Ataxias (CIRAH)HolguínCuba
  5. 5.Department of Genetics and Molecular BiologyCenter of Research and Advanced Studies (CINVESTAV-IPN)Mexico CityMexico
  6. 6.Cuban Academy of SciencesHavanaCuba

Personalised recommendations