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Grifoni J, Crispiatico V, Castagna A, Quartarone A, Converti RM, Ramella M, Granata G, Di Iorio R, Brancucci A, Bevacqua G, Pagani M, L'Abbate T, Armonaite K, Paulon L, Tecchio F. Musician's dystonia: an opinion on novel treatment strategies. Front Neurosci 2024; 18:1393767. [PMID: 38660229 PMCID: PMC11041626 DOI: 10.3389/fnins.2024.1393767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Joy Grifoni
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | | | | | | | | | | | - Giuseppe Granata
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Di Iorio
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Brancucci
- Dipartimento di Scienze Motorie, Umane e della Salute, Università di Roma “Foro Italico”, Rome, Italy
| | | | - Marco Pagani
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Teresa L'Abbate
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Karolina Armonaite
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Luca Paulon
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
- Independent Researcher, Rome, Italy
| | - Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
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Cai H, Dong J, Mei L, Feng G, Li L, Wang G, Yan H. Functional and structural abnormalities of the speech disorders: a multimodal activation likelihood estimation meta-analysis. Cereb Cortex 2024; 34:bhae075. [PMID: 38466117 DOI: 10.1093/cercor/bhae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Speech disorders are associated with different degrees of functional and structural abnormalities. However, the abnormalities associated with specific disorders, and the common abnormalities shown by all disorders, remain unclear. Herein, a meta-analysis was conducted to integrate the results of 70 studies that compared 1843 speech disorder patients (dysarthria, dysphonia, stuttering, and aphasia) to 1950 healthy controls in terms of brain activity, functional connectivity, gray matter, and white matter fractional anisotropy. The analysis revealed that compared to controls, the dysarthria group showed higher activity in the left superior temporal gyrus and lower activity in the left postcentral gyrus. The dysphonia group had higher activity in the right precentral and postcentral gyrus. The stuttering group had higher activity in the right inferior frontal gyrus and lower activity in the left inferior frontal gyrus. The aphasia group showed lower activity in the bilateral anterior cingulate gyrus and left superior frontal gyrus. Across the four disorders, there were concurrent lower activity, gray matter, and fractional anisotropy in motor and auditory cortices, and stronger connectivity between the default mode network and frontoparietal network. These findings enhance our understanding of the neural basis of speech disorders, potentially aiding clinical diagnosis and intervention.
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Affiliation(s)
- Hao Cai
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
| | - Jie Dong
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
| | - Leilei Mei
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University); School of Psychology; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Genyi Feng
- Imaging Department, Xi'an GEM Flower Changqing Hospital, Xi'an 710201, China
| | - Lili Li
- Speech Language Therapy Department, Shaanxi Provincial Rehabilitation Hospital, Xi'an 710065, China
| | - Gang Wang
- Imaging Department, Xi'an GEM Flower Changqing Hospital, Xi'an 710201, China
| | - Hao Yan
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
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Al-Hashel JY, Soliman DY, Ismail II. New-Onset Focal Task Specific Oromandibular Dystonia in Association with Quran Recitation: A Case Series. Tremor Other Hyperkinet Mov (N Y) 2024; 14:3. [PMID: 38222897 PMCID: PMC10785953 DOI: 10.5334/tohm.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
Background Focal task-specific dystonia is a form of isolated focal dystonia that occurs during the performance of a specific skilled motor task. The occurrence of oromandibular dystonia (OMD) specifically in association with the recitation of Quranic verses have been rarely reported in the literature, in non-native Arabic-speaking patients. This case series describe a rare type of focal task-specific dystonia that occurs exclusively by reciting Quran in native Arabic-speaking patients, which has never been reported, to the best of our knowledge. Methods In this case series, we identified five patients with new-onset OMD that was exclusively induced by reciting Quran. Cases were evaluated in our Movement Disorders outpatient clinic at Ibn Sina hospital; the main tertiary neurology center in Kuwait, between 2015 and 2023. Results Five cases (3 males, 2 females) were identified in this study. Mean age of onset of the symptoms was 52.3 ± 4.1 years, while the median duration of the symptoms prior to diagnosis was 3 years. All patients were native Arab-speaking, with no previous history of other types of dystonia. No identifiable risk factors could be obtained including exposure to dopamine blocking agents or antipsychotics, or history of oral or dental surgery. Patients underwent a full clinical, laboratory, and radiological evaluation. All patients had OMD dystonia in varying forms and severity, while two patients had additional spasmodic dysphonia/ blepharospasm on progressive recitation. Most patients had minimal improvement with combination of oral medications and speech therapy. Four patients received botulinum toxin injections with better results. Discussion The mental and physical stress in attempting to recite the Quranic verses could have contributed to the development of OMD. Moreover, the increased demand on the muscles of the jaw, lips, and tongue during recitation can trigger the dystonic symptoms. Highlights OMD exclusively during Quran recitation is a rare phenomenon, and expands the spectrum of task-specific focal dystonia described in the literature. It was found to be distressing to the patients and a challenge to treat. Prompt recognition could minimize unnecessary testing and procedures, and facilitate earlier treatment.
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Affiliation(s)
- Jasem Youssef Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait
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Gill JS, Nguyen MX, Hull M, van der Heijden ME, Nguyen K, Thomas SP, Sillitoe RV. Function and dysfunction of the dystonia network: an exploration of neural circuits that underlie the acquired and isolated dystonias. DYSTONIA 2023; 2:11805. [PMID: 38273865 PMCID: PMC10810232 DOI: 10.3389/dyst.2023.11805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Dystonia is a highly prevalent movement disorder that can manifest at any time across the lifespan. An increasing number of investigations have tied this disorder to dysfunction of a broad "dystonia network" encompassing the cerebellum, thalamus, basal ganglia, and cortex. However, pinpointing how dysfunction of the various anatomic components of the network produces the wide variety of dystonia presentations across etiologies remains a difficult problem. In this review, a discussion of functional network findings in non-mendelian etiologies of dystonia is undertaken. Initially acquired etiologies of dystonia and how lesion location leads to alterations in network function are explored, first through an examination of cerebral palsy, in which early brain injury may lead to dystonic/dyskinetic forms of the movement disorder. The discussion of acquired etiologies then continues with an evaluation of the literature covering dystonia resulting from focal lesions followed by the isolated focal dystonias, both idiopathic and task dependent. Next, how the dystonia network responds to therapeutic interventions, from the "geste antagoniste" or "sensory trick" to botulinum toxin and deep brain stimulation, is covered with an eye towards finding similarities in network responses with effective treatment. Finally, an examination of how focal network disruptions in mouse models has informed our understanding of the circuits involved in dystonia is provided. Together, this article aims to offer a synthesis of the literature examining dystonia from the perspective of brain networks and it provides grounding for the perspective of dystonia as disorder of network function.
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Affiliation(s)
- Jason S. Gill
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
| | - Megan X. Nguyen
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
| | - Mariam Hull
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Meike E. van der Heijden
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United State
| | - Ken Nguyen
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United State
| | - Sruthi P. Thomas
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Roy V. Sillitoe
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United State
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
- Development, Disease Models and Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX, United States
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5
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Ehrlich SK, Battistella G, Simonyan K. Temporal Signature of Task-Specificity in Isolated Focal Laryngeal Dystonia. Mov Disord 2023; 38:1925-1935. [PMID: 37489600 PMCID: PMC10615685 DOI: 10.1002/mds.29557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Laryngeal dystonia (LD) is focal task-specific dystonia, predominantly affecting speech but not whispering or emotional vocalizations. Prior neuroimaging studies identified brain regions forming a dystonic neural network and contributing to LD pathophysiology. However, the underlying temporal dynamics of these alterations and their contribution to the task-specificity of LD remain largely unknown. The objective of the study was to identify the temporal-spatial signature of altered cortical oscillations associated with LD pathophysiology. METHODS We used high-density 128-electrode electroencephalography (EEG) recordings during symptomatic speaking and two asymptomatic tasks, whispering and writing, in 24 LD patients and 22 healthy individuals to investigate the spectral dynamics, spatial localization, and interregional effective connectivity of aberrant cortical oscillations within the dystonic neural network, as well as their relationship with LD symptomatology. RESULTS Symptomatic speaking in LD patients was characterized by significantly increased gamma synchronization in the middle/superior frontal gyri, primary somatosensory cortex, and superior parietal lobule, establishing the altered prefrontal-parietal loop. Hyperfunctional connectivity from the left middle frontal gyrus to the right superior parietal lobule was significantly correlated with the age of onset and the duration of LD symptoms. Asymptomatic whisper in LD patients had not no statistically significant changes in any frequency band, whereas asymptomatic writing was characterized by significantly decreased synchronization of beta-band power localized in the right superior frontal gyrus. CONCLUSION Task-specific oscillatory activity of prefrontal-parietal circuitry is likely one of the underlying mechanisms of aberrant heteromodal integration of information processing and transfer within the neural network leading to dystonic motor output. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stefan K. Ehrlich
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Giovanni Battistella
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA
- Department of Neurology - Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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6
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Zito GA, Tarrano C, Ouarab S, Jegatheesan P, Ekmen A, Béranger B, Valabregue R, Hubsch C, Sangla S, Bonnet C, Delorme C, Méneret A, Degos B, Bouquet F, Apoil Brissard M, Vidailhet M, Hasboun D, Worbe Y, Roze E, Gallea C. Fixel-Based Analysis Reveals Whole-Brain White Matter Abnormalities in Cervical Dystonia. Mov Disord 2023. [PMID: 37148555 DOI: 10.1002/mds.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Cervical dystonia (CD) is a form of isolated focal dystonia typically associated to abnormal head, neck, and shoulder movements and postures. The complexity of the clinical presentation limits the investigation of its pathophysiological mechanisms, and the neural networks associated to specific motor manifestations are still the object of debate. OBJECTIVES We investigated the morphometric properties of white matter fibers in CD and explored the networks associated with motor symptoms, while regressing out nonmotor scores. METHODS Nineteen patients affected by CD and 21 healthy controls underwent diffusion-weighted magnetic resonance imaging. We performed fixel-based analysis, a novel method evaluating fiber orientation within specific fiber bundles, and compared fiber morphometric properties between groups. Moreover, we correlated fiber morphometry with the severity of motor symptoms in patients. RESULTS Compared to controls, patients exhibited decreased white matter fibers in the right striatum. Motor symptom severity negatively correlated with white matter fibers passing through inferior parietal areas and the head representation area of the motor cortex. CONCLUSIONS Abnormal white matter integrity at the basal ganglia level may affect several functional networks involved, for instance, in motor preparation and execution, visuomotor coordination, and multimodal integration. This may result in progressive maladaptive plasticity, culminating in overt symptoms of dystonia. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Clément Tarrano
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim Ouarab
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Prasanthi Jegatheesan
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Asya Ekmen
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Benoît Béranger
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR 7225, Paris, France
| | - Romain Valabregue
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR 7225, Paris, France
| | - Cécile Hubsch
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Sophie Sangla
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Cécilia Bonnet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Cécile Delorme
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Aurélie Méneret
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Degos
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Neurology Unit, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
| | - Floriane Bouquet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | | | - Marie Vidailhet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Hasboun
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Yulia Worbe
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Roze
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Gallea
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
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Yao D, O'Flynn LC, Simonyan K. DystoniaBoTXNet: Novel Neural Network Biomarker of Botulinum Toxin Efficacy in Isolated Dystonia. Ann Neurol 2023; 93:460-471. [PMID: 36440757 DOI: 10.1002/ana.26558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Isolated dystonia is characterized by abnormal, often painful, postures and repetitive movements due to sustained or intermittent involuntary muscle contractions. Botulinum toxin (BoTX) injections into the affected muscles are the first line of therapy. However, there are no objective predictive markers or standardized tests of BoTX efficacy that can be utilized for appropriate candidate selection prior to treatment initiation. METHODS We developed a deep learning algorithm, DystoniaBoTXNet, which uses a 3D convolutional neural network architecture and raw structural brain magnetic resonance images (MRIs) to automatically discover and test a neural network biomarker of BoTX efficacy in 284 patients with 4 different forms of focal dystonia, including laryngeal dystonia, blepharospasm, cervical dystonia, and writer's cramp. RESULTS DystoniaBoTXNet identified clusters in superior parietal lobule, inferior and middle frontal gyri, middle orbital gyrus, inferior temporal gyrus, corpus callosum, inferior fronto-occipital fasciculus, and anterior thalamic radiation as components of the treatment biomarker. These regions are known to contribute to both dystonia pathophysiology across a broad clinical spectrum of disorder and the central effects of botulinum toxin treatment. Based on its biomarker, DystoniaBoTXNet achieved an overall accuracy of 96.3%, with 100% sensitivity and 86.1% specificity, in predicting BoTX efficacy in patients with isolated dystonia. The algorithmic decision was computed in 19.2 seconds per case. INTERPRETATION DystoniaBoTXNet and its treatment biomarker have a high translational potential as an objective, accurate, generalizable, fast, and cost-effective algorithmic platform for enhancing clinical decision making for BoTX treatment in patients with isolated dystonia. ANN NEUROL 2023;93:460-471.
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Affiliation(s)
- Dongren Yao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA
| | - Lena C O'Flynn
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA.,Program in Speech Hearing Bioscience and Technology, Harvard University, Boston, MA
| | - Kristina Simonyan
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA.,Program in Speech Hearing Bioscience and Technology, Harvard University, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Boston, MA
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8
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Furuya S, Oku T. Sensorimotor Incoordination in Musicians' Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:61-70. [PMID: 37338696 DOI: 10.1007/978-3-031-26220-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
To acquire and maintain outstanding sensorimotor skills for playing musical instruments inevitably requires extensive training from childhood. However, on the way toward musical excellence, musicians sometimes develop serious disorders, such as tendinitis, carpal tunnel syndrome, and task-specific focal dystonia. Particularly, task-specific focal dystonia in musicians, which is referred to as musician's dystonia (MD), has no perfect cure and therefore often terminates professional careers of musicians. To better understand its pathological and pathophysiological mechanisms, the present article focuses on malfunctions of the sensorimotor system at the behavioral and neurophysiological levels. Based on emerging empirical evidence, we propose that the aberrant sensorimotor integration, possibly which occurs in both cortical and subcortical systems, underlies not only movement incoordination between the fingers (i.e., maladaptive synergy) but also failure of long-term retention of intervention effects in the patients with MD.
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Affiliation(s)
- Shinichi Furuya
- Sony Computer Science Laboratories Inc. (Sony CSL), Tokyo, Japan.
- NeuroPiano Institute, Kyoto, Japan.
| | - Takanori Oku
- Sony Computer Science Laboratories Inc. (Sony CSL), Tokyo, Japan
- NeuroPiano Institute, Kyoto, Japan
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9
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Marapin RS, van der Horn HJ, van der Stouwe AMM, Dalenberg JR, de Jong BM, Tijssen MAJ. Altered brain connectivity in hyperkinetic movement disorders: A review of resting-state fMRI. Neuroimage Clin 2023; 37:103302. [PMID: 36669351 PMCID: PMC9868884 DOI: 10.1016/j.nicl.2022.103302] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperkinetic movement disorders (HMD) manifest as abnormal and uncontrollable movements. Despite reported involvement of several neural circuits, exact connectivity profiles remain elusive. OBJECTIVES Providing a comprehensive literature review of resting-state brain connectivity alterations using resting-state fMRI (rs-fMRI). We additionally discuss alterations from the perspective of brain networks, as well as correlations between connectivity and clinical measures. METHODS A systematic review was performed according to PRISMA guidelines and searching PubMed until October 2022. Rs-fMRI studies addressing ataxia, chorea, dystonia, myoclonus, tics, tremor, and functional movement disorders (FMD) were included. The standardized mean difference was used to summarize findings per region in the Automated Anatomical Labeling atlas for each phenotype. Furthermore, the activation likelihood estimation meta-analytic method was used to analyze convergence of significant between-group differences per phenotype. Finally, we conducted hierarchical cluster analysis to provide additional insights into commonalities and differences across HMD phenotypes. RESULTS Most articles concerned tremor (51), followed by dystonia (46), tics (19), chorea (12), myoclonus (11), FMD (11), and ataxia (8). Altered resting-state connectivity was found in several brain regions: in ataxia mainly cerebellar areas; for chorea, the caudate nucleus; for dystonia, sensorimotor and basal ganglia regions; for myoclonus, the thalamus and cingulate cortex; in tics, the basal ganglia, cerebellum, insula, and frontal cortex; for tremor, the cerebello-thalamo-cortical circuit; finally, in FMD, frontal, parietal, and cerebellar regions. Both decreased and increased connectivity were found for all HMD. Significant spatial convergence was found for dystonia, FMD, myoclonus, and tremor. Correlations between clinical measures and resting-state connectivity were frequently described. CONCLUSION Key brain regions contributing to functional connectivity changes across HMD often overlap. Possible increases and decreases of functional connections of a specific region emphasize that HMD should be viewed as a network disorder. Despite the complex interplay of physiological and methodological factors, this review serves to gain insight in brain connectivity profiles across HMD phenotypes.
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Affiliation(s)
- Ramesh S Marapin
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Harm J van der Horn
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - A M Madelein van der Stouwe
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jelle R Dalenberg
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Bauke M de Jong
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marina A J Tijssen
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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Liu B, Mao Z, Cui Z, Ling Z, Xu X, He K, Cui M, Feng Z, Yu X, Zhang Y. Cerebellar gray matter alterations predict deep brain stimulation outcomes in Meige syndrome. Neuroimage Clin 2023; 37:103316. [PMID: 36610311 PMCID: PMC9827385 DOI: 10.1016/j.nicl.2023.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/21/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The physiopathologic mechanism of Meige syndrome (MS) has not been clarified, and neuroimaging studies centering on cerebellar changes in MS are scarce. Moreover, even though deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been recognized as an effective surgical treatment for MS, there has been no reliable biomarker to predict its efficacy. OBJECTIVE To characterize the volumetric alterations of gray matter (GM) in the cerebellum in MS and to identify GM measurements related to a good STN-DBS outcome. METHODS We used voxel-based morphometry and lobule-based morphometry to compare the regional and lobular GM differences in the cerebellum between 47 MS patients and 52 normal human controls (HCs), as well as between 31 DBS responders and 10 DBS non-responders. Both volumetric analyses were achieved using the Spatially Unbiased Infratentorial Toolbox (SUIT). Further, we performed partial correlation analyses to probe the relationship between the cerebellar GM changes and clinical scores. Finally, we plotted the receiver operating characteristic (ROC) curve to select biomarkers for MS diagnosis and DBS outcomes prediction. RESULTS Compared to HCs, MS patients had GM atrophy in lobule Crus I, lobule VI, lobule VIIb, lobule VIIIa, and lobule VIIIb. Compared to DBS responders, DBS non-responders had lower GM volume in the left lobule VIIIb. Moreover, partial correlation analyses revealed a positive relationship between the GM volume of the significant regions/lobules and the symptom improvement rate after DBS surgery. ROC analyses demonstrated that the GM volume of the significant cluster in the left lobule VIIIb could not only distinguish MS patients from HCs but also predict the outcomes of STN-DBS surgery with high accuracy. CONCLUSION MS patients display bilateral GM shrinkage in the cerebellum relative to HCs. Regional GM volume of the left lobule VIIIb can be a reliable biomarker for MS diagnosis and DBS outcomes prediction.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhipei Ling
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Kunyu He
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Mengchu Cui
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Zhebin Feng
- Medical School of Chinese PLA, Beijing, PR China; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China; Neurosurgery Institute, Chinese PLA General Hospital, Beijing, PR China.
| | - Yanyang Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, PR China; Neurosurgery Institute, Chinese PLA General Hospital, Beijing, PR China.
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11
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Battistella G, Simonyan K. Clinical Implications of Dystonia as a Neural Network Disorder. ADVANCES IN NEUROBIOLOGY 2023; 31:223-240. [PMID: 37338705 DOI: 10.1007/978-3-031-26220-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Isolated dystonia is a neurological disorder of diverse etiology, multifactorial pathophysiology, and wide spectrum of clinical presentations. We review the recent neuroimaging advances that led to the conceptualization of dystonia as a neural network disorder and discuss how current knowledge is shaping the identification of biomarkers of dystonia and the development of novel pharmacological therapies.
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Affiliation(s)
- Giovanni Battistella
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
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12
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MacIver CL, Tax CMW, Jones DK, Peall KJ. Structural magnetic resonance imaging in dystonia: A systematic review of methodological approaches and findings. Eur J Neurol 2022; 29:3418-3448. [PMID: 35785410 PMCID: PMC9796340 DOI: 10.1111/ene.15483] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Structural magnetic resonance techniques have been widely applied in neurological disorders to better understand tissue changes, probing characteristics such as volume, iron deposition and diffusion. Dystonia is a hyperkinetic movement disorder, resulting in abnormal postures and pain. Its pathophysiology is poorly understood, with normal routine clinical imaging in idiopathic forms. More advanced tools provide an opportunity to identify smaller scale structural changes which may underpin pathophysiology. This review aims to provide an overview of methodological approaches undertaken in structural brain imaging of dystonia cohorts, and to identify commonly identified pathways, networks or regions that are implicated in pathogenesis. METHODS Structural magnetic resonance imaging studies of idiopathic and genetic forms of dystonia were systematically reviewed. Adhering to strict inclusion and exclusion criteria, PubMed and Embase databases were searched up to January 2022, with studies reviewed for methodological quality and key findings. RESULTS Seventy-seven studies were included, involving 1945 participants. The majority of studies employed diffusion tensor imaging (DTI) (n = 45) or volumetric analyses (n = 37), with frequently implicated areas of abnormality in the brainstem, cerebellum, basal ganglia and sensorimotor cortex and their interconnecting white matter pathways. Genotypic and motor phenotypic variation emerged, for example fewer cerebello-thalamic tractography streamlines in genetic forms than idiopathic and higher grey matter volumes in task-specific than non-task-specific dystonias. DISCUSSION Work to date suggests microstructural brain changes in those diagnosed with dystonia, although the underlying nature of these changes remains undetermined. Employment of techniques such as multiple diffusion weightings or multi-exponential relaxometry has the potential to enhance understanding of these differences.
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Affiliation(s)
- Claire L. MacIver
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK,Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Chantal M. W. Tax
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK,Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Derek K. Jones
- Cardiff University Brain Imaging Centre (CUBRIC)Cardiff UniversityCardiffUK
| | - Kathryn J. Peall
- Neuroscience and Mental Health Research InstituteDivision of Psychological Medicine and Clinical NeurosciencesCardiff University School of MedicineCardiffUK
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13
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O'Flynn LC, Simonyan K. Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia. Neurology 2022; 99:e1178-e1190. [PMID: 35764404 PMCID: PMC9536744 DOI: 10.1212/wnl.0000000000200850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laryngeal dystonia (LD) is isolated task-specific focal dystonia selectively impairing speech production. The first choice of LD treatment is botulinum neurotoxin (BoNT) injections into the affected laryngeal muscles. However, whether BoNT has a lasting therapeutic effect on disorder pathophysiology is unknown. We investigated short-term and long-term effects of BoNT treatment on brain function in patients with LD. METHODS A total of 161 participants were included in the functional MRI study. Statistical analyses examined central BoNT effects in patients with LD who were stratified based on the effectiveness and duration of treatment. RESULTS Patients with LD who were treated and benefited from BoNT injections had reduced activity in the left precuneus compared with BoNT-naive and treatment nonbenefiting patients. In addition, BoNT-treated patients with adductor LD had decreased activity in the right thalamus, whereas BoNT-treated abductor patients with LD had reduced activity in the left inferior frontal cortex. No statistically significant differences in brain activity were found between patients with shorter (1-5 years) and longer (13-28 years) treatment durations. However, patients with intermediate treatment duration of 6-12 years showed reduced activity in the right cerebellum compared with patients with both shorter and longer treatment durations and reduced activity in the right prefrontal cortex compared with patients with shorter treatment duration. DISCUSSION Our findings suggest that the left precuneus is the site of short-term BoNT central action in patients with LD, whereas the prefrontal-cerebellar axis is engaged in the BoNT response in patients with intermediate treatment duration of 6-12 years. Involvement of these structures points to indirect action of BoNT treatment on the dystonic sensorimotor network through modulation of motor sequence planning and coordination.
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Affiliation(s)
- Lena C O'Flynn
- From the Department of Otolaryngology-Head and Neck Surgery (L.C.O., K.S.), Massachusetts Eye and Ear and Harvard Medical School; Program in Speech Hearing Bioscience and Technology (L.C.O., K.S.), Harvard University; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston
| | - Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (L.C.O., K.S.), Massachusetts Eye and Ear and Harvard Medical School; Program in Speech Hearing Bioscience and Technology (L.C.O., K.S.), Harvard University; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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14
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Borngräber F, Hoffmann M, Paulus T, Junker J, Bäumer T, Altenmüller E, Kühn AA, Schmidt A. Characterizing the temporal discrimination threshold in musician's dystonia. Sci Rep 2022; 12:14939. [PMID: 36056047 PMCID: PMC9440005 DOI: 10.1038/s41598-022-18739-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
The temporal discrimination threshold (TDT) has been established as a biomarker of impaired temporal processing and endophenotype in various forms of focal dystonia patients, such as cervical dystonia, writer's cramp or blepharospasm. The role of TDT in musician's dystonia (MD) in contrast is less clear with preceding studies reporting inconclusive results. We therefore compared TDT between MD patients, healthy musicians and non-musician controls using a previously described visual, tactile, and visual-tactile paradigm. Additionally, we compared TDT of the dystonic and non-dystonic hand and fingers in MD patients and further characterized the biomarker regarding its potential influencing factors, i.e. musical activity, disease variables, and personality profiles. Repeated measures ANOVA and additional Bayesian analyses revealed lower TDT in healthy musicians compared to non-musicians. However, TDTs in MD patients did not differ from both healthy musicians and non-musicians, although pairwise Bayesian t-tests indicated weak evidence for group differences in both comparisons. Analyses of dystonic and non-dystonic hands and fingers revealed no differences. While in healthy musicians, age of first instrumental practice negatively correlated with visual-tactile TDTs, TDTs in MD patients did not correlate with measures of musical activity, disease variables or personality profiles. In conclusion, TDTs in MD patients cannot reliably be distinguished from healthy musicians and non-musicians and are neither influenced by dystonic manifestation, musical activity, disease variables nor personality profiles. Unlike other isolated focal dystonias, TDT seems not to be a reliable biomarker in MD.
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Affiliation(s)
- Friederike Borngräber
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Movement Disorder and Neuromodulation Unit, Department of Neurology, Berlin, Germany.
- Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Martina Hoffmann
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany
- Charité-Universitätsmedizin, Department of Neurology, Berlin, Germany
| | - Theresa Paulus
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Johanna Junker
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Andrea A Kühn
- Charité-Universitätsmedizin Berlin, Movement Disorder and Neuromodulation Unit, Department of Neurology, Berlin, Germany
| | - Alexander Schmidt
- Berlin Center for Musicians' Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Kurt Singer Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin, Berlin, Germany
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15
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Simonyan K, Ehrlich SK, Andersen R, Brumberg J, Guenther F, Hallett M, Howard MA, Millán JDR, Reilly RB, Schultz T, Valeriani D. Brain-Computer Interfaces for Treatment of Focal Dystonia. Mov Disord 2022; 37:1798-1802. [PMID: 35947366 PMCID: PMC9474652 DOI: 10.1002/mds.29178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Task-specificity in isolated focal dystonias is a powerful feature that may successfully be targeted with therapeutic brain-computer interfaces. While performing a symptomatic task, the patient actively modulates momentary brain activity (disorder signature) to match activity during an asymptomatic task (target signature), which is expected to translate into symptom reduction.
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Affiliation(s)
- Kristina Simonyan
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stefan K. Ehrlich
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Andersen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California, USA
| | - Jonathan Brumberg
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, Kansas, USA
| | - Frank Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew A. Howard
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - José del R. Millán
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Texas, USA
- Department of Neurology, University of Texas at Austin, Austin, Texas, USA
| | - Richard B. Reilly
- Center for Biomedical Engineering, Trinity College Institute of Neuroscience, School of Medicine, School of Engineering, Trinity College Dublin and the University of Dublin, Dublin, Ireland
| | - Tanja Schultz
- Faculty 03 Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Davide Valeriani
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
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16
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The Patho-Neurophysiological Basis and Treatment of Focal Laryngeal Dystonia: A Narrative Review and Two Case Reports Applying TMS over the Laryngeal Motor Cortex. J Clin Med 2022; 11:jcm11123453. [PMID: 35743523 PMCID: PMC9224879 DOI: 10.3390/jcm11123453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/10/2022] Open
Abstract
Focal laryngeal dystonia (LD) is a rare, idiopathic disease affecting the laryngeal musculature with an unknown cause and clinically presented as adductor LD or rarely as abductor LD. The most effective treatment options include the injection of botulinum toxin (BoNT) into the affected laryngeal muscle. The aim of this narrative review is to summarize the patho-neuro-physiological and genetic background of LD, as well as the standard recommended therapy (BoNT) and pharmacological treatment options, and to discuss possible treatment perspectives using neuro-modulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and vibrotactile stimulation. The review will present two LD cases, patients with adductor and abductor LD, standard diagnostic procedure, treatments and achievement, and the results of cortical excitability mapping the primary motor cortex for the representation of the laryngeal muscles in the assessment of corticospinal and corticobulbar excitability.
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17
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Zhang M, Huang X, Li B, Shang H, Yang J. Gray Matter Structural and Functional Alterations in Idiopathic Blepharospasm: A Multimodal Meta-Analysis of VBM and Functional Neuroimaging Studies. Front Neurol 2022; 13:889714. [PMID: 35734475 PMCID: PMC9207395 DOI: 10.3389/fneur.2022.889714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Neuroimaging studies have shown gray matter structural and functional alterations in patients with idiopathic blepharospasm (iBSP) but with variations. Here we aimed to investigate the specific and common neurostructural/functional abnormalities in patients with iBSP. Methods A systematic literature search from PubMed, Web of Science and Embase was conducted to identify relevant publications. We conducted separate meta-analysis for whole-brain voxel-based morphometry (VBM) studies and for functional imaging studies, and a multimodal meta-analysis across VBM and functional studies in iBSP, using anisotropic effect size-based signed differential mapping. Results The structural database comprised 129 patients with iBSP and 144 healthy controls whilst the functional database included 183 patients with iBSP and 253 healthy controls. The meta-analysis of VBM studies showed increased gray matter in bilateral precentral and postcentral gyri, right supplementary motor area and bilateral paracentral lobules, while decreased gray matter in right superior and inferior parietal gyri, left inferior parietal gyrus, left inferior temporal gyrus, left fusiform gyrus and parahippocampal gyrus. The meta-analysis of functional studies revealed hyperactivity in right dorsolateral superior frontal gyrus, left thalamus and right fusiform gyrus, while hypoactivity in left temporal pole, left insula, left precentral gyrus, bilateral precuneus and paracentral lobules, right supplementary motor area and middle frontal gyrus. The multimodal meta-analysis identified conjoint anatomic and functional changes in left precentral gyrus, bilateral supplementary motor areas and paracentral lobules, right inferior occipital gyrus and fusiform gyrus. Conclusions The patterns of conjoint and dissociated gray matter alterations identified in the meta-analysis may enhance our understanding of the pathophysiological mechanisms underlying iBSP.
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18
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Wu Y, Zhang C, Li Y, Feng J, Zhang M, Li H, Wang T, Zhang Y, Jin Z, Zhang C, Zhang Y, Li D, Wu Y, Wei H, Sun B. Imaging Insights of Isolated Idiopathic Dystonia: Voxel-Based Morphometry and Activation Likelihood Estimation Studies. Front Neurol 2022; 13:823882. [PMID: 35557619 PMCID: PMC9087834 DOI: 10.3389/fneur.2022.823882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
The understanding of brain structural abnormalities across different clinical forms of dystonia and their contribution to clinical characteristics remains unclear. The objective of this study is to investigate shared and specific gray matter volume (GMV) abnormalities in various forms of isolated idiopathic dystonia. We collected imaging data from 73 isolated idiopathic dystonia patients and matched them with healthy controls to explore the GMV alterations in patients and their correlations with clinical characteristics using the voxel-based morphometry (VBM) technique. In addition, we conducted an activation likelihood estimation (ALE) meta-analysis of previous VBM studies. Our study demonstrated widespread morphometry alterations in patients with idiopathic dystonia. Multiple systems were affected, which mainly included basal ganglia, sensorimotor, executive control, and visual networks. As the result of the ALE meta-analysis, a convergent cluster with increased GMV was found in the left globus pallidus. In subgroup VBM analyses, decreased putamen GMV was observed in all clinic forms, while the increased GMV was observed in parahippocampal, lingual, and temporal gyrus. GD demonstrated the most extensive GMV abnormalities in cortical regions, and the aberrant GMV of the posterior cerebellar lobe was prominent in CD. Moreover, trends of increased GMV regions of the left precuneus and right superior frontal gyrus were demonstrated in the moderate-outcome group compared with the superior-outcome group. Results of our study indicated shared pathophysiology of the disease-centered on the dysfunction of the basal ganglia-thalamo-cortical circuit, impairing sensorimotor integration, high-level motor execution, and cognition of patients. Dysfunction of the cerebello-thalamo-cortical circuit could also be involved in CD especially. Finally, the frontal-parietal pathway may act as a potential marker for predicting treatment outcomes such as deep brain stimulation.
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Affiliation(s)
- Yunhao Wu
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufei Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Feng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijia Jin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Hongjiang Wei
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Bomin Sun
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19
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Kothare H, Schneider S, Mizuiri D, Hinkley L, Bhutada A, Ranasinghe K, Honma S, Garrett C, Klein D, Naunheim M, Yung K, Cheung S, Rosen C, Courey M, Nagarajan S, Houde J. Temporal specificity of abnormal neural oscillations during phonatory events in laryngeal dystonia. Brain Commun 2022; 4:fcac031. [PMID: 35356032 PMCID: PMC8962453 DOI: 10.1093/braincomms/fcac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 01/03/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022] Open
Abstract
Laryngeal dystonia is a debilitating disorder of voicing in which the laryngeal muscles are intermittently in spasm resulting in involuntary interruptions during speech. The central pathophysiology of laryngeal dystonia, underlying computational impairments in vocal motor control, remains poorly understood. Although prior imaging studies have found aberrant activity in the CNS during phonation in patients with laryngeal dystonia, it is not known at what timepoints during phonation these abnormalities emerge and what function may be impaired. To investigate this question, we recruited 22 adductor laryngeal dystonia patients (15 female, age range = 28.83-72.46 years) and 18 controls (eight female, age range = 27.40-71.34 years). We leveraged the fine temporal resolution of magnetoencephalography to monitor neural activity around glottal movement onset, subsequent voice onset and after the onset of pitch feedback perturbations. We examined event-related beta-band (12-30 Hz) and high-gamma-band (65-150 Hz) neural oscillations. Prior to glottal movement onset, we observed abnormal frontoparietal motor preparatory activity. After glottal movement onset, we observed abnormal activity in the somatosensory cortex persisting through voice onset. Prior to voice onset and continuing after, we also observed abnormal activity in the auditory cortex and the cerebellum. After pitch feedback perturbation onset, we observed no differences between controls and patients in their behavioural responses to the perturbation. But in patients, we did find abnormal activity in brain regions thought to be involved in the auditory feedback control of vocal pitch (premotor, motor, somatosensory and auditory cortices). Our study results confirm the abnormal processing of somatosensory feedback that has been seen in other studies. However, there were several remarkable findings in our study. First, patients have impaired vocal motor activity even before glottal movement onset, suggesting abnormal movement preparation. These results are significant because (i) they occur before movement onset, abnormalities in patients cannot be ascribed to deficits in vocal performance and (ii) they show that neural abnormalities in laryngeal dystonia are more than just abnormal responses to sensory feedback during phonation as has been hypothesized in some previous studies. Second, abnormal auditory cortical activity in patients begins even before voice onset, suggesting abnormalities in setting up auditory predictions before the arrival of auditory feedback at voice onset. Generally, activation abnormalities identified in key brain regions within the speech motor network around various phonation events not only provide temporal specificity to neuroimaging phenotypes in laryngeal dystonia but also may serve as potential therapeutic targets for neuromodulation.
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Affiliation(s)
- Hardik Kothare
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Schneider
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Leighton Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Abhishek Bhutada
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Kamalini Ranasinghe
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Susanne Honma
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Coleman Garrett
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - David Klein
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Molly Naunheim
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Katherine Yung
- San Francisco Voice & Swallowing, San Francisco, CA, USA
| | - Steven Cheung
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Clark Rosen
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mark Courey
- Department of Otolaryngology—Head and Neck Surgery, Mount Sinai Health System, New York, NY, USA
| | - Srikantan Nagarajan
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - John Houde
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
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20
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Abstract
Background Task-specific dystonia (TSD) is a form of focal dystonia that occurs in the context of the performance of selective, highly skilled, often repetitive, motor activity. TSD may be apparent during certain tasks such as writing, playing musical instruments, or other activities requiring fine motor control, but may also occur during certain sports, and maybe detrimental to professional athletes' careers. Therefore, sports physicians and movement disorder neurologists need to be aware of the presentation and phenomenology of sports-related dystonia (SRD), the topic of this review. Methods A broad PubMed search using a wide range of keywords and combinations was done in October 2021 to identify suitable articles for this review. Results Most of the publications are on yips in golfers and on runners' dystonia. Other sports in which SRD has been reported are ice skating, tennis, table tennis, pistol shooting, petanque, baseball, and billiards. Discussion Yips, which may affect up to half of the golfers and rarely athletes in other sports (e.g., baseball, cricket, basketball, speed skating, gymnastics) seems to be a multi-factorial form of TSD that is particularly troublesome in highly skilled professional golfers. Runners' dystonia, affecting the foot, leg, and hip (in decreasing order), may evolve into more generalized and less specific dystonia. The pathophysiologic mechanisms of SRD are not well understood. Botulinum toxin has been reported to alleviate dystonia in golfers', runners', and other forms of SRD. Future studies should utilize neurophysiologic, imaging, and other techniques to elucidate mechanisms of this underrecognized group of movement disorders.
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21
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Huang X, Lin J, Shang H, Yang J. Voxel-based meta-analysis of gray matter abnormalities in idiopathic dystonia. J Neurol 2022; 269:2862-2873. [PMID: 35013788 DOI: 10.1007/s00415-022-10961-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Neuroimaging studies have reported gray matter changes in patients with idiopathic dystonia but with considerable variations. Here, we aimed to investigate the convergence of dystonia-related gray matter changes across studies. METHODS The whole brain voxel-based morphometry studies comparing idiopathic dystonia and healthy controls were systematically searched in the PubMed, Web of Science and Embase. Meta-analysis of gray matter changes was performed using the anisotropic effect size-based signed differential mapping. RESULTS Twenty-eight studies comparing 701 idiopathic dystonia patients and 712 healthy controls were included in the meta-analysis. Compared to healthy controls, idiopathic dystonia patients showed increased gray matter in bilateral precentral and postcentral gyri, bilateral putamen and pallidum, right insula, and left supramarginal gyrus, while decreased gray matter in bilateral temporal poles, bilateral supplementary motor areas, right angular gyrus, inferior parietal gyrus and precuneus, left insula and inferior frontal gyrus. These findings remained robust in the jackknife sensitivity analysis, and no significant heterogeneity was detected. Subgroup analyses of different phenotypes of dystonia were performed to further confirm the above findings. CONCLUSION The meta-analysis showed that consistent widespread gray matter abnormalities were shared in different subtypes of idiopathic dystonia and were not restricted to the corticostriatal circuits.
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Affiliation(s)
- Xiang Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junyu Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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22
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Smit M, Albanese A, Benson M, Edwards MJ, Graessner H, Hutchinson M, Jech R, Krauss JK, Morgante F, Pérez Dueñas B, Reilly RB, Tinazzi M, Contarino MF, Tijssen MAJ. Dystonia Management: What to Expect From the Future? The Perspectives of Patients and Clinicians Within DystoniaNet Europe. Front Neurol 2021; 12:646841. [PMID: 34149592 PMCID: PMC8211212 DOI: 10.3389/fneur.2021.646841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Improved care for people with dystonia presents a number of challenges. Major gaps in knowledge exist with regard to how to optimize the diagnostic process, how to leverage discoveries in pathophysiology into biomarkers, and how to develop an evidence base for current and novel treatments. These challenges are made greater by the realization of the wide spectrum of symptoms and difficulties faced by people with dystonia, which go well-beyond motor symptoms. A network of clinicians, scientists, and patients could provide resources to facilitate information exchange at different levels, share mutual experiences, and support each other's innovative projects. In the past, collaborative initiatives have been launched, including the American Dystonia Coalition, the European Cooperation in Science and Technology (COST-which however only existed for a limited time), and the Dutch DystonieNet project. The European Reference Network on Rare Neurological Diseases includes dystonia among other rare conditions affecting the central nervous system in a dedicated stream. Currently, we aim to broaden the scope of these initiatives to a comprehensive European level by further expanding the DystoniaNet network, in close collaboration with the ERN-RND. In line with the ERN-RND, the mission of DystoniaNet Europe is to improve care and quality of life for people with dystonia by, among other endeavors, facilitating access to specialized care, overcoming the disparity in education of medical professionals, and serving as a solid platform to foster international clinical and research collaborations. In this review, both professionals within the dystonia field and patients and caregivers representing Dystonia Europe highlight important unsolved issues and promising new strategies and the role that a European network can play in activating them.
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Affiliation(s)
- Marenka Smit
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Alberto Albanese
- Department of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Milan, Italy
| | | | - Mark J. Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Holm Graessner
- Institute of Medical Genetics and Applied Genomics and Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Michael Hutchinson
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Joachim K. Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hanover, Germany
| | - Francesca Morgante
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Belen Pérez Dueñas
- Pediatric Neurology Research Group, Hospital Vall d'Hebron–Institut de Recerca (VHIR), Barcelona, Spain
| | - Richard B. Reilly
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands
| | - Marina A. J. Tijssen
- Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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Simonyan K, Barkmeier-Kraemer J, Blitzer A, Hallett M, Houde JF, Jacobson Kimberley T, Ozelius LJ, Pitman MJ, Richardson RM, Sharma N, Tanner K. Laryngeal Dystonia: Multidisciplinary Update on Terminology, Pathophysiology, and Research Priorities. Neurology 2021; 96:989-1001. [PMID: 33858994 DOI: 10.1212/wnl.0000000000011922] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To delineate research priorities for improving clinical management of laryngeal dystonia, the NIH convened a multidisciplinary panel of experts for a 1-day workshop to examine the current progress in understanding its etiopathophysiology and clinical care. METHODS The participants reviewed the current terminology of disorder and discussed advances in understanding its pathophysiology since a similar workshop was held in 2005. Clinical and research gaps were identified, and recommendations for future directions were delineated. RESULTS The panel unanimously agreed to adopt the term "laryngeal dystonia" instead of "spasmodic dysphonia" to reflect the current progress in characterizations of this disorder. Laryngeal dystonia was recognized as a multifactorial, phenotypically heterogeneous form of isolated dystonia. Its etiology remains unknown, whereas the pathophysiology likely involves large-scale functional and structural brain network disorganization. Current challenges include the lack of clinically validated diagnostic markers and outcome measures and the paucity of therapies that address the disorder pathophysiology. CONCLUSION Research priorities should be guided by challenges in clinical management of laryngeal dystonia. Identification of disorder-specific biomarkers would allow the development of novel diagnostic tools and unified measures of treatment outcome. Elucidation of the critical nodes within neural networks that cause or modulate symptoms would allow the development of targeted therapies that address the underlying pathophysiology. Given the rarity of laryngeal dystonia, future rapid research progress may be facilitated by multicenter, national and international collaborations.
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Affiliation(s)
- Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT.
| | - Julie Barkmeier-Kraemer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Andrew Blitzer
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Mark Hallett
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - John F Houde
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Teresa Jacobson Kimberley
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Laurie J Ozelius
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Michael J Pitman
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Robert Mark Richardson
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Nutan Sharma
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
| | - Kristine Tanner
- From the Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School and Massachusetts Eye and Ear, Boston, MA, Department of Neurology (K.S., L.J.O., N.S.), Massachusetts General Hospital, Boston, MA; Division of Otolaryngology (J.B.-K.), University of Utah, Salt Lake City, UT; New York Center for Voice and Swallowing Disorders and Department of Neurology (A.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Department of Otolaryngology-Head and Neck Surgery (J.H.), University of California San Francisco, San Francisco, CA; School of Rehabilitation and Health Sciences (T.J.K.), Massachusetts General Hospital Institute of Health Professions, Boston, MA; Department of Otolaryngology-Head and Neck Surgery (M.J.P.), Columbia University Irving Medical Center, New York, NY; Department of Neurosurgery (R.M.R.), Massachusetts General Hospital, Boston, MA; and Department of Communication Disorders (K.T.), Brigham Young University, Provo, UT
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24
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Abstract
Overuse of specific muscles in perfecting movements in performing arts makes an artist prone to many medical conditions. Musicians' hand dystonia is focal task-specific dystonia (FTSD) of hand among musicians that has been extensively studied. However, embouchure, lower limbs, and laryngeal muscles can also be affected among musicians. Embouchure dystonia (ED) refers to dystonia of the perioral and facial muscles that occurs in musicians while playing embouchure instruments. It is essential to identify ED since the dystonia might become persistent and non-task-specific if the musician continues to play the instrument. Task-specific dystonia of lower limbs among musicians has been exclusively reported among drummers. The diagnosis rests on electromyogram (EMG) of the involved muscles during the task. Singer's dystonia (SD) refers to task-specific laryngeal dystonia that occurs only while singing. The diagnosis of SD is based on laryngeal EMG and spectrographic analysis. Cortical hyperexcitability, loss of inhibition, and aberrant plasticity are central to the pathogenesis in both ED and musicians' hand dystonia. The pathophysiological studies in SD are limited. This review aims to discuss the lesser known dystonias among performing artists - ED, FTSD of lower limb, and SD.
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25
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Merchant SHI, Frangos E, Parker J, Bradson M, Wu T, Vial-Undurraga F, Leodori G, Bushnell MC, Horovitz SG, Hallett M, Popa T. The role of the inferior parietal lobule in writer's cramp. Brain 2021; 143:1766-1779. [PMID: 32428227 DOI: 10.1093/brain/awaa138] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 12/28/2022] Open
Abstract
Humans have a distinguishing ability for fine motor control that is subserved by a highly evolved cortico-motor neuronal network. The acquisition of a particular motor skill involves a long series of practice movements, trial and error, adjustment and refinement. At the cortical level, this acquisition begins in the parieto-temporal sensory regions and is subsequently consolidated and stratified in the premotor-motor cortex. Task-specific dystonia can be viewed as a corruption or loss of motor control confined to a single motor skill. Using a multimodal experimental approach combining neuroimaging and non-invasive brain stimulation, we explored interactions between the principal nodes of the fine motor control network in patients with writer's cramp and healthy matched controls. Patients and healthy volunteers underwent clinical assessment, diffusion-weighted MRI for tractography, and functional MRI during a finger tapping task. Activation maps from the task-functional MRI scans were used for target selection and neuro-navigation of the transcranial magnetic stimulation. Single- and double-pulse TMS evaluation included measurement of the input-output recruitment curve, cortical silent period, and amplitude of the motor evoked potentials conditioned by cortico-cortical interactions between premotor ventral (PMv)-motor cortex (M1), anterior inferior parietal lobule (aIPL)-M1, and dorsal inferior parietal lobule (dIPL)-M1 before and after inducing a long term depression-like plastic change to dIPL node with continuous theta-burst transcranial magnetic stimulation in a randomized, sham-controlled design. Baseline dIPL-M1 and aIPL-M1 cortico-cortical interactions were facilitatory and inhibitory, respectively, in healthy volunteers, whereas the interactions were converse and significantly different in writer's cramp. Baseline PMv-M1 interactions were inhibitory and similar between the groups. The dIPL-PMv resting state functional connectivity was increased in patients compared to controls, but no differences in structural connectivity between the nodes were observed. Cortical silent period was significantly prolonged in writer's cramp. Making a long term depression-like plastic change to dIPL node transformed the aIPL-M1 interaction to inhibitory (similar to healthy volunteers) and cancelled the PMv-M1 inhibition only in the writer's cramp group. These findings suggest that the parietal multimodal sensory association region could have an aberrant downstream influence on the fine motor control network in writer's cramp, which could be artificially restored to its normal function.
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Affiliation(s)
- Shabbir Hussain I Merchant
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Eleni Frangos
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Jacob Parker
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Megan Bradson
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Felipe Vial-Undurraga
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Giorgio Leodori
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - M C Bushnell
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Traian Popa
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.,Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
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26
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Khosravani S, Chen G, Ozelius LJ, Simonyan K. Neural endophenotypes and predictors of laryngeal dystonia penetrance and manifestation. Neurobiol Dis 2020; 148:105223. [PMID: 33316367 PMCID: PMC8284879 DOI: 10.1016/j.nbd.2020.105223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Focal dystonias are the most common forms of isolated dystonia; however, the etiopathophysiological signatures of disorder penetrance and clinical manifestation remain unclear. Using an imaging genetics approach, we investigated functional and structural representations of neural endophenotypes underlying the penetrance and manifestation of laryngeal dystonia in families, including 21 probands and 21 unaffected relatives, compared to 32 unrelated healthy controls. We further used a supervised machine-learning algorithm to predict the risk for dystonia development in susceptible individuals based on neural features of identified endophenotypes. We found that abnormalities in prefrontal-parietal cortex, thalamus, and caudate nucleus were commonly shared between patients and their unaffected relatives, representing an intermediate endophenotype of laryngeal dystonia. Machine learning classified 95.2% of unaffected relatives as patients rather than healthy controls, substantiating that these neural alterations represent the endophenotypic marker of dystonia penetrance, independent of its symptomatology. Additional abnormalities in premotor-parietal-temporal cortical regions, caudate nucleus, and cerebellum were present only in patients but not their unaffected relatives, likely representing a secondary endophenotype of dystonia manifestation. Based on alterations in the parietal cortex and caudate nucleus, the machine learning categorized 28.6% of unaffected relative as patients, indicating their increased lifetime risk for developing clinical manifestation of dystonia. The identified endophenotypic neural markers may be implemented for screening of at-risk individuals for dystonia development, selection of families for genetic studies of novel variants based on their risk for disease penetrance, or stratification of patients who would respond differently to a particular treatment in clinical trials.
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Affiliation(s)
- Sanaz Khosravani
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Gang Chen
- National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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27
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A microstructural neural network biomarker for dystonia diagnosis identified by a DystoniaNet deep learning platform. Proc Natl Acad Sci U S A 2020; 117:26398-26405. [PMID: 33004625 PMCID: PMC7586425 DOI: 10.1073/pnas.2009165117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This research identified a microstructural neural network biomarker for objective and accurate diagnosis of isolated dystonia based on the disorder pathophysiology using an advanced deep learning algorithm, DystoniaNet, and raw structural brain images of large cohorts of patients with isolated focal dystonia and healthy controls. DystoniaNet significantly outperformed shallow machine-learning pipelines and substantially exceeded the current agreement rates between clinicians, reaching an overall accuracy of 98.8% in diagnosing different forms of isolated focal dystonia. These results suggest that DystoniaNet could serve as an objective, robust, and generalizable algorithmic platform of dystonia diagnosis for enhanced clinical decision-making. Implementation of the identified biomarker for objective and accurate diagnosis of dystonia may be transformative for clinical management of this disorder. Isolated dystonia is a neurological disorder of heterogeneous pathophysiology, which causes involuntary muscle contractions leading to abnormal movements and postures. Its diagnosis is remarkably challenging due to the absence of a biomarker or gold standard diagnostic test. This leads to a low agreement between clinicians, with up to 50% of cases being misdiagnosed and diagnostic delays extending up to 10.1 y. We developed a deep learning algorithmic platform, DystoniaNet, to automatically identify and validate a microstructural neural network biomarker for dystonia diagnosis from raw structural brain MRIs of 612 subjects, including 392 patients with three different forms of isolated focal dystonia and 220 healthy controls. DystoniaNet identified clusters in corpus callosum, anterior and posterior thalamic radiations, inferior fronto-occipital fasciculus, and inferior temporal and superior orbital gyri as the biomarker components. These regions are known to contribute to abnormal interhemispheric information transfer, heteromodal sensorimotor processing, and executive control of motor commands in dystonia pathophysiology. The DystoniaNet-based biomarker showed an overall accuracy of 98.8% in diagnosing dystonia, with a referral of 3.5% of cases due to diagnostic uncertainty. The diagnostic decision by DystoniaNet was computed in 0.36 s per subject. DystoniaNet significantly outperformed shallow machine-learning algorithms in benchmark comparisons, showing nearly a 20% increase in its diagnostic performance. Importantly, the microstructural neural network biomarker and its DystoniaNet platform showed substantial improvement over the current 34% agreement on dystonia diagnosis between clinicians. The translational potential of this biomarker is in its highly accurate, interpretable, and generalizable performance for enhanced clinical decision-making.
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Tomić A, Agosta F, Sarasso E, Svetel M, Kresojević N, Fontana A, Canu E, Petrović I, Kostić VS, Filippi M. Brain Structural Changes in Focal Dystonia—What About Task Specificity? A Multimodal
MRI
Study. Mov Disord 2020; 36:196-205. [DOI: 10.1002/mds.28304] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Aleksandra Tomić
- Clinic of Neurology, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
| | - Marina Svetel
- Clinic of Neurology, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Nikola Kresojević
- Clinic of Neurology, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo Foggia Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
| | - Igor Petrović
- Clinic of Neurology, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Vladimir S. Kostić
- Clinic of Neurology, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
- Neurology Unit and Neurophysiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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29
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Mantel T, Altenmüller E, Li Y, Lee A, Meindl T, Jochim A, Zimmer C, Haslinger B. Structure-function abnormalities in cortical sensory projections in embouchure dystonia. NEUROIMAGE-CLINICAL 2020; 28:102410. [PMID: 32932052 PMCID: PMC7495104 DOI: 10.1016/j.nicl.2020.102410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 08/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Embouchure dystonia (ED) is a task-specific focal dystonia in professional brass players leading to abnormal orofacial muscle posturing/spasms during performance. Previous studies have outlined abnormal cortical sensorimotor function during sensory/motor tasks and in the resting state as well as abnormal cortical sensorimotor structure. Yet, potentially underlying white-matter tract abnormalities in this network disease are unknown. OBJECTIVE To delineate structure-function abnormalities within cerebral sensorimotor trajectories in ED. METHOD Probabilistic tractography and seed-based functional connectivity analysis were performed in 16/16 ED patients/healthy brass players within a simple literature-informed network model of cortical sensorimotor processing encompassing supplementary motor, superior parietal, primary somatosensory and motor cortex as well as the putamen. Post-hoc grey matter volumetry was performed within cortices of abnormal trajectories. RESULTS ED patients showed average axial diffusivity reduction within projections between the primary somatosensory cortex and putamen, with converse increases within projections between supplementary motor and superior parietal cortex in both hemispheres. Increase in the mode of anisotropy in patients was accompanying the latter left-hemispheric projection, as well as in the supplementary motor area's projection to the left primary motor cortex. Patient's left primary somatosensory functional connectivity with the putamen was abnormally reduced and significantly associated with the axial diffusivity reduction. Left primary somatosensory grey matter volume was increased in patients. CONCLUSION Correlates of abnormal tract integrity within primary somatosensory cortico-subcortical projections and higher-order sensorimotor projections support the key role of dysfunctional sensory information propagation in ED pathophysiology. Differential directionality of cortico-cortical and cortico-subcortical abnormalities hints at non-uniform sensory system changes.
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Eckart Altenmüller
- Hochschule für Musik, Theater und Medien Hannover, Emmichplatz 1, Hanover, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - André Lee
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany; Hochschule für Musik, Theater und Medien Hannover, Emmichplatz 1, Hanover, Germany
| | - Tobias Meindl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany.
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Norris SA, Jinnah HA, Klein C, Jankovic J, Berman BD, Roze E, Mahajan A, Espay AJ, Murthy AV, Fung VSC, LeDoux MS, Chang FCF, Vidailhet M, Testa C, Barbano R, Malaty IA, Bäumer T, Loens S, Wright LJ, Perlmutter JS. Clinical and Demographic Characteristics of Upper Limb Dystonia. Mov Disord 2020; 35:2086-2090. [PMID: 32845549 DOI: 10.1002/mds.28223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Knowledge of characteristics in upper limb dystonia remains limited, derived primarily from small, single-site studies. OBJECTIVE The objective of this study was to characterize demographic and clinical characteristics of upper limb dystonia from the Dystonia Coalition data set, a large, international, multicenter resource. METHODS We evaluated clinical and demographic characteristics of 367 participants with upper limb dystonia from onset, comparing across subcategories of focal (with and without dystonia spread) versus nonfocal onset. RESULTS Focal onset occurred in 80%; 67% remained focal without spread. Task specificity was most frequent in this subgroup, most often writer's cramp and affecting the dominant limb (83%). Focal onset with spread was more frequent in young onset (<21 years). Focal onset occurred equally in women and men; nonfocal onset affected women disproportionately. CONCLUSIONS Upper limb dystonia distribution, focality, and task specificity relate to onset age and likelihood of regional spread. Observations may inform clinical counseling and design, execution, and interpretation of future studies. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Scott A Norris
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emmanuel Roze
- Sorbonne University, Inserm U 1127, National Centre for Scientific Research, Joint Research Units 7225, Institut du Cerveau et de la Moelle épinière and Assistance Public Hôpitaux de Paris, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark S LeDoux
- Department of Psychology and School of Health Studies, University of Memphis, Memphis, Tennessee, USA.,Veracity Neurosciences LLC, Memphis, Tennessee, USA
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, AP-HP, Paris, France.,Department of Neurology, Sorbonne Université, Paris, France.,Brain & Spine Institute, Joint Research Units 1127, INSERM 1127, Center National De Recherche Scientific 7235, Paris, France
| | - Claudia Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Irene A Malaty
- University of Florida Department of Neurology, Fixel Institute for Neurologic Diseases, Gainesville, Florida, USA
| | - Tobias Bäumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Laura J Wright
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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31
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Human brain connectivity: Clinical applications for clinical neurophysiology. Clin Neurophysiol 2020; 131:1621-1651. [DOI: 10.1016/j.clinph.2020.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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What Is New in Laryngeal Dystonia: Review of Novel Findings of Pathophysiology and Novel Treatment Options. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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33
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Maguire F, Reilly RB, Simonyan K. Normal Temporal Discrimination in Musician's Dystonia Is Linked to Aberrant Sensorimotor Processing. Mov Disord 2020; 35:800-807. [PMID: 31930574 PMCID: PMC7818836 DOI: 10.1002/mds.27984] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Alterations in sensory discrimination are a prominent nonmotor feature of dystonia. Abnormal temporal discrimination in focal dystonia is considered to represent its mediational endophenotype, albeit unclear pathophysiological correlates. We examined the associations between the visual temporal discrimination threshold (TDT) and brain activity in patients with musician's dystonia, nonmusician's dystonia, and healthy controls. METHODS A total of 42 patients and 41 healthy controls participated in the study. Between-group differences in TDT z scores were computed using inferential statistics. Statistical associations of TDT z scores with clinical characteristics of dystonia and resting-state functional brain activity were examined using nonparametric rank correlations. RESULTS The TDT z scores of healthy controls were significantly different from those of patients with nonmusician's dystonia, but not of patients with musician's dystonia. Healthy controls showed a significant relationship between normal TDT levels and activity in the inferior parietal cortex. This relationship was lost in all patients. Instead, TDT z scores in musician's dystonia established additional correlations with activity in premotor, primary somatosensory, ventral extrastriate cortices, inferior occipital gyrus, precuneus, and cerebellum, whereas nonmusician's dystonia showed a trending correlation in the lingual gyrus extending to the cerebellar vermis. There were no significant relationships between TDT z scores and dystonia onset, duration, or severity. CONCLUSIONS TDT assessment as an endophenotypic marker may only be relevant to nonmusician forms of dystonia because of the lack of apparent alterations in musician's dystonia. Compensatory adaptation of neural circuitry responsible for TDT processing likely adjusted the TDT performance to the behaviorally normal levels in patients with musician's dystonia, but not nonmusician's dystonia. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Fiachra Maguire
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Richard B. Reilly
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Kristina Simonyan
- Trinity Centre for Bioengineering, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Hanekamp S, Simonyan K. The large-scale structural connectome of task-specific focal dystonia. Hum Brain Mapp 2020; 41:3253-3265. [PMID: 32311207 PMCID: PMC7375103 DOI: 10.1002/hbm.25012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
The emerging view of dystonia is that of a large‐scale functional network disorder, in which the communication is disrupted between sensorimotor cortical areas, basal ganglia, thalamus, and cerebellum. The structural underpinnings of functional alterations in dystonia are, however, poorly understood. Notably, it is unclear whether structural changes form a larger‐scale dystonic network or rather remain focal to isolated brain regions, merely underlying their functional abnormalities. Using diffusion‐weighted imaging and graph theoretical analysis, we examined inter‐regional white matter connectivity of the whole‐brain structural network in two different forms of task‐specific focal dystonia, writer's cramp and laryngeal dystonia, compared to healthy individuals. We show that, in addition to profoundly altered functional network in focal dystonia, its structural connectome is characterized by large‐scale aberrations due to abnormal transfer of prefrontal and parietal nodes between neural communities and the reorganization of normal hub architecture, commonly involving the insula and superior frontal gyrus in patients compared to controls. Other prominent common changes involved the basal ganglia, parietal and cingulate cortical regions, whereas premotor and occipital abnormalities distinctly characterized the two forms of dystonia. We propose a revised pathophysiological model of focal dystonia as a disorder of both functional and structural connectomes, where dystonia form‐specific abnormalities underlie the divergent mechanisms in the development of distinct clinical symptomatology. These findings may guide the development of novel therapeutic strategies directed at targeted neuromodulation of pathophysiological brain regions for the restoration of their structural and functional connectivity.
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Affiliation(s)
- Sandra Hanekamp
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristina Simonyan
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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35
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Thirugnanasambandam N, Zimmerman T, Pillai AS, Shields J, Horovitz SG, Hallett M. Task-specific interhemispheric hypoconnectivity in writer's cramp - An EEG study. Clin Neurophysiol 2020; 131:985-993. [PMID: 32193164 DOI: 10.1016/j.clinph.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Writer's cramp (WC) is a focal task-specific dystonia characterized by abnormal posturing of the hand muscles during handwriting, but not during other tasks that involve the same set of muscles and objects such as sharpening a pencil. Our objective was to investigate the pathophysiology underlying the task specificity of this disorder using EEG. We hypothesized that premotor-parietal connectivity will be lower in WC patients specifically during handwriting and motor imagery of handwriting. METHODS We recruited 15 WC patients and 15 healthy controls. EEG was recorded while participants performed 4 tasks - writing with a pencil, sharpening a pencil, imagining writing and imagining sharpening. We determined the connectivity changes between relevant brain regions during these tasks. RESULTS We found reduced interhemispheric alpha coherence in the sensorimotor areas in WC patients exclusively during handwriting. WC patients also showed less reduction of task-related beta spectral power and a trend for reduced premotor-parietal coherence during motor tasks. CONCLUSION We could not confirm an abnormality in premotor-parietal connectivity specific to handwriting by this method. However, there was a task-specific reduction in interhemispheric alpha connectivity in WC patients, whose behavioral correlate remains unknown. SIGNIFICANCE Interhemispheric alpha connectivity can be a potential interventional target in WC.
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Affiliation(s)
| | - Tyler Zimmerman
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA; The Catholic University of America, Washington D.C., USA
| | - Ajay S Pillai
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Jessica Shields
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA; Louisiana State University School of Medicine at New Orleans, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
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Thirugnanasambandam N, Leodori G, Popa T, Kassavetis P, Mandel A, Shaft A, Kee J, Kashyap S, Khodorov G, Hallett M. Parietal conditioning enhances motor surround inhibition. Brain Stimul 2019; 13:447-449. [PMID: 31879086 PMCID: PMC8214400 DOI: 10.1016/j.brs.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Motor surround inhibition (mSI) is a phenomenon supportive for executing selective finger movements, wherein synergist muscles are selectively facilitated while surround muscles are inhibited. Previous studies of conditioning inputs to several intracortical and cortico-cortical inhibitory networks did not show an influence on mSI. The inhibitory posterior parietal-motor network, which is crucial for executing fine movements, however, has not been studied. OBJECTIVE/HYPOTHESIS To investigate the role of inhibitory posterior parietal-motor network in mSI. We hypothesized that conditioning this inhibitory network would enhance mSI. METHODS 11 healthy adults completed study. mSI was elicited by applying a TMS pulse over the motor cortex coupled with or without a conditioning input to an inhibitory spot in the posterior parietal cortex at 2 or 4 ms interval. RESULTS Conditioning input to the posterior parietal cortex increased mSI by ∼20% CONCLUSION: The inhibitory posterior parietal-motor network appears to contribute to the genesis of mSI.
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Affiliation(s)
- Nivethida Thirugnanasambandam
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA
| | | | - Traian Popa
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA
| | - Panagiotis Kassavetis
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA
| | - Alexandra Mandel
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA; The George Washington University, Washington, D.C, USA
| | - Alexander Shaft
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA; University of Nevada School of Medicine, Reno, NV, USA
| | - Jaron Kee
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA; University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sarung Kashyap
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA
| | - Gregg Khodorov
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA; The George Washington University, Washington, D.C, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, USA.
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Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update. II. Hyperkinetic disorders. J Neural Transm (Vienna) 2019; 126:997-1027. [DOI: 10.1007/s00702-019-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
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