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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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Albanese A, Bhatia KP, Cardoso F, Comella C, Defazio G, Fung VSC, Hallett M, Jankovic J, Jinnah HA, Kaji R, Krauss JK, Lang A, Tan EK, Tijssen MAJ, Vidailhet M. Isolated Cervical Dystonia: Diagnosis and Classification. Mov Disord 2023; 38:1367-1378. [PMID: 36989390 PMCID: PMC10528915 DOI: 10.1002/mds.29387] [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: 12/20/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
This document presents a consensus on the diagnosis and classification of isolated cervical dystonia (iCD) with a review of proposed terminology. The International Parkinson and Movement Disorder Society Dystonia Study Group convened a panel of experts to review the main clinical and diagnostic issues related to iCD and to arrive at a consensus on diagnostic criteria and classification. These criteria are intended for use in clinical research, but also may be used to guide clinical practice. The benchmark is expert clinical observation and evaluation. The criteria aim to systematize the use of terminology as well as the diagnostic process, to make it reproducible across centers and applicable by expert and non-expert clinicians. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations, which are incorporated into the current criteria. Three iCD presentations are described in some detail: idiopathic (focal or segmental) iCD, genetic iCD, and acquired iCD. The relationship between iCD and isolated head tremor is also reviewed. Recognition of idiopathic iCD has two levels of certainty, definite or probable, supported by specific diagnostic criteria. Although a probable diagnosis is appropriate for clinical practice, a higher diagnostic level may be required for specific research studies. The consensus retains elements proven valuable in previous criteria and omits aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of iCD expands, these criteria will need continuous revision to accommodate new advances. © 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)
- Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL, Queen Square, Institute of Neurology, University College London, London, UK
| | - Francisco Cardoso
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cynthia Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, Bari, Italy
| | - Victor S C Fung
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, Australia
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Hyder A Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ryuji Kaji
- Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Eng King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie Vidailhet
- Department of Neurology, Sorbonne Université, Paris, France
- Institut du Cerveau et de la Moelle épinière-Inserm U1127, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Scott AB, Fahn S, Brin MF. Treatment of strabismus and blepharospasm with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32374. [PMID: 37499080 PMCID: PMC10374181 DOI: 10.1097/md.0000000000032374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Strabismus, deviation of the ocular alignment, can adversely affect quality of life and activities of daily living. Surgery was the prior standard of care for strabismus, but up to 40% of patients required additional surgeries. This need for more effective and less invasive treatment, along with the convergence of other events such as the development of electromyography, purification of botulinum toxin A, and the finding that injection of botulinum toxin type A could paralyze the hind limbs of chicks, led Dr. Alan Scott to investigate injection of his formulation for strabismus. The positive results of initial trials in monkeys segued to human trials with observations of alignment improvements and few adverse events. The success of botulinum toxin type A in the treatment of strabismus led to interest in its use to treat other skeletal muscles, particularly in blepharospasm, a type of focal dystonia involving eyelid spasms and involuntary eye closure that lacked an effective pharmacological treatment. Patient groups helped to increase awareness of this novel treatment, and results from clinical trials confirmed its effectiveness. Dr. Scott's formulation, then known as Oculinum, received its first Food and Drug Administration approvals in 1989 for strabismus and blepharospasm. Allergan acquired Oculinum in 1991, renaming it Botox. These initial uses led to its application in a myriad of other indications as outlined in other articles of this supplement.
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Affiliation(s)
- Alan B Scott
- Strabismus Research Foundation, San Francisco, CA, USA
| | | | - Mitchell F Brin
- Allergan/AbbVie, Irvine, CA, USA
- University of California, Irvine, CA, USA
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Killian O, Hutchinson M, Reilly R. Neuromodulation in Dystonia - Harnessing the Network. ADVANCES IN NEUROBIOLOGY 2023; 31:177-194. [PMID: 37338702 DOI: 10.1007/978-3-031-26220-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Adult-onset isolated focal dystonia (AOIFD) is a network disorder characterised by abnormalities of sensory processing and motor control. These network abnormalities give rise to both the phenomenology of dystonia and the epiphenomena of altered plasticity and loss of intracortical inhibition. Existing modalities of deep brain stimulation effectively modulate parts of this network but are limited both in terms of targets and invasiveness. Novel approaches using a variety of non-invasive neuromodulation techniques including transcranial stimulation and peripheral stimulation present an interesting alternative approach and may, in conjunction with rehabilitative strategies, have a role in tailored therapies targeting the underlying network abnormality behind AOIFD.
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Affiliation(s)
- Owen Killian
- The Dublin Neurological Institute, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.
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Kaji R. Direct cerebello-striatal loop in dystonia as a possible new target for deep brain stimulation: A revised view of subcortical pathways involved. Front Neurol 2022; 13:912818. [PMID: 36090883 PMCID: PMC9450946 DOI: 10.3389/fneur.2022.912818] [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: 04/04/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Dystonia is the second most common movement disorder next to tremor, but its pathophysiology remains unsettled. Its therapeutic measures include anti-cholingerics and other medications, in addition to botulinum neurotoxin injections, and stereotaxic surgery including deep brain stimulation (DBS), but there still remain a number of patients resistant to the therapy. Evidence has been accumulating suggesting that basal ganglia in association with the cerebellum are playing a pivotal role in pathogenesis. Clinical observations such as sensory tricks and the effects of muscle afferent stimulation and blockage suggest the conflict between the cortical voluntary motor plan and the subcortical motor program or motor subroutine controlling the intended action semi-automatically. In this review, the current understanding of the possible pathways or loops involved in dystonia is presented, and we review promising new targets for Deep Brain Stimulation (DBS) including the cerebellum.
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Affiliation(s)
- Ryuji Kaji
- Department of Clinical Neuroscience, Tokushima University, Tokushima, Japan
- National Hospital Organization Utano Hospital, Kyoto, Japan
- *Correspondence: Ryuji Kaji
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Sensory trick imagery as a potential adjunctive treatment in cervical dystonia – A preliminary study. Parkinsonism Relat Disord 2022; 102:77-78. [DOI: 10.1016/j.parkreldis.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
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Lagrand TJ, Almuwais A, Lehn AC. ‘Tricked’ sensory trick: a geste antagoniste in functional dystonia. BMJ Case Rep 2022; 15:15/7/e248779. [PMID: 35793856 PMCID: PMC9260767 DOI: 10.1136/bcr-2022-248779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A sensory trick, or geste antagoniste, is a manoeuvre used by patients with dystonia to ameliorate their dystonic movements or posturing. Typically, a sensory trick is a confirmatory clue indicating an organic nature of the dystonia. In this report, we present an extremely rare case of a sensory trick in a patient with functional dystonia.
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Affiliation(s)
- Tjerk J Lagrand
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ahmed Almuwais
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Alexander C Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Rosales RL, Cuffe L, Regnault B, Trosch RM. Pain in cervical dystonia: mechanisms, assessment and treatment. Expert Rev Neurother 2021; 21:1125-1134. [PMID: 34569398 DOI: 10.1080/14737175.2021.1984230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In patients with cervical dystonia (CD), pain is a major contributor to disability and social isolation and is often the main reason patients seek treatment. Surveys evaluating patient perceptions of their CD symptoms consistently highlight pain as a troublesome and disabling feature of their condition with significant impact on daily life and work. AREAS COVERED In this article, the authors review the epidemiology, assessment, possible mechanisms and treatment of pain in CD, including a meta-analysis of randomized controlled trial data with abobotulinumtoxinA. EXPERT OPINION Mechanisms of pain in CD may be muscle-based and non-muscle based. Accumulating evidence suggests that non-muscle-based mechanisms (such as abnormal transmission and processing of nociceptive stimuli, dysfunction of descending pain inhibitory pathways as well as structural and network changes in the basal ganglia, cortex and other areas) may also contribute to pain in CD alongside prolonged muscle contraction. Chemodenervation with botulinum toxin is considered the first-line treatment for CD. Treatment with botulinum toxin is usually effective, but optimization of the injection parameters should include consideration of pain as a core symptom in addition to the motor problems.
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Affiliation(s)
- Raymond L Rosales
- Dept. of Neurology and Psychiatry, the Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines.,The Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | | | | | - Richard M Trosch
- The Parkinson's and Movement Disorders Center, Farmington Hills, MI, USA
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Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins (Basel) 2021; 13:toxins13040282. [PMID: 33923397 PMCID: PMC8071570 DOI: 10.3390/toxins13040282] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia.
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Hao Q, Wang D, OuYang J, Ding H, Wu G, Liu Z, Liu R. Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features. J Neurol Neurosurg Psychiatry 2020; 91:1343-1348. [PMID: 33028603 DOI: 10.1136/jnnp-2020-323701] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/06/2020] [Accepted: 09/06/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study the efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) in refractory Meige syndrome (MS) and evaluate the psychiatric disorders before and after surgery. METHODS Twenty-two patients with MS treated with bilateral GPi-DBS were retrospectively analysed before surgery and after continuous neurostimulation. Before surgery, patients were assessed by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Self-Rating Depression Scale, Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PQSI), which corresponded to motor symptoms, depressive state, quality of life and sleep quality, respectively. The implantable pulse generator of each patient was activated at 1 month after surgery. At 1 month, 3 months, 6 months and 12 months after continuous neurostimulation, all patients were evaluated by the same scales above. RESULTS The BFMDRS movement scores decreased from 15.0±5.3 before surgery to 3.5±4.5 at 12 months after neurostimulation, with a mean improvement of 78% (p<0.001). The BFMDRS disability scores improved from 7.4±4.9 before surgery to 4.0±4.6 at 12 months after neurostimulation, with a mean improvement of 56% (p<0.001). The postoperative SF-36 scores had the remarkable improvement compared with baseline scores. Impaired sleep quality was found in 82% of patients and depression in 64% before surgery, which didn't neither obtained amelioration after continuous neurostimulation. CONCLUSIONS Bilateral pallidal neurostimulation is a beneficial therapeutic option for refractory MS, which could improve the motor symptoms except for depression and sleep quality.
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Affiliation(s)
- Qingpei Hao
- Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Dongliang Wang
- Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Jia OuYang
- Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Hu Ding
- Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Gaungyong Wu
- Neurosurgery, The Hospital of Shunyi District Beijing, Beijing, China
| | - Zhi Liu
- Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Ru'en Liu
- Neurosurgery, Peking University People's Hospital, Beijing, China
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Cisneros E, Stebbins GT, Chen Q, Vu JP, Benadof CN, Zhang Z, Barbano RL, Fox SH, Goetz CG, Jankovic J, Jinnah HA, Perlmutter JS, Adler CH, Factor SA, Reich SG, Rodriguez R, Severt LL, Stover NP, Berman BD, Comella CL, Peterson DA. It's tricky: Rating alleviating maneuvers in cervical dystonia. J Neurol Sci 2020; 419:117205. [PMID: 33160248 DOI: 10.1016/j.jns.2020.117205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate hypothesized sources of error when quantifying the effect of the sensory trick in cervical dystonia (CD) with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-2), test strategies to mitigate them, and provide guidance for future research on the sensory trick. METHODS Previous analyses suggested the sensory trick (or "alleviating maneuver", AM) item be removed from the TWSTRS-2 because of its poor clinimetric properties. We hypothesized three sources of clinimetric weakness for rating the AM: 1) whether patients were given sufficient time to demonstrate their AM; 2) whether patients' CD was sufficiently severe for detecting AM efficacy; and 3) whether raters were inadvertently rating the item in reverse of scale instructions. We tested these hypotheses with video recordings and TWSTRS-2 ratings by one "site rater" and a panel of five "video raters" for each of 185 Dystonia Coalition patients with isolated CD. RESULTS Of 185 patients, 23 (12%) were not permitted sufficient testing time to exhibit an AM, 23 (12%) had baseline CD too mild to allow confident rating of AM effect, and 1 site- and 1 video-rater each rated the AM item with a reverse scoring convention. When these confounds were eliminated in step-wise fashion, the item's clinimetric properties improved. CONCLUSIONS The AM's efficacy can contribute to measuring CD motor severity by addressing identified sources of error during its assessment and rating. Given the AM's sensitive diagnostic and potential pathophysiologic significance, we also provide guidance on modifications to how AMs can be assessed in future CD research.
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Affiliation(s)
- Elizabeth Cisneros
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America.
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - Qiyu Chen
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America.
| | - Jeanne P Vu
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Casey N Benadof
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Zheng Zhang
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America
| | - Richard L Barbano
- Department of Neurology, University of Rochester, 500 Joseph C. Wilson Blvd, Rochester, NY 14627, United States of America.
| | - Susan H Fox
- Movement Disorder Clinic, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States of America.
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, 1365 Clifton Rd building b suite 2200, Atlanta, GA 30322, United States of America.
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States of America; Departments of Radiology, Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States of America.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, United States of America.
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States of America.
| | - Stephen G Reich
- Department of Neurology, University of Maryland Medical Centre, 22 S Greene St, Baltimore, MD 21201, United States of America.
| | - Ramon Rodriguez
- UF Department of Neurology, 1149 Newell Dr, Gainesville, FL 32611, United States of America.
| | - Lawrence L Severt
- Department of Neurology, Beth Israel Medical Center, 529 W 42nd St # 6K, New York, NY 10036, United States of America
| | - Natividad P Stover
- Department of Neurology, The University of Alabama, Tuscaloosa, AL 35487, United States of America.
| | - Brian D Berman
- Department of Neurology, Virginia Commonwealth University, 1101 East Marshall Street, PO Box 980599, Richmond, VA 23298-0599, United States of America.
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America.
| | - David A Peterson
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States of America; CNL-S, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd, La Jolla, CA 92037, United States of America.
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De Meyer M, Vereecke L, Bottenberg P, Jacquet W, Sims AB, Santens P. Oral appliances in the treatment of oromandibular dystonia: a systematic review. Acta Neurol Belg 2020; 120:831-836. [PMID: 32594465 DOI: 10.1007/s13760-020-01404-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022]
Abstract
Oromandibular dystonia (OMD) is a clinically and etiologically heterogeneous form of focal dystonia with variable social and functional implications. The results of pharmacological treatment and botulinum toxin infiltrations are often unsatisfactory. We performed a systematic review on the effects of oral and dental appliances in patients with OMD. Most of the reports in the literature are single subject descriptions or small case series with a considerable variability in the type of dystonia, the type of evaluated appliances and in the outcome measures. Only one report included a large group of unselected patients that were evaluated with a mixture of outcome measures. Although it appears that a number of OMD patients, especially those who benefit from sensory tricks, may sustain some improvement with the use of oral appliances, no definitive conclusions can be drawn about the type of patients that may benefit, nor about the preferred type or mode of appliance. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of OMD patients that are clinically and diagnostically well characterized.
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Affiliation(s)
- Micheline De Meyer
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
- Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Lisa Vereecke
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Bottenberg
- Oral Health Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Oral Health Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Anthony B Sims
- The Maryland Center for Craniofacial, TMJ and Dental Sleep Disorders, Columbia, MD, USA
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Sarasso E, Agosta F, Piramide N, Bianchi F, Butera C, Gatti R, Amadio S, Del Carro U, Filippi M. Sensory trick phenomenon in cervical dystonia: a functional MRI study. J Neurol 2020; 267:1103-1115. [DOI: 10.1007/s00415-019-09683-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
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Khosravani S, Mahnan A, Yeh IL, Aman JE, Watson PJ, Zhang Y, Goding G, Konczak J. Laryngeal vibration as a non-invasive neuromodulation therapy for spasmodic dysphonia. Sci Rep 2019; 9:17955. [PMID: 31784618 PMCID: PMC6884515 DOI: 10.1038/s41598-019-54396-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023] Open
Abstract
Spasmodic dysphonia (SD) is an incurable focal dystonia of the larynx that impairs speech and communication. Vibro-tactile stimulation (VTS) alters afferent proprioceptive input to sensorimotor cortex that controls speech. This proof-of-concept study examined the effect of laryngeal VTS on speech quality and cortical activity in 13 SD participants who vocalized the vowel /a/ while receiving VTS for 29 minutes. In response to VTS, 9 participants (69%) exhibited a reduction of voice breaks and/or a meaningful increase in smoothed cepstral peak prominence, an acoustic measure of voice/speech quality. Symptom improvements persisted for 20 minutes past VTS. Application of VTS induced a significant suppression of theta band power over the left somatosensory-motor cortex and a significant rise of gamma rhythm over right somatosensory-motor cortex. Such suppression of theta oscillations is observed in patients with cervical dystonia who apply effective sensory tricks, suggesting that VTS in SD may activate a similar neurophysiological mechanism. Results of this feasibility study indicate that laryngeal VTS modulates neuronal synchronization over sensorimotor cortex, which can induce short-term improvements in voice quality. The effects of long-term VTS and its optimal dosage for treating voice symptoms in SD are still unknown and require further systematic study.
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Affiliation(s)
- Sanaz Khosravani
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minnesota, USA
| | - Arash Mahnan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minnesota, USA
| | - I-Ling Yeh
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minnesota, USA.,Department of Occupational Therapy, Singapore Institute of Technology, Singapore, Singapore
| | - Joshua E Aman
- Department of Neurology, University of Minnesota, Minnesota, USA
| | - Peter J Watson
- Department of Speech, Language, and Hearing Sciences, University of Minnesota, Minnesota, USA
| | - Yang Zhang
- Department of Speech, Language, and Hearing Sciences, University of Minnesota, Minnesota, USA
| | - George Goding
- Department of Otolaryngology, University of Minnesota, Minnesota, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minnesota, USA.
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Pandey S, Bhattad S. Sensory tricks. ANNALS OF MOVEMENT DISORDERS 2019. [DOI: 10.4103/aomd.aomd_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Marques PT, Germiniani FMB, Camargo CHF, Munhoz RP, Teive HAG. Édouard Brissaud: distinguished neurologist and Charcot's pupil. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:490-493. [PMID: 30066801 DOI: 10.1590/0004-282x20180063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/19/2018] [Indexed: 11/22/2022]
Abstract
Professor Charcot had several pupils in his famous neurological service at the Salpêtrière Hospital in Paris, France. Among them, Édouard Brissaud was one of Charcot's favorite pupils, temporarily becoming his successor after Charcot's death. Brissaud's neurological contributions were significant, including the description of hemifacial spasm, "geste antagoniste" in dystonia, pseudobulbar affect, post-traumatic stress disorder, the Brissaud-Sicard syndrome, and Brissaud's sign. Additionally, Brissaud was the first to suggest that Parkinson's disease pathology could be related to the substantia nigra.
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Affiliation(s)
- Paula Teixeira Marques
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Curitiba PR, Brasil
| | - Francisco Manoel Branco Germiniani
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Curitiba PR, Brasil
| | | | - Renato Puppi Munhoz
- University of Toronto, Toronto Western Hospital, Centre for Movement Disorders, Toronto, ON, Canada
| | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Curitiba PR, Brasil
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Disrupted superior collicular activity may reveal cervical dystonia disease pathomechanisms. Sci Rep 2017; 7:16753. [PMID: 29196716 PMCID: PMC5711841 DOI: 10.1038/s41598-017-17074-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/21/2017] [Indexed: 11/13/2022] Open
Abstract
Cervical dystonia is a common neurological movement disorder characterised by muscle contractions causing abnormal movements and postures affecting the head and neck. The neural networks underpinning this condition are incompletely understood. While animal models suggest a role for the superior colliculus in its pathophysiology, this link has yet to be established in humans. The present experiment was designed to test the hypothesis that disrupted superior collicular processing is evident in affected patients and in relatives harbouring a disease-specific endophenotype (abnormal temporal discrimination). The study participants were 16 cervical dystonia patients, 16 unaffected first-degree relatives with abnormal temporal discrimination, 16 unaffected first-degree relatives with normal temporal discrimination and 16 healthy controls. The response of participant’s superior colliculi to looming stimuli was assessed by functional magnetic resonance imaging. Cervical dystonia patients and relatives with abnormal temporal discrimination demonstrated (i) significantly reduced superior collicular activation for whole brain and region of interest analysis; (ii) a statistically significant negative correlation between temporal discrimination threshold and superior collicular peak values. Our results support the hypothesis that disrupted superior collicular processing is involved in the pathogenesis of cervical dystonia. These findings, which align with animal models of cervical dystonia, shed new light on pathomechanisms in humans.
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Platho-Elwischger K, Kranz G, Sycha T, Dunkler D, Rommer P, Mueller C, Auff E, Wiest G. Plasticity of static graviceptive function in patients with cervical dystonia. J Neurol Sci 2017; 373:230-235. [PMID: 28131194 DOI: 10.1016/j.jns.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten Platho-Elwischger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gottfried Kranz
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Daniela Dunkler
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna; Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Christian Mueller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gerald Wiest
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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The clinical phenomenology and associations of trick maneuvers in cervical dystonia. J Neural Transm (Vienna) 2015; 123:269-75. [PMID: 26645376 DOI: 10.1007/s00702-015-1488-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Sensory trick is an unusual clinical feature in cervical dystonia that attenuates disease symptoms by slight touch to a specific area of the face or head. Using a semi-quantitative questionnaire-based study of 197 patients with idiopathic cervical dystonia, we sought to determine probable pathophysiologic correlates, with the wider aim of examining its eventual clinical significance. The typical sensory trick, i.e., light touch, not necessitating the use of force leading to simple overpowering of dystonic activity, was present in 83 (42.1 %) patients. The vast majority of the patients required a specific sequence of sensorimotor inputs, including touch sensation on the face or different areas of the head, and also sensory and motor input of the hand itself. Deviations often led to a significant decrease in effectiveness and lack of expected benefit. Moreover, patients able to perform the maneuver reported compellingly higher subjective effect of botulinum toxin treatment (median 7 vs. 5 on a scale of 0-10; p < 0.0001) and lower depression score (median 10 vs. 14 on the Montgomery Åsberg Depression Rating scale; p < 0.001). Overall, the results point to marked disruption of sensorimotor networks in cervical dystonia. The mechanism of the sensory trick action may be associated with balancing the abnormal activation patterns by specific sensorimotor inputs. Its presence may be considered a positive predictive factor for responsiveness to botulinum toxin treatment.
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Broussolle E, Laurencin C, Bernard E, Thobois S, Danaila T, Krack P. Early Illustrations of Geste Antagoniste in Cervical and Generalized Dystonia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:332. [PMID: 26417535 PMCID: PMC4582593 DOI: 10.7916/d8kd1x74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/01/2015] [Indexed: 12/03/2022]
Abstract
Background Geste antagoniste, or sensory trick, is a voluntary maneuver that temporarily reduces the severity of dystonic postures or movements. We present a historical review of early reports and illustrations of geste antagoniste. Results In 1894, Brissaud described this phenomenon in Paris in patients with torticollis. He noted that a violent muscular contraction could be reversed by a minor voluntary action. He considered the improvement obtained by what he called “simple mannerisms, childish behaviour or fake pathological movements” was proof of the psychogenic origin of what he named mental torticollis. This concept was supported by photographical illustrations of the patients. The term geste antagoniste was used by Brissaud’s pupils, Meige and Feindel, in their 1902 monograph on movement disorders. Other reports and illustrations of this sign were published in Europe between 1894 and 1906. Although not mentioned explicitly, geste antagoniste was also illustrated in a case report of generalized dystonia in Oppenheim’s 1911 seminal description of dystonia musculorum deformans in Berlin. Discussion Brissaud-Meige’s misinterpretation of the geste antagoniste unfortunately anchored the psychogenic origin of dystonia for decades. In New York, Herz brought dystonia back into the realm of organic neurology in 1944. Thereafter, it was given prominence by other authors, notably Fahn and Marsden in the 1970–1980s. Nowadays, neurologists routinely investigate for geste antagoniste when a dystonic syndrome is suspected, because it provides a further argument in favor of dystonia. The term alleviating maneuver was proposed in 2014 to replace sensory trick or geste antagoniste. This major sign is now part of the motor phenomenology of the 2013 Movement Disorder Society’s classification of dystonia.
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Affiliation(s)
- Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Emilien Bernard
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Département de Psychiatrie et de Neurologie, Unité des Mouvements Anormaux, Centre Hospitalier Universitaire de Grenoble, Grenoble, France ; INSERM Unité 836, Grenoble Institut des Neurosciences, Grenoble, France ; Université Joseph Fourier, Grenoble, France
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Farag AM, Mier RW, Correa LP. Utilizing the concept of geste antagoniste for conservative management of oro-mandibular tardive dyskinesia: a case report and mini-review. Cranio 2015; 34:338-42. [PMID: 26293144 DOI: 10.1179/2151090315y.0000000022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This case report highlights the implication of the concept of "geste antagoniste" in conservatively managing oromotor dysfunction and its complications. CLINICAL PRESENTATION A 66-year-old female with a 1-year history of tardive dyskinesia (TD) was referred to the Craniofacial Pain Department (CPC) at Tufts University School of Dental Medicine for management of sore labial/lingual mucosa secondary to excessive daytime involuntary activity of the tongue, lips, and mandible. A detailed head/neck examination revealed excessive involuntary movements of the tongue, lips, and mandible with generalized tenderness of her masticatory muscles. No TMJ or bone pathology was evident in a panoramic radiograph. INTERVENTION A lower daytime appliance with bilateral posterior contacts was fabricated to protect her oral mucosa. On reevaluation, excessive movement of the jaw/tongue was significantly reduced with the presence of the appliance in her mouth. Face/neck muscle tenderness was also greatly reduced. CONCLUSION The use of oral appliance therapy in TD patients plays an important role in protecting the teeth/oral mucosa. The subsequent inhibition of excessive motor activity is proposed and should be further investigated.
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Affiliation(s)
- Arwa M Farag
- a Department of Maxillofacial Pathology, Oral Medicine and Orofacial Pain , Tufts University School of Dental Medicine , Boston , MA , USA.,b Department of Oral Medicine, Faculty of Dentistry , King AbdulAziz University , Saudi Arabia
| | - Robert W Mier
- a Department of Maxillofacial Pathology, Oral Medicine and Orofacial Pain , Tufts University School of Dental Medicine , Boston , MA , USA
| | - Leopoldo P Correa
- a Department of Maxillofacial Pathology, Oral Medicine and Orofacial Pain , Tufts University School of Dental Medicine , Boston , MA , USA
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Ghosh A, Rothwell J, Haggard P. Using voluntary motor commands to inhibit involuntary arm movements. Proc Biol Sci 2015; 281:20141139. [PMID: 25253453 DOI: 10.1098/rspb.2014.1139] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A hallmark of voluntary motor control is the ability to stop an ongoing movement. Is voluntary motor inhibition a general neural mechanism that can be focused on any movement, including involuntary movements, or is it mere termination of a positive voluntary motor command? The involuntary arm lift, or 'floating arm trick', is a distinctive long-lasting reflex of the deltoid muscle. We investigated how a voluntary motor network inhibits this form of involuntary motor control. Transcranial magnetic stimulation of the motor cortex during the floating arm trick produced a silent period in the reflexively contracting deltoid muscle, followed by a rebound of muscle activity. This pattern suggests a persistent generator of involuntary motor commands. Instructions to bring the arm down voluntarily reduced activity of deltoid muscle. When this voluntary effort was withdrawn, the involuntary arm lift resumed. Further, voluntary motor inhibition produced a strange illusion of physical resistance to bringing the arm down, as if ongoing involuntarily generated commands were located in a 'sensory blind-spot', inaccessible to conscious perception. Our results suggest that voluntary motor inhibition may be a specific neural function, distinct from absence of positive voluntary motor commands.
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Affiliation(s)
- Arko Ghosh
- Institute of Cognitive Neuroscience, University College London, London, UK Institute of Neuroinformatics, University of Zurich and ETH Zurich, Switzerland Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
| | - John Rothwell
- Institute of Neurology, University College London, London, UK
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
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Konczak J, Aman JE, Chen YW, Li KY, Watson PJ. Impaired Limb Proprioception in Adults With Spasmodic Dysphonia. J Voice 2015; 29:777.e17-23. [PMID: 25737471 DOI: 10.1016/j.jvoice.2014.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Focal dystonia of the head and neck are associated with a loss of kinesthetic acuity at muscles distant from the dystonic sites. That is, while the motor deficits in focal dystonia are confined, the associated somatosensory deficits are generalized. This is the first systematic study to examine, if patients diagnosed with spasmodic dystonia (SD) show somatosensory impairments similar in scope to other forms of focal dystonia. METHODS Proprioceptive acuity (ability to discriminate between two stimuli) for forearm position and motion sense was assessed in 14 spasmodic dystonia subjects and 28 age-matched controls using a passive motion apparatus. Psychophysical thresholds, uncertainty area (UA), and a proprioceptive acuity index (AI) were computed based on the subjects' verbal responses. RESULTS The main findings are as follows: first, the SD group showed significantly elevated thresholds and UAs for forearm position sense compared with the control group. Second, 9 of 14 dystonia subjects (64%) exhibited an AI for position sense above the control group maximum. Three SD subjects had a motion sense AI above the control group maximum. CONCLUSIONS The results indicate that impaired limb proprioception is a common feature of SD. Like other forms of focal dystonia, spasmodic dystonia does affect the somatosensation of nondystonic muscle systems. That is, SD is associated with a generalized somatosensory deficit.
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Affiliation(s)
- Jürgen Konczak
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, Minnesota.
| | - Joshua E Aman
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - Yu-Wen Chen
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Kuan-yi Li
- Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, Healthy Aging Center, Chang Gung University, Taoyuan, Taiwan
| | - Peter J Watson
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota
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Evinger CL. Animal Models of Focal Dystonia. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Frucht SJ. "Closing the loop" in cervical dystonia: a new clinical phenomenon. Tremor Other Hyperkinet Mov (N Y) 2014; 4:tre-04-283-6428-1. [PMID: 25610723 PMCID: PMC4284401 DOI: 10.7916/d8dz071r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/02/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The sensory trick or geste antagoniste is a cardinal feature of cervical dystonia. Patients are often aware of their tricks, using them to their advantage to temporarily improve dystonic symptoms. The typical sensory trick must be internally generated by the patient in order to be effective, and external mechanical pressure alone may not be sufficient. METHODS We present a case description. We present and demonstrate a new clinical phenomenon in patients with cervical dystonia, which we call "closing the loop". DISCUSSION We discuss the possible mechanisms underlying this finding.
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Affiliation(s)
- Steven J. Frucht
- Mount Sinai School of Medicine, New York, NY, USA,*To whom correspondence should be addressed. E-mail:
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Abstract
Sensory tricks are various manoeuvres that can ameliorate dystonia. Common characteristics are well known, but their variety is wide, sensory stimulation is not necessarily the critical feature, and their physiology is unknown. To enumerate the various forms of sensory tricks and describe their nature, research findings and theories that may elucidate their neurophysiologic mechanism, we reviewed the literature pertaining to sensory tricks, including variants like motor tricks, imaginary tricks, forcible tricks and reverse sensory tricks. On the basis of this information, we propose a new classification of sensory tricks to include its variants. We highlight neurophysiologic evidence suggesting that sensory tricks work by decreasing abnormal facilitation. We tie this with established dystonia pathogenesis and postulate that sensory tricks decrease abnormally increased facilitation to inhibition ratios in the dystonic brain. It appears worthwhile for patients to search for possible sensory tricks.
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Affiliation(s)
| | | | - Mark Hallett
- Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
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Patel N, Hanfelt J, Marsh L, Jankovic J. Alleviating manoeuvres (sensory tricks) in cervical dystonia. J Neurol Neurosurg Psychiatry 2014; 85:882-4. [PMID: 24828895 PMCID: PMC4871143 DOI: 10.1136/jnnp-2013-307316] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is limited information on the phenomenology, clinical characteristics and pathophysiology of alleviating manoeuvres (AM), also called 'sensory tricks' in cervical dystonia (CD). METHODS Individual data, collected from 10 sites participating in the Dystonia Coalition (http://clinicaltrials.gov/show/NCT01373424), included description of localisation and phenomenology of AM collected by systematic review of standardised video examinations. Analyses correlated demographic, neurologic, and psychiatric features of CD patients with or without effective AM. RESULTS Of 154 people studied, 138 (89.6%) used AM, of which 60 (43.4%) reported partial improvement, 55 (39.8%) marked improvement, and 4 (0.03%) no effect on dystonic posture. Light touch, usually to the lower face or neck, was used by >90%. The presence or location of AM did not correlate with the severity of the dystonia. CONCLUSIONS In this large and comprehensive study of CD, we found no clinical predictors of effective AM. Further studies of sensorimotor integration in dystonia are needed to better understand the pathophysiology of AM.
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Affiliation(s)
- Neepa Patel
- Department of Neurology and Neurotherapeutics, Center for Movement Disorders, University of Texas Southwestern, Dallas, Texas, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Laura Marsh
- Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Thiriez C, Gurruchaga JM, Goujon C, Fénelon G, Palfi S. Spinal stimulation for movement disorders. Neurotherapeutics 2014; 11:543-52. [PMID: 25015323 PMCID: PMC4121450 DOI: 10.1007/s13311-014-0291-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Epidural spinal cord stimulation (SCS) is currently proposed to treat intractable neuropathic pain. Since the 1970s, isolated cases and small cohorts of patients suffering from dystonia, tremor, painful leg and moving toes (PLMT), or Parkinson’s disease were also treated with SCS in the context of exploratory clinical studies. Despite the safety profile of SCS observed in these various types of movement disorders, the degree of improvement of abnormal movements following SCS has been heterogeneous among patients and across centers in open-label trials, stressing the need for larger, randomized, double-blind studies. This article provides a comprehensive review of both experimental and clinical studies of SCS application in movement disorders.
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Affiliation(s)
- Claire Thiriez
- />AP-HP, Department of Neurology, Groupe Hospitalier Henri Mondor, Créteil, France
| | | | - Colette Goujon
- />Department of Neurosurgery, Groupe Hospitalier Henri Mondor, Créteil, France
| | - Gilles Fénelon
- />AP-HP, Department of Neurology, Groupe Hospitalier Henri Mondor, Créteil, France
| | - Stéphane Palfi
- />Department of Neurosurgery, Groupe Hospitalier Henri Mondor, Créteil, France
- />Université Paris Est-Créteil, Faculté de Médecine, 94010 Créteil, Cedex France
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Abstract
Movement disorders, which include disorders such as Parkinson's disease, dystonia, Tourette's syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia. This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms. The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality. The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration. However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed.
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Affiliation(s)
- Neepa Patel
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
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Bova JA, Sergent AW. Chiropractic care using a functional neurologic approach for idiopathic cervical dystonia in a 59-year-old woman. J Chiropr Med 2013; 12:60-5. [PMID: 24294147 DOI: 10.1016/j.jcm.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/11/2013] [Accepted: 04/26/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the care and outcomes of a patient with cervical dystonia who was treated using chiropractic and other alternative medicine interventions. CLINICAL FEATURES A 59-year-old woman had an 11-year history of cervical dystonia. She had an uncontrollable 60° leftward head rotation upon shutting her eyes and had spasmodic contractions that caused fatigue. INTERVENTION AND OUTCOME The management consisted of blue-lensed glasses, vibration stimulation, spinal manipulation, and eye-movement exercises. Within the first week of treatment, she had a reduction in symptoms, which was documented using a functional numeric scale, and improved posture, which was assessed using measurements from her midsternal line to the center of her chin. CONCLUSION This patient with cervical dystonia responded to the use of conservative, nonpharmacological treatment procedures that consisted of chiropractic care using a functional neurologic approach aimed at improving her spasmodic contractions and function.
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Broussolle E, Trocello JM, Woimant F, Lachaux A, Quinn N. Samuel Alexander Kinnier Wilson. Wilson's disease, Queen Square and neurology. Rev Neurol (Paris) 2013; 169:927-35. [PMID: 24125461 DOI: 10.1016/j.neurol.2013.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 03/27/2013] [Accepted: 04/05/2013] [Indexed: 11/15/2022]
Abstract
This historical article describes the life and work of the British physician Samuel Alexander Kinnier Wilson (1878-1937), who was one of the world's greatest neurologists of the first half of the 20th century. Early in his career, Wilson spent one year in Paris in 1903 where he learned from Pierre-Marie at Bicêtre Hospital. He subsequently retained uninterrupted links with French neurology. He also visited in Leipzig the German anatomist Paul Flechsig. In 1904, Wilson returned to London, where he worked for the rest of his life at the National Hospital for the Paralysed and Epileptic (later the National Hospital for Nervous Diseases, and today the National Hospital for Neurology and Neurosurgery) in Queen Square, and also at Kings' College Hospital. He wrote on 'the old motor system and the new', on disorders of motility and muscle tone, on the epilepsies, on aphasia, apraxia, tics, and pathologic laughing and crying, and most importantly on Wilson's disease. The other objective of our paper is to commemorate the centenary of Wilson's most important work published in 1912 in Brain, and also in Revue Neurologique, on an illness newly recognized and characterized by him entitled "Progressive lenticular degeneration, a familial nervous disease associated with liver cirrhosis". He analyzed 12 clinical cases, four of whom he followed himself, but also four cases previously published by others and a further two that he considered in retrospect had the same disease as he was describing. The pathological profile combined necrotic damage in the lenticular nuclei of the brain and hepatic cirrhosis. This major original work is summarized and discussed in the present paper. Wilson not only delineated what was later called hepato-lenticular degeneration and Wilson's disease, but also introduced for the first time the terms extrapyramidal syndrome and extrapyramidal system, stressing the role of the basal ganglia in motility. The present historical work emphasizes the special contributions made by Wilson to the study of movement disorders, including akinesia and bradykinesia in Parkinson's disease, and their relation to basal ganglia pathology.
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Affiliation(s)
- E Broussolle
- Service de neurologie C, université Claude-Bernard-Lyon I, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France; CNRS UMR 5229, centre de neurosciences cognitives, 67, boulevard Pinel, 69675 Bron cedex, France.
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Konczak J, Abbruzzese G. Focal dystonia in musicians: linking motor symptoms to somatosensory dysfunction. Front Hum Neurosci 2013; 7:297. [PMID: 23805090 PMCID: PMC3691509 DOI: 10.3389/fnhum.2013.00297] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/05/2013] [Indexed: 11/29/2022] Open
Abstract
Musician's dystonia (MD) is a neurological motor disorder characterized by involuntary contractions of those muscles involved in the play of a musical instrument. It is task-specific and initially only impairs the voluntary control of highly practiced musical motor skills. MD can lead to a severe decrement in a musician's ability to perform. While the etiology and the neurological pathomechanism of the disease remain unknown, it is known that MD like others forms of focal dystonia is associated with somatosensory deficits, specifically a decreased precision of tactile and proprioceptive perception. The sensory component of the disease becomes also evident by the patients' use of “sensory tricks” such as touching dystonic muscles to alleviate motor symptoms. The central premise of this paper is that the motor symptoms of MD have a somatosensory origin and are not fully explained as a problem of motor execution. We outline how altered proprioceptive feedback ultimately leads to a loss of voluntary motor control and propose two scenarios that explain why sensory tricks are effective. They are effective, because the sensorimotor system either recruits neural resources normally involved in tactile-proprioceptive (sensory) integration, or utilizes a fully functioning motor efference copy mechanism to align experienced with expected sensory feedback. We argue that an enhanced understanding of how a primary sensory deficit interacts with mechanisms of sensorimotor integration in MD provides helpful insights for the design of more effective behavioral therapies.
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Affiliation(s)
- Jürgen Konczak
- Human Sensorimotor Control Laboratory, Center for Clinical Movement Science, School of Kinesiology, University of Minnesota Minneapolis, MN, USA
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