2
|
Demİr T, Balal M, Demİrkİran M. The effect of cognitive task on postural stability in cervical dystonia. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:549-555. [PMID: 32609289 DOI: 10.1590/0004-282x20200038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cervical dystonia (CD) is the most common form of focal dystonia. It is not known exactly whether abnormal head postures in cervical dystonia cause balance problems. Dual-tasking is a common every-day life situation. OBJECTIVE We aimed to evaluate postural stability (PS) in patients with CD and the effect of cognitive task on PS. As a secondary aim, we evaluated the effect of onabotulinum toxin A (BoNT) injection on PS. METHODS A total of 24 patients with CD who were on BoNT treatment for at least one year and 23 healthy controls were included. Posturographic analyses were carried out in all the subjects on static posturography platform under four different conditions: eyes open, eyes closed, tandem stance and cognitive task. In patients, posturographic analysis was carried out just before the BoNT injections and was repeated four weeks later. RESULTS Before treatment, the anterior-posterior sway was significantly higher in CD patients with the eyes open condition compared to the controls (p=0.03). Cognitive task significantly affected several sway velocities. Tandem stance significantly affected many sway parameters, whereas the eyes closed condition did not. After treatment, only two parameters in tandem stance and one in cognitive task improved within the patient group, in a pairwise comparison. CONCLUSIONS Postural control is impaired in CD patients probably due to the impaired proprioceptive and sensorimotor integration. In reference to dual task theories possibly due to divided attention and task prioritization, cognitive dual-task and harder postural task disturbes the PS in these patients.
Collapse
Affiliation(s)
- Turgay Demİr
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey
| | - Mehmet Balal
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.,Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey
| | - Meltem Demİrkİran
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.,Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey
| |
Collapse
|
3
|
Avanzino L, Cherif A, Crisafulli O, Carbone F, Zenzeri J, Morasso P, Abbruzzese G, Pelosin E, Konczak J. Tactile and proprioceptive dysfunction differentiates cervical dystonia with and without tremor. Neurology 2020; 94:e639-e650. [PMID: 31937622 DOI: 10.1212/wnl.0000000000008916] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether different phenotypes of cervical dystonia (CD) express different types and levels of somatosensory impairment. METHODS We assessed somatosensory function in patients with CD with and without tremor (n = 12 each) and in healthy age-matched controls (n = 22) by measuring tactile temporal discrimination thresholds of the nondystonic forearm and proprioceptive acuity in both the dystonic (head/neck) and nondystonic body segments (forearm/hand) using a joint position-matching task. The head or the wrist was passively displaced along different axes to distinct joint positions by the experimenter or through a robotic exoskeleton. Participants actively reproduced the experienced joint position, and the absolute joint position-matching error between the target and the reproduced positions served as a marker of proprioceptive acuity. RESULTS Tactile temporal discrimination thresholds were significantly elevated in both CD subgroups compared to controls. Proprioceptive acuity of both the dystonic and nondystonic body segments was elevated in patients with CD and tremor with respect to both healthy controls and patients with CD without tremor. That is, tactile abnormalities were a shared dysfunction of both CD phenotypes, while proprioceptive dysfunction was observed in patients with CD with tremor. CONCLUSIONS Our findings suggest that the pathophysiology in CD can be characterized by 2 abnormal neural processes: a dysfunctional somatosensory gating mechanism involving the basal ganglia that triggers involuntary muscle spasms and abnormal processing of proprioceptive information within a defective corticocerebellar loop, likely affecting the feedback and feedforward control of head positioning. This dysfunction is expressed mainly in CD with tremor.
Collapse
Affiliation(s)
- Laura Avanzino
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis.
| | - Amel Cherif
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Oscar Crisafulli
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Federico Carbone
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Jacopo Zenzeri
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Pietro Morasso
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Giovanni Abbruzzese
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Elisa Pelosin
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| | - Jürgen Konczak
- From the Department of Experimental Medicine (L.A.), Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, Department of Informatics, Bioengineering, Robotics and System Engineering (A.C.), and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (O.C., F.C., G.A., E.P.), University of Genova; Ospedale Policlinico San Martino (L.A., E.P.), IRCCS; Robotics, Brain and Cognitive Sciences Department (A.C., J.Z., P.M.), Istituto Italiano di Tecnologia, Genoa, Italy; and Human Sensorimotor Control Laboratory (J.K.), Center for Clinical Movement Science and School of Kinesiology, University of Minnesota, Minneapolis
| |
Collapse
|