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Giorgi V, Apostolo G, Bertelè L. Treating Dystonia in a Soccer Player Through an Integrated Rehabilitative Approach: A Case Report. J Sport Rehabil 2024:1-11. [PMID: 38702050 DOI: 10.1123/jsr.2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 05/06/2024]
Abstract
CONTEXT Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined. CASE PRESENTATION We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely. MANAGEMENT AND OUTCOMES An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer. CONCLUSIONS This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations.
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Affiliation(s)
- Valeria Giorgi
- Rehabilitation Center, Apostolo Foundation, Merate, Italy
- Unità di Ricerca Clinica, Gruppo Ospedaliero Moncucco, Lugano, Switzerland
| | | | - Laura Bertelè
- Rehabilitation Center, Apostolo Foundation, Merate, Italy
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Nijenhuis B, van Wensen E, Smit M, van Zutphen T, Zwerver J, Tijssen M. Treatment of task-specific dystonia in sports: A systematic review. Clin Park Relat Disord 2024; 10:100245. [PMID: 38456155 PMCID: PMC10918566 DOI: 10.1016/j.prdoa.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/30/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Task specific dystonia is a movement disorder only affecting a highly practiced skill and is found in a broad set of expert movements including in sports. Despite affecting many sports, there is no comprehensive review of treatment options, which is in contrast to better studied forms of task specific dystonia in musicians and writers. For this reason, studies involving an intervention to treat task specific dystonia in sports were systematically reviewed, with special attention for the quality of outcome measures. Methods The PICO systematic search strategy was employed on task-specific dystonia, and all synonyms. Inclusion criteria were peer reviewed published studies pertaining to sports, studies with a measurement and/or intervention in TSD, all in English. We excluded abstracts, expert opinions, narrative review articles, unpublished studies, dissertations and studies exclusively relating to choking. We included case reports, case studies and case-control studies. Results In April 2022 Pubmed, Embase, Web of Science, and Psychinfo were searched. Of the 7000 articles identified, 31 were included that described psychological and invasive and/or pharmacological interventions. There was a lack of formal standardized outcome measures in studies resulting in low quality evidence for the effectiveness of treatment options. A descriptive synthesis showed emotional regulation was effective, but was exclusively tried in golfers. Interventions like botulinum toxin or pharmacology had a similar effectiveness compared to studies in musicians dystonia, however there was almost no formal evidence for these treatments. Conclusion The quality of studies was low with a lack of standardized outcome measures. Future studies with larger cohorts and quantitative outcome measures are needed to improve understanding of treatments for task specific dystonia in athletes.
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Affiliation(s)
- B. Nijenhuis
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - E. van Wensen
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn and Sports Dystonia Centre, Apeldoorn, The Netherlands
| | - M. Smit
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T. van Zutphen
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - J. Zwerver
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Kawama K, Ikezawa J, Saitoh Y, Takahashi K. Focal task-specific hand dystonia related to esports in a rhythm gamer: A case report. Parkinsonism Relat Disord 2024; 119:105967. [PMID: 38171173 DOI: 10.1016/j.parkreldis.2023.105967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
Herein, we report a novel case of focal task-specific dystonia of the upper extremity that occurred in a 27-year-old man who presented with flexion of the left third, fourth, and fifth fingers exclusively during rhythm gameplay. Dystonia during electronic sports should be recognized as a new type of occupational dystonia.
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Affiliation(s)
- Kentaro Kawama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
| | - Jun Ikezawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
| | - Yuji Saitoh
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
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Tibben MI, van Wensen E, Nijenhuis B, Zwerver J. Is Behavioural Therapy a New Treatment Option for Task-Specific Dystonia in Athletes? A Case Series. Tremor Other Hyperkinet Mov (N Y) 2023; 13:16. [PMID: 37187797 PMCID: PMC10178567 DOI: 10.5334/tohm.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Background Task-specific dystonia is a movement disorder of the central nervous system characterized by focal involuntary spasms and muscle contractions, which can negatively affect performance of a specific task. It can affect a wide range of fine motor skills, also in athletes. Current management of task-specific dystonia includes mainly prescribing drugs, exercise therapy or botulinum injections to the affected muscles. Psychological interventions for athletes suffering from task-specific dystonia have not been described extensively so far. Methods We present a case-series of 4 different advanced skill-level athletes with suspected task-specific dystonia, which had a major impact on their performance. They all received treatment consisting of a combination of standardized behavioural therapy and relaxation techniques in the form of hypnosis in a total of 8 sessions in a 16-week time period. Results After treatment, all athletes returned to their original high level of sport performance without further symptoms of their suspected task-specific dystonia. Discussion Behavioural therapy in combination with a relaxation technique seems to be a safe and promising treatment for athletes with suspected task-specific dystonia. Further studies in a larger, preferably randomized controlled trial, are warranted to evaluate if this treatment strategy is effective in athletes with suspected task-specific dystonia.
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Affiliation(s)
- Marleen Ieke Tibben
- HSK Expertise Center Functional Movement Disorders, Woerden, The Netherlands
| | - Erik van Wensen
- Gelre Hospital & Sports Dystonia Centre, Apeldoorn, The Netherlands
| | | | - Johannes Zwerver
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen and Department Sports and Exercise Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
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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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Gupta N, Pandey S. Treatment of focal hand dystonia: current status. Neurol Sci 2021; 42:3561-3584. [PMID: 34213695 DOI: 10.1007/s10072-021-05432-7] [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: 04/26/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Focal hand dystonia (FHD) is usually adult-onset focal dystonia that can be associated with marked occupational and functional disability leading to reduced quality of life. METHODS Relevant studies on treatment options for FHD, their limitations, and current recommendations were reviewed using the PubMed search until March 31, 2021. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. RESULTS and conclusion Currently, botulinum toxin has the best evidence for treatment of FHD, and 20-90% of patients experience symptomatic improvement. However, its benefit is often limited by the reduction of muscle tonus acting on the muscle spindle. Different surgical modalities that have been used to treat focal hand dystonia include lesional surgery, deep brain stimulation, and magnetic resonance-guided focused ultrasound thalamotomy. Recent studies exploring the role of behavioral techniques, sensorimotor training, and neuromodulation for the treatment of focal hand dystonia have reported good outcomes, but larger studies are required before implementing these interventions in practice.
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Affiliation(s)
- Navnika Gupta
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, 110002, India.
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Modulation of sensorimotor cortical oscillations in athletes with yips. Sci Rep 2021; 11:10376. [PMID: 33990687 PMCID: PMC8121935 DOI: 10.1038/s41598-021-89947-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/05/2021] [Indexed: 02/05/2023] Open
Abstract
The yips, an involuntary movement impediment that affects performance in skilled athletes, is commonly described as a form of task-specific focal dystonia or as a disorder lying on a continuum with focal dystonia at one end (neurological) and chocking under pressure at the other (psychological). However, its etiology has been remained to be elucidated. In order to understand sensorimotor cortical activity associated with this movement disorder, we examined electroencephalographic oscillations over the bilateral sensorimotor areas during a precision force task in athletes with yips, and compared them with age-, sex-, and years of experience-matched controls. Alpha-band event-related desynchronization (ERD), that occurs during movement execution, was greater in athlete with yips as compared to controls when increasing force output to match a target but not when adjusting the force at around the target. Event-related synchronization that occurs after movement termination was also greater in athletes with yips. There was no significant difference in task performance between groups. The enhanced ERD is suggested to be attributed to dysfunction of inhibitory system or increased allocation of attention to the body part used during the task. Our findings indicate that sensorimotor cortical oscillatory response is increased during movement initiation in athletes with yips.
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Asahi T, Taira T, Ikeda K, Horisawa S, Yamamoto J, Tsubono H, Sato S. Improvement of Writer's Cramp from an Old Lesion in the Contralateral Hemisphere with Transient Gait Disturbance After Thalamotomy. World Neurosurg 2019; 127:8-10. [PMID: 30928593 DOI: 10.1016/j.wneu.2019.03.199] [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: 02/11/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stereotactic ventro-oral thalamotomy has been performed in cases of focal task-specific dystonia, including writer's cramp, with excellent outcomes. However, no reports have revealed the outcome of ventro-oral thalamotomy in a patient with a contralateral cerebral lesion. We describe a patient with left-hand writer's cramp with an old lesion in the left hemisphere and transient gait disturbance after right ventro-oral thalamotomy. CASE DESCRIPTION A 43-year-old man had a hemorrhage in the left basal ganglia due to cerebral arteriovenous malformation at 22 years of age, and right hemiparesis remained as a sequela. He developed left-handed writing ability; however, he became aware of the stiffness of his left hand and difficulty in writing. Writer's cramp was diagnosed. Medical treatments were not effective, and right ventro-oral thalamotomy was performed. Although his writing ability improved, he could not walk. After performing rehabilitation, his walking completely improved, reaching the level before surgery, after 3 months, and his writer's cramp was completely cured. CONCLUSIONS In patients with basal nucleus lesions, gait disturbance may appear transiently after contralateral thalamotomy. It is crucial to fully explain the potential complications, particularly in relation to temporal gait disturbances, and obtain informed consent.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan.
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Kiyonobu Ikeda
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Jiro Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsubono
- Department of Medical Engineering, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shuji Sato
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
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Horisawa S, Ochiai T, Goto S, Nakajima T, Takeda N, Fukui A, Hanada T, Kawamata T, Taira T. Safety and long-term efficacy of ventro-oral thalamotomy for focal hand dystonia: A retrospective study of 171 patients. Neurology 2018; 92:e371-e377. [PMID: 30587520 PMCID: PMC6345121 DOI: 10.1212/wnl.0000000000006818] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To report the safety and long-term efficacy of ventro-oral thalamotomy for 171 consecutive patients with task-specific focal hand dystonia. Methods Between October 2003 and February 2017, 171 consecutive patients with task-specific focal hand dystonia underwent unilateral ventro-oral thalamotomy. Etiologies included writer's cramps (n = 92), musician's dystonias (n = 58), and other occupational task-related dystonias (n = 21). The task-specific focal hand dystonia scale was used to evaluate patients' neurologic conditions (range 1–5, high score indicated a better condition). The scores before surgery; at 1 week, 3 months, and 12 months postoperatively; and the last available follow-up period were determined. Postoperative complications and postoperative recurrence were also evaluated. Results The scores before surgery; at 1 week (1.72 ± 0.57, 4.33 ± 0.85 [p < 0.001]), 3 months (4.30 ± 1.06 [p < 0.001]), and 12 months (4.30 ± 1.13 [p < 0.001]); and the last available follow-up (4.39 ± 1.07 [p < 0.001]) postoperatively improved. The mean clinical follow-up period was 25.4 ± 32.1 months (range: 3–165). Permanent adverse events developed in 6 patients (3.5%). Eighteen patients developed recurrent dystonic symptoms postoperatively. Of these 18 patients, 9 underwent ventro-oral thalamotomy again, of which 7 achieved improvement. Conclusion Ventro-oral thalamotomy is a feasible and reasonable treatment for patients with refractory task-specific focal hand dystonias. Prospective, randomized, and blinded studies are warranted to clarify more accurate assessment of the safety and efficacy of ventro-oral thalamotomy for task-specific focal hand dystonia. Classification of evidence This study provides Class IV evidence that for patients with task-specific focal hand dystonia, ventro-oral thalamotomy improves dystonia.
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Affiliation(s)
- Shiro Horisawa
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Taku Ochiai
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Shinichi Goto
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takeshi Nakajima
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Nobuhiko Takeda
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Atsushi Fukui
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Tomoko Hanada
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takakazu Kawamata
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takaomi Taira
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan.
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