Aberrant Cerebello-Cortical Connectivity in Pianists With Focal Task-Specific Dystonia

Comparing level 1 and level 2 visuo-spatial perspective-taking in the brain: evidence from fMRI

Level 1 visuo-spatial perspective-taking (VSPT) refers to judging what other people can and cannot see. Previous research has suggested that this form of VSPT can be achieved relatively effortlessly. Level 2 VSPT, which refers to judgments about how an object appears from different viewpoints, is conceptually more complex and linked to higher-level social cognition and mentalizing. Despite growing neuroscientific evidence on VSPT, fMRI studies have not yet directly compared levels of perspective-taking. Study 1 collected fMRI data from a within-subject comparison of level 2 versus level 1 VSPT. We used a common activation contrast comparing inconsistent versus consistent perspectives between self and others. In Study 2, we further distinguished the brain regions associated with level 2 VSPT from those responsive to stimulus ambiguity and complexity. To achieve this, we asked participants to adopt different viewpoints on ambiguous and unambiguous stimuli. Results from both studies found that brain activation for level 2 VSPT was particularly high in areas of the dorsal attention network. Follow-up connectivity analysis found that level 2 VSPT is primarily carried out by the dorsal attention and the frontoparietal network. These results align with theories suggesting that VSPT can be achieved by engaging visuospatial attention and inhibitory control processes.

Increased functional connectivity of motor regions and dorsolateral prefrontal cortex in musicians with focal hand dystonia

BACKGROUND

Musician's dystonia is the most common form of focal task-specific dystonia and is suggested to be the result of dysfunctional communication among sensory-motor networks. Thus far, few functional connectivity studies have investigated musician's dystonia specifically, leaving its exact pathophysiological mechanisms unclear. The goal of this study was to verify connectivity findings from other task-specific dystonias on a large sample of musician's hand dystonia patients and to analyze associations with possible adverse childhood experiences, a suggested risk factor for dystonia.

METHODS

Forty professional musicians suffering from musician's hand dystonia and a matched control group of healthy musicians underwent resting-state functional magnetic resonance imaging and answered the childhood trauma questionnaire. Using a seed-to-whole brain approach, functional connectivity alterations between motor cortices, the prefrontal cortex, the basal ganglia and the thalamus were analyzed.

RESULTS

Musician's dystonia patients showed increased functional connectivity of the dorsolateral prefrontal cortex with the putamen and the pallidum, especially in right-side affected patients. Patients further displayed increased connectivity of the left thalamus and the right lateral premotor cortex. No associations between functional connectivity, duration of disorder and childhood adversity were observed.

CONCLUSION

The findings are consistent with previous research, highlighting the pathophysiological importance of the basal ganglia. Altered resting-state functional connectivity may reflect underlying neuroplastic changes in musicians with dystonia that lead to an altered flow of information, disrupting movement inhibition. Involvement of the dorsolateral prefrontal and premotor cortices further suggests that motor disturbances occur in the early planning phase of a movement. The findings indicate that a holistic re-training approach with and without the instrument could be beneficial for regaining motor control.

Gender Differences in Task Specific Dystonia: What Can we Learn from Musician's Dystonia?

BACKGROUND

Musician's Dystonia (MD) is a task specific, focal dystonia which usually occurs only at the instrument. The pathophysiology is not fully understood, but several risk factors like over-practice and genetic predisposition are known. Interestingly, 80% of those affected are men, which stands in contrast to the gender distribution in other focal dystonias, such as cervical dystonia.

OBJECTIVES

Our aim was to evaluate the difference in women and men with regard to risk factors leading to MD.

METHODS

We investigated known risk factors for MD in a large cohort of 364 MD patients by retrospectively collecting data on practice behavior and family history.

RESULTS

In line with previous studies, we found a ratio of ~4:1 men to women. Age at onset of MD was significantly lower in women; however, subsequent analysis revealed that it was a positive family history (FH+) and not gender that was associated with a lower age at onset. Furthermore, we found that those with negative family history had accumulated more practice time until onset of MD.

CONCLUSIONS

These results imply that the earlier age at onset in women did not depend on gender but was due to the higher proportion of a positive family history. In contrast, men were less likely to have a positive family history, suggesting that genetic factors may not be the primary reason for the higher prevalence of MD in men. Instead, differences in practice behaviors between men and women may contribute to this gender disparity.

The correlation between upper body grip strength and resting-state EEG network

Current research in the field of neuroscience primarily focuses on the analysis of electroencephalogram (EEG) activities associated with movement within the central nervous system. However, there is a dearth of studies investigating the impact of prolonged individual strength training on the resting state of the brain. Therefore, it is crucial to examine the correlation between upper body grip strength and resting-state EEG networks. In this study, coherence analysis was utilized to construct resting-state EEG networks using the available datasets. A multiple linear regression model was established to examine the correlation between the brain network properties of individuals and their maximum voluntary contraction (MVC) during gripping tasks. The model was used to predict individual MVC. The beta and gamma frequency bands showed significant correlation between RSN connectivity and MVC (p < 0.05), particularly in left hemisphere frontoparietal and fronto-occipital connectivity. RSN properties were consistently correlated with MVC in both bands, with correlation coefficients greater than 0.60 (p < 0.01). Additionally, predicted MVC positively correlated with actual MVC, with a coefficient of 0.70 and root mean square error of 5.67 (p < 0.01). The results show that the resting-state EEG network is closely related to upper body grip strength, which can indirectly reflect an individual's muscle strength through the resting brain network.

The functional anatomy of dystonia: Recent developments

While dystonia has traditionally been viewed as a disorder of the basal ganglia, the involvement of other key brain structures is now accepted. However, just what these structures are remains to be defined. Neuroimaging has been an especially valuable tool in dystonia, yet traditional cross-sectional designs have not been able to separate causal from compensatory brain activity. Therefore, this chapter discusses recent studies using causal brain lesions, and animal models, to converge upon the brain regions responsible for dystonia with increasing precision. This evidence strongly implicates the basal ganglia, thalamus, brainstem, cerebellum, and somatosensory cortex, yet shows that different types of dystonia involve different nodes of this brain network. Nearly all of these nodes fall within the recently identified two-way networks connecting the basal ganglia and cerebellum, suggesting dysfunction of these specific pathways. Localisation of the functional anatomy of dystonia has strong implications for targeted treatment options, such as deep brain stimulation, and non-invasive brain stimulation.

Peripherally-induced Movement Disorders: An Update

Background

Peripherally-induced movement disorders (PIMD) should be considered when involuntary or abnormal movements emerge shortly after an injury to a body part. A close topographic and temporal association between peripheral injury and onset of the movement disorders is crucial to diagnosing PIMD. PIMD is under-recognized and often misdiagnosed as functional movement disorder, although both may co-exist. Given the considerable diagnostic, therapeutic, and psychosocial-legal challenges associated with PIMD, it is crucial to update the clinical and scientific information about this important movement disorder.

Methods

A comprehensive PubMed search through a broad range of keywords and combinations was performed in February 2023 to identify relevant articles for this narrative review.

Results

The spectrum of the phenomenology of PIMD is broad and it encompasses both hyperkinetic and hypokinetic movements. Hemifacial spasm is probably the most common PIMD. Others include dystonia, tremor, parkinsonism, myoclonus, painful leg moving toe syndrome, tics, polyminimyoclonus, and amputation stump dyskinesia. We also highlight conditions such as neuropathic tremor, pseudoathetosis, and MYBPC1-associated myogenic tremor as examples of PIMD.

Discussion

There is considerable heterogeneity among PIMD in terms of severity and nature of injury, natural course, association with pain, and response to treatment. As some patients may have co-existing functional movement disorder, neurologists should be able to differentiate the two disorders. While the exact pathophysiology remains elusive, aberrant central sensitization after peripheral stimuli and maladaptive plasticity in the sensorimotor cortex, on a background of genetic (two-hit hypothesis) or other predisposition, seem to play a role in the pathogenesis of PIMD.

Embouchure Dystonia as a Network Disease

While the pathophysiology of embouchure dystonia, a sub-entity of musician's dystonia, is still not fully understood, recent research has shown that it involves alterations of several brain functions and networks. Maladaptive plasticity in sensorimotor integration, sensory perception, and deficient inhibitory mechanisms at cortical, subcortical, and spinal level seem to contribute to its pathophysiology. Furthermore, functional systems of the basal ganglia and the cerebellum are involved, clearly pointing toward a network disorder. We therefore propose a novel network model, based on electrophysiological and recent neuroimaging studies highlighting embouchure dystonia.

Sensorimotor Incoordination in Musicians' Dystonia

To acquire and maintain outstanding sensorimotor skills for playing musical instruments inevitably requires extensive training from childhood. However, on the way toward musical excellence, musicians sometimes develop serious disorders, such as tendinitis, carpal tunnel syndrome, and task-specific focal dystonia. Particularly, task-specific focal dystonia in musicians, which is referred to as musician's dystonia (MD), has no perfect cure and therefore often terminates professional careers of musicians. To better understand its pathological and pathophysiological mechanisms, the present article focuses on malfunctions of the sensorimotor system at the behavioral and neurophysiological levels. Based on emerging empirical evidence, we propose that the aberrant sensorimotor integration, possibly which occurs in both cortical and subcortical systems, underlies not only movement incoordination between the fingers (i.e., maladaptive synergy) but also failure of long-term retention of intervention effects in the patients with MD.

Precise motor rhythmicity relies on motor network responsivity

Rhythmic movements are the building blocks of human behavior. However, given that rhythmic movements are achieved through complex interactions between neural modules, it remains difficult to clarify how the central nervous system controls motor rhythmicity. Here, using a novel tempo-precision trade-off paradigm, we first modeled interindividual behavioral differences in tempo-dependent rhythmicity for various external tempi. We identified 2 behavioral extremes: conventional and paradoxical tempo-precision trade-off types. We then explored the neural substrates of these behavioral differences using task and resting-state functional magnetic resonance imaging. We found that the responsibility of interhemispheric motor network connectivity to tempi was a key to the behavioral repertoire. In the paradoxical trade-off type, interhemispheric connectivity was low at baseline but increased in response to increasing tempo; in the conventional trade-off type, strong baseline connectivity was coupled with low responsivity. These findings suggest that tunable interhemispheric connectivity underlies tempo-dependent rhythmicity control.

Impaired feedforward control of movements in pianists with focal dystonia

Learning accurate and fast movements typically accompanies the modulation of feedforward control. Nevertheless, it remains unclear how motor skill learning modulates feedforward control, such as through maladaptation of the sensorimotor system by extensive training (e.g., task-specific dystonia). Here, we examined the modulation of feedforward control through motor skill learning while focusing on the motion of piano playing at either a natural tempo or the fastest tempo. The current study compared the kinematics and keypress data among individuals in three groups: healthy and well-trained pianists (i.e., subjects with skill learning), non-musicians (i.e., subjects without skill learning), and patients with focal-hand dystonia (FHD) (i.e., subjects with maladaptation by skill learning). Compared to healthy pianists, patients with FHD showed impairment in some feedforward motion components that are relevant to classifying the two playing tempi. However, while focusing on motion components that are irrelevant to the tempo classification, patients with FHD showed movements comparable to those of healthy pianists. Furthermore, patients with FHD demonstrated significantly slower movement times than healthy pianists. Our results suggest that maladaptation by skill learning affects parts of feedforward control rather than its entirety. Nevertheless, the affected feedforward components are relevant to performing movements as fast as possible, which may underlie the speed dependence of dystonic symptoms.

Functional abnormalities in the cerebello-thalamic pathways in a mouse model of DYT25 dystonia

Dystonia is often associated with functional alterations in the cerebello-thalamic pathways, which have been proposed to contribute to the disorder by propagating pathological firing patterns to the forebrain. Here, we examined the function of the cerebello-thalamic pathways in a model of DYT25 dystonia. DYT25 (Gnal^+/−) mice carry a heterozygous knockout mutation of the Gnal gene, which notably disrupts striatal function, and systemic or striatal administration of oxotremorine to these mice triggers dystonic symptoms. Our results reveal an increased cerebello-thalamic excitability in the presymptomatic state. Following the first dystonic episode, Gnal^+/- mice in the asymptomatic state exhibit a further increase of the cerebello-thalamo-cortical excitability, which is maintained after θ-burst stimulations of the cerebellum. When administered in the symptomatic state induced by a cholinergic activation, these stimulations decreased the cerebello-thalamic excitability and reduced dystonic symptoms. In agreement with dystonia being a multiregional circuit disorder, our results suggest that the increased cerebello-thalamic excitability constitutes an early endophenotype, and that the cerebellum is a gateway for corrective therapies via the depression of cerebello-thalamic pathways.

Lateral Prefrontal Cortex Is a Hub for Music Production from Structural Rules to Movements

Complex sequential behaviors, such as speaking or playing music, entail flexible rule-based chaining of single acts. However, it remains unclear how the brain translates abstract structural rules into movements. We combined music production with multimodal neuroimaging to dissociate high-level structural and low-level motor planning. Pianists played novel musical chord sequences on a muted MR-compatible piano by imitating a model hand on screen. Chord sequences were manipulated in terms of musical harmony and context length to assess structural planning, and in terms of fingers used for playing to assess motor planning. A model of probabilistic sequence processing confirmed temporally extended dependencies between chords, as opposed to local dependencies between movements. Violations of structural plans activated the left inferior frontal and middle temporal gyrus, and the fractional anisotropy of the ventral pathway connecting these two regions positively predicted behavioral measures of structural planning. A bilateral frontoparietal network was instead activated by violations of motor plans. Both structural and motor networks converged in lateral prefrontal cortex, with anterior regions contributing to musical structure building, and posterior areas to movement planning. These results establish a promising approach to study sequence production at different levels of action representation.