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Vogelnik Žakelj K, Trošt M, Tomše P, Petrović IN, Tomić Pešić A, Radovanović S, Kojović M. Zolpidem improves task-specific dystonia: A randomized clinical trial integrating exploratory transcranial magnetic stimulation and [18F] FDG-PET imaging. Parkinsonism Relat Disord 2024; 124:107014. [PMID: 38823169 DOI: 10.1016/j.parkreldis.2024.107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Task-specific dystonia (TSFD) is a disabling movement disorder. Effective treatment options are currently limited. Zolpidem was reported to improve primary focal and generalized dystonia in a proportion of patients. The mechanisms underlying its therapeutic effects have not yet been investigated. METHODS We conducted a randomized, double-blind, placebo-controlled, crossover trial of single-dose zolpidem in 24 patients with TSFD. Patients were clinically assessed using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Writers' Cramp Rating Scale (WCRS), and Visual Analogue Scale (VAS), before and after receiving placebo and zolpidem. Transcranial magnetic stimulation was conducted on placebo and zolpidem to compare corticospinal excitability - active and resting motor thresholds (AMT and RMT), resting and active input/output curves and intracortical excitability - cortical silent period (CSP), short-interval intracortical inhibition curve (SICI), long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF). Eight patients underwent brain FDG-PET imaging on zolpidem and placebo. RESULTS Zolpidem treatment improved TSFD. Zolpidem compared to placebo flattened rest and active input/output curves, reduced ICF and was associated with hypometabolism in the right cerebellum and hypermetabolism in the left inferior parietal lobule and left cingulum. Correlations were found between changes in dystonia severity on WCRS and changes in active input/output curve and in brain metabolism, respectively. Patients with lower RMT, and higher rest and active input/output curves exhibited better response to zolpidem compared to placebo. CONCLUSIONS Zolpidem improved TSFD by reducing corticomotor output and influencing crucial nodes in higher-order sensory and motor networks.
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Affiliation(s)
- Katarina Vogelnik Žakelj
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia
| | - Petra Tomše
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Igor N Petrović
- Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Saša Radovanović
- Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia.
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Tawfik HA, Dutton JJ. Debunking the Puzzle of Eyelid Apraxia: The Muscle of Riolan Hypothesis. Ophthalmic Plast Reconstr Surg 2023; 39:211-220. [PMID: 36136731 DOI: 10.1097/iop.0000000000002291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Apraxia of eyelid opening (AEO) has been defined by the presence of an intermittent nonparalytic bilateral loss of the volitional ability to open the eyes or to maintain the eyelids in a sustained elevated position. It is not known whether the condition represents an apraxia, a dystonia, or a freezing phenomenon, and several different nomenclatorial terms have been suggested for this condition including the so-called AEO (scAEO), blepahrocolysis, focal eyelid dystonia, and so on. The primary goal of this review is to attempt to clarify the pathogenetic mechanisms underlying scAEO as a clinical phenomenon. This review also addresses the issue of whether scAEO is part of the spectrum of blepharospasm (BSP) which includes BSP, dystonic blinks and other dystonic eyelid conditions, or whether it is a separate phenomenologically heterogeneous disease with clinical features that merely overlap with BSP. METHODS A literature review was conducted in PubMed, MEDLINE, PubMed Central (PMC), NCBI Bookshelf, and Embase for several related keywords including the terms "apraxia of eyelid opening," "pretarsal blepharospasm," "blepharocolysis," "eyelid freezing," "eyelid akinesia," "levator inhibition," "blepharospasm-plus," as well as "blepharospasm." The clinical findings in patients with scAEO who fulfilled the classic diagnostic criteria of the disease that were originally set by Lepore and Duvoisin were included, while patients with isolated blepharospasm or dystonic blinks (DB) were excluded. In addition, electromyographic (EMG) studies in patients with scAEO were reviewed in detail with special emphasis on studies that performed synchronous EMG recordings both from the levator muscle (LPS) and the pretarsal orbicularis oculi muscle (OO). RESULTS The apraxia designation is clearly a misnomer. Although scAEO behaves clinically as a hypotonic freezing phenomenon, it also shares several cardinal features with focal dystonias. The authors broadly categorized the EMG data into 3 different patterns. The first pattern (n = 26/94 [27.6%]) was predominantly associated with involuntary discharges in the OO muscle and has been termed pretarsal blepharospasm (ptBSP). The commonest pattern was pattern no. 2 (n = 53/94 [56.38%]), which was characterized by involuntary discharges in the OO muscle, together with a disturbed reciprocal innervation of the antagonist levator muscle and is dubbed disturbed reciprocal innervation (DRI). This EMG pattern is difficult to discern from the first pattern. Pattern no. 3 (n = 15/94 [15.9%]) is characterized by an isolated levator palpebrae inhibition (ILPI). This levator silence was observed alone without EMG evidence of contractions in the pretarsal orbicularis or a disturbed reciprocal relation of both muscles. CONCLUSION EMG evidence shows that the great majority (84%) of patients show a dystonic pattern, whereas ILPI (16%) does not fit the dystonic spectrum. The authors propose that a spasmodic contraction of the muscle of Riolan may be the etiological basis for levator inhibition in patients with ILPI. If this is true, all the 3 EMG patterns observed in scAEO patients (ptBSP, DRI, and ILPI) would represent an atypical form of BSP. The authors suggest coining the terms Riolan muscle BSP ( rmBSP ) for ILPI, and the term atypical focal eyelid dystonia ( AFED ) instead of the term scAEO, as both terms holistically encompass both the clinical and EMG data and concur with the authors' theorem.
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Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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Rafee S, Hutchinson M, Reilly R. The Collicular-Pulvinar-Amygdala Axis and Adult-Onset Idiopathic Focal Dystonias. ADVANCES IN NEUROBIOLOGY 2023; 31:195-210. [PMID: 37338703 DOI: 10.1007/978-3-031-26220-3_11] [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 idiopathic focal dystonias (AOIFD) are the most common type of dystonia. It has varied expression including multiple motor (depending on body part affected) and non-motor symptoms (psychiatric, cognitive and sensory). The motor symptoms are usually the main reason for presentation and are most often treated with botulinum toxin. However, non-motor symptoms are the main predictors of quality of life and should be addressed appropriately, as well as treating the motor disorder. Rather than considering AOIFD as a movement disorder, a syndromic approach should be taken, one that accommodates all the symptoms. Dysfunction of the collicular-pulvinar-amygdala axis, with the superior colliculus as a central node, can explain the diverse expression of this syndrome.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Reilly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland.
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Battistella G, Simonyan K. Clinical Implications of Dystonia as a Neural Network Disorder. ADVANCES IN NEUROBIOLOGY 2023; 31:223-240. [PMID: 37338705 DOI: 10.1007/978-3-031-26220-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Isolated dystonia is a neurological disorder of diverse etiology, multifactorial pathophysiology, and wide spectrum of clinical presentations. We review the recent neuroimaging advances that led to the conceptualization of dystonia as a neural network disorder and discuss how current knowledge is shaping the identification of biomarkers of dystonia and the development of novel pharmacological therapies.
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Affiliation(s)
- Giovanni Battistella
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
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Gombaut C, Holmes SA. Sensorimotor Integration and Pain Perception: Mechanisms Integrating Nociceptive Processing. A Systematic Review and ALE-Meta Analysis. Front Integr Neurosci 2022; 16:931292. [PMID: 35990591 PMCID: PMC9390858 DOI: 10.3389/fnint.2022.931292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Pain treatment services and clinical indicators of pain chronicity focus on afferent nociceptive projections and psychological markers of pain perception with little focus on motor processes. Research supports a strong role for the motor system both in terms of pain related disability and in descending pain modulation. However, there is little understanding of the neurological regions implicated in pain-motor interactions and how the motor and sensory systems interact under conditions of pain. We performed an ALE meta-analysis on two clinical cohorts with atypical sensory and motor processes under conditions of pain and no pain. Persons with sensory altered processing (SAP) and no pain presented with greater activity in the precentral and supplementary motor area relative to persons with self-reported pain. In persons with motor altered processing (MAP), there appeared to be a suppression of activity in key pain regions such as the insula, thalamus, and postcentral gyrus. As such, activation within the motor system may play a critical role in dampening pain symptoms in persons with SAP, and in suppressing activity in key pain regions of the brain in persons with MAP. Future research endeavors should focus on understanding how sensory and motor processes interact both to understand disability and discover new treatment avenues.
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Affiliation(s)
- Cindy Gombaut
- Pediatric Pain Pathway Lab, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- *Correspondence: Cindy Gombaut
| | - Scott A. Holmes
- Department of Anesthesia, Harvard Medical School, Boston, MA, United States
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Tomasino B, Valente M, Del Negro I, De Colle MC, Guarracino I, Maieron M, Gigli GL. Cortical activation and motor body representations in a patient with subacute sclerosing panencephalitis. Neuropsychologia 2022; 173:108299. [PMID: 35714969 DOI: 10.1016/j.neuropsychologia.2022.108299] [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: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
The current neuroimaging study investigated the sensorimotor maps during hand, feet and lips movements at one year after diagnosis of of subacute sclerosing panencephalitis (SSPE) in a 17 years-old patient. A lesion prediction algorithm showed that the posterior thalamic radiations, the splenium of the corpus callosum, the posterior and superior corona radiate, and the cingolum, showed a high lesion probability. Comparing the fMRI activations of the left and right hemisphere, we found that the representation of the left hand movement was more inferior/anterior and less represented than the representation of the right one; and the representation of the right foot movement was more superior, less represented than the representation of the left one and poorly activated at the predefined statistical threshold. The fMRI results are in line with the clinical report, describing an asymmetrical distribution of the periodic stereotyped myoclonic jerks, which mainly occurred for the left arm/hand and for the right leg/foot. This is the first fMRI study investigating the representation of the body parts in patients with SSPE. Results show that in SSPE the hyper-stimulation of the motor system (dedicated to the arm/hand and leg/foot more involved by the occurrence of the jerks) is accompanied by an under-activation of the corresponding motor representations in coincidence with voluntary movements.
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Affiliation(s)
- Barbara Tomasino
- Scientific Institute IRCCS "Eugenio Medea", Polo FVG, Pasian di Prato, UD, Italy.
| | - Mariarosaria Valente
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy; Neurology Unit, Department of Medicine (DAME), University of Udine, Italy
| | - Ilaria Del Negro
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Maria Cristina De Colle
- Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Ilaria Guarracino
- Scientific Institute IRCCS "Eugenio Medea", Polo FVG, Pasian di Prato, UD, Italy
| | - Marta Maieron
- Medical Physics, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy; Neurology Unit, Department of Medicine (DAME), University of Udine, Italy
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Low-frequency oscillations in cortical level to help diagnose task-specific dystonia. Neurobiol Dis 2021; 157:105444. [PMID: 34265424 DOI: 10.1016/j.nbd.2021.105444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/20/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Task-specific dystonia is a neurological movement disorder that abnormal contractions of muscles result in the twisting of fixed postures or muscle spasm during specific tasks. Due to the rareness and the pathophysiology of the disease, there is no test to confirm the diagnosis of task-specific dystonia, except comprehensive observations by the experts. Evidence from neural electrophysiological data suggests that enhanced low frequency (4-12 Hz) oscillations in the subcortical structure of the globus pallidus were associated with the pathological abnormalities concerning β and γ rhythms in motor areas and motor cortical network in patients with task-specific dystonia. However, whether patients with task-specific dystonia have any low-frequency abnormalities in motor cortical areas remains unclear. In this study, we hypothesized that low-frequency abnormalities are present in core motor areas and motor cortical networks in patients with task-specific dystonia during performing the non-symptomatic movements and those low-frequency abnormalities can help the diagnosis of this disease. We tested this hypothesis by using EEG, effective connectivity analysis, and a machine learning method. Fifteen patients with task-specific dystonia and 15 healthy controls were recruited. The machine learning method identified 8 aberrant movement-related network connections concerning low frequency, β and γ frequencies, which enabled the separation of the data of patients from those of controls with an accuracy of 90%. Importantly, 7 of the 8 aberrant connections engaged the premotor area contralateral to the affected hand, suggesting an important role of the premotor area in the pathological abnormities. The patients exhibited significantly lower low frequency activities during the movement preparation and significantly lower β rhythms during movements compared with healthy controls in the core motor areas. Our findings of low frequency- and β-related abnormalities at the cortical level and aberrant motor network could help diagnose task-specific dystonia in the clinical setting, and the importance of the contralesional premotor area suggests its diagnostic potential for task-specific dystonia.
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8
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Perturbed Ca2+-dependent signaling of DYT2 hippocalcin mutant as mechanism of autosomal recessive dystonia. Neurobiol Dis 2019; 132:104529. [DOI: 10.1016/j.nbd.2019.104529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
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9
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Chirumamilla VC, Dresel C, Koirala N, Gonzalez-Escamilla G, Deuschl G, Zeuner KE, Muthuraman M, Groppa S. Structural brain network fingerprints of focal dystonia. Ther Adv Neurol Disord 2019; 12:1756286419880664. [PMID: 31798688 PMCID: PMC6859688 DOI: 10.1177/1756286419880664] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 09/10/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Focal dystonias are severe and disabling movement disorders of a still unclear origin. The structural brain networks associated with focal dystonia have not been well characterized. Here, we investigated structural brain network fingerprints in patients with blepharospasm (BSP) compared with those with hemifacial spasm (HFS), and healthy controls (HC). The patients were also examined following treatment with botulinum neurotoxin (BoNT). Methods: This study included matched groups of 13 BSP patients, 13 HFS patients, and 13 HC. We measured patients using structural-magnetic resonance imaging (MRI) at baseline and after one month BoNT treatment, at time points of maximal and minimal clinical symptom representation, and HC at baseline. Group regional cross-correlation matrices calculated based on grey matter volume were included in graph-based network analysis. We used these to quantify global network measures of segregation and integration, and also looked at local connectivity properties of different brain regions. Results: The networks in patients with BSP were more segregated than in patients with HFS and HC (p < 0.001). BSP patients had increased connectivity in frontal and temporal cortices, including sensorimotor cortex, and reduced connectivity in the cerebellum, relative to both HFS patients and HC (p < 0.05). Compared with HC, HFS patients showed increased connectivity in temporal and parietal cortices and a decreased connectivity in the frontal cortex (p < 0.05). In BSP patients, the connectivity of the frontal cortex diminished after BoNT treatment (p < 0.05). In contrast, HFS patients showed increased connectivity in the temporal cortex and reduced connectivity in cerebellum after BoNT treatment (p < 0.05). Conclusions: Our results show that BSP patients display alterations in both segregation and integration in the brain at the network level. The regional differences identified in the sensorimotor cortex and cerebellum of these patients may play a role in the pathophysiology of focal dystonia. Moreover, symptomatic reduction of hyperkinesia by BoNT treatment was associated with different brain network fingerprints in both BSP and HFS patients.
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Affiliation(s)
- Venkata C Chirumamilla
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Dresel
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience network (rmn), Johannes-Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
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Abstract
Dystonia is a neurological disorder characterized by involuntary, repetitive movements. Although the precise mechanisms of dystonia development remain unknown, the diversity of its clinical phenotypes is thought to be associated with multifactorial pathophysiology, which is linked not only to alterations of brain organization, but also environmental stressors and gene mutations. This chapter will present an overview of the pathophysiology of isolated dystonia through the lens of applications of major neuroimaging methodologies, with links to genetics and environmental factors that play a prominent role in symptom manifestation.
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Kita K, Rokicki J, Furuya S, Sakamoto T, Hanakawa T. Resting-state basal ganglia network codes a motor musical skill and its disruption From dystonia. Mov Disord 2018; 33:1472-1480. [PMID: 30277603 PMCID: PMC6220822 DOI: 10.1002/mds.27448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Musician's dystonia critically impacts professional musicians' careers as they may lose musical skills, which have been acquired through long and intensive training. Yet the pathophysiology of musician's dystonia and its link to the neural mechanisms supporting musical skills is poorly understood. We tested if resting‐state functional connectivity might reflect an aspect of musical skill linked to the pathophysiology of musician's dystonia. We also tested a second hypothesis that the region with altered resting‐state functional connectivity might be correlated with a quantitative measure of musical skills. Methods: We studied 21 patients with musician's dystonia affecting their hands and 34 healthy musicians, using resting‐state functional magnetic resonance imaging and behavioral assessment. We tested between‐group differences of resting‐state functional connectivity throughout the whole brain using independent component analysis. Results: We found abnormal basal ganglia resting‐state functional connectivity in the putamina of patients with musician's dystonia compared with those of healthy musicians (P = 0.035 corrected for multiple comparisons). We also found that the temporal precision of keystrokes was correlated with basal ganglia functional connectivity in the putamina of healthy pianists (r = 0.72, P = 0.0005), but not in pianists with musician's dystonia (r = −0.11, P = 0.64). Conclusions: We show that abnormalities of the putamen exist even at rest in musician's dystonia, whereas putaminal abnormality has previously been reported during a task. Moreover, basal ganglia resting‐state functional connectivity in the putamen represented training levels in healthy musicians, and its disruption was associated with musician's dystonia. This novel finding hints at the pathophysiological mechanisms by which musician's dystonia follows extensive musical training. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kahori Kita
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.,Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jaroslav Rokicki
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Psychology, University of Oslo, Oslo, Norway.,Department of Clinical Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinichi Furuya
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Musical Skill and Injury Center, Sophia University, Tokyo, Japan.,Sony Computer Science Laboratories, Tokyo, Japan
| | - Takashi Sakamoto
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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Berndt M, Li Y, Gora-Stahlberg G, Jochim A, Haslinger B. Impaired white matter integrity between premotor cortex and basal ganglia in writer's cramp. Brain Behav 2018; 8:e01111. [PMID: 30239158 PMCID: PMC6192408 DOI: 10.1002/brb3.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Writer's cramp (WC) as a focal hand dystonia is characterized by abnormal postures of the hand during writing. Impaired inhibition and maladaptive plasticity in circuits linking the basal ganglia and sensorimotor cortices have been described. In particular, a dysfunction of lateral premotor cortices has been associated with impaired motor control in WC. We applied diffusion tensor imaging to identify changes in white matter connectivity between premotor regions and important cortical and subcortical structures. METHODS Whole brain white matter tracts were reconstructed in 18 right-handed WC patients and 18 matched controls, using probabilistic fiber tracking. We restricted our analyses to left-hemispheric fibers between the middle frontal gyrus (MFG) and basal ganglia, thalamus, primary motor, and sensory cortex. Diffusion parameters (fractional anisotropy and linear anisotropy) were compared between both groups. RESULTS A significant reduction in fractional anisotropy values was shown for patients (mean ± SD: 0.37 ± 0.02) vs. controls (0.39 ± 0.03) regarding fibers between the left-sided MFG and the putamen (p < 0.05). The same applied for linear anisotropy values in this connection (p < 0.05). CONCLUSIONS Our results suggest an impaired structural connectivity between the left-hemispheric MFG and putamen with a loss of equally aligned fibers in WC patients. This could reflect a structural basis for functional findings interpreted as altered inhibition and plasticity, both within the premotor cortex and the basal ganglia, that at last lead to the clinical symptoms of WC.
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Affiliation(s)
- Maria Berndt
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Gina Gora-Stahlberg
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
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Dynamic causal modeling revealed dysfunctional effective connectivity in both, the cortico-basal-ganglia and the cerebello-cortical motor network in writers' cramp. NEUROIMAGE-CLINICAL 2018; 18:149-159. [PMID: 29868443 PMCID: PMC5984595 DOI: 10.1016/j.nicl.2018.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 12/25/2022]
Abstract
Writer's cramp (WC) is a focal task-specific dystonia characterized by sustained or intermittent muscle contractions while writing, particularly with the dominant hand. Since structural lesions rarely cause WC, it has been assumed that the disease might be caused by a functional maladaptation within the sensory-motor system. Therefore, our objective was to examine the differences between patients suffering from WC and a healthy control (HC) group with regard to the effective connectivity that describes causal influences one brain region exerts over another within the motor network. The effective connectivity within a network including contralateral motor cortex (M1), supplementary motor area (SMA), globus pallidus (GP), putamen (PU) and ipsilateral cerebellum (CB) was investigated using dynamic causal modeling (DCM) for fMRI. Eight connectivity models of functional motor systems were compared. Fifteen WC patients and 18 age-matched HC performed a sequential, five-element finger-tapping task with the non-dominant and non-affected left hand within a 3 T MRI-scanner as quickly and accurately as possible. The task was conducted in a fixed block design repeated 15 times and included 30 s of tapping followed by 30 s of rest. DCM identified the same model in WC and HC as superior for reflecting basal ganglia and cerebellar motor circuits of healthy subjects. The M1-PU, as well as M1-CB connectivity, was more strongly influenced by tapping in WC, but the intracortical M1-SMA connection was more facilitating in controls. Inhibiting influences originating from GP to M1 were stronger in controls compared to WC patients whereby facilitating influences the PU exerts over CB and CB exerts over M1 were not as strong. Although the same model structure explains the given data best, DCM confirms previous research demonstrating a malfunction in effective connectivity intracortically (M1-SMA) and in the cortico-basal ganglia circuitry in WC. In addition, DCM analysis demonstrates abnormal reciprocal excitatory connectivity in the cortico-cerebellar circuitry. These results highlight the dysfunctional cerebello-cortical as well as basalganglio-cortical interaction in WC. Effective connectivity in writer`s cramp differs under sequential finger movements. We found a deficient inhibitory pallido-cortical connectivity in writer`s cramp. We found a diverging effective connectivity in the cortico-cerebellar loop. We found a diverging effective connectivity in the cortico-basal ganglia pathway. Pathophysiological interaction between the cerebellum and the basal ganglia.
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Simonyan K, Cho H, Hamzehei Sichani A, Rubien-Thomas E, Hallett M. The direct basal ganglia pathway is hyperfunctional in focal dystonia. Brain 2017; 140:3179-3190. [PMID: 29087445 PMCID: PMC5841143 DOI: 10.1093/brain/awx263] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 12/22/2022] Open
Abstract
See Fujita and Eidelberg (doi:10.1093/brain/awx305) for a scientific commentary on this article. Focal dystonias are the most common type of isolated dystonia. Although their causative pathophysiology remains unclear, it is thought to involve abnormal functioning of the basal ganglia-thalamo-cortical circuitry. We used high-resolution research tomography with the radioligand 11C-NNC-112 to examine striatal dopamine D1 receptor function in two independent groups of patients, writer’s cramp and laryngeal dystonia, compared to healthy controls. We found that availability of dopamine D1 receptors was significantly increased in bilateral putamen by 19.6–22.5% in writer’s cramp and in right putamen and caudate nucleus by 24.6–26.8% in laryngeal dystonia (all P ≤ 0.009). This suggests hyperactivity of the direct basal ganglia pathway in focal dystonia. Our findings paralleled abnormally decreased dopaminergic function via the indirect basal ganglia pathway and decreased symptom-induced phasic striatal dopamine release in writer’s cramp and laryngeal dystonia. When examining topological distribution of dopamine D1 and D2 receptor abnormalities in these forms of dystonia, we found abnormal separation of direct and indirect pathways within the striatum, with negligible, if any, overlap between the two pathways and with the regions of phasic dopamine release. However, despite topological disorganization of dopaminergic function, alterations of dopamine D1 and D2 receptors were somatotopically localized within the striatal hand and larynx representations in writer’s cramp and laryngeal dystonia, respectively. This finding points to their direct relevance to disorder-characteristic clinical features. Increased D1 receptor availability showed significant negative correlations with dystonia duration but not its severity, likely representing a developmental endophenotype of this disorder. In conclusion, a comprehensive pathophysiological mechanism of abnormal basal ganglia function in focal dystonia is built upon upregulated dopamine D1 receptors that abnormally increase excitation of the direct pathway, downregulated dopamine D2 receptors that abnormally decrease inhibition within the indirect pathway, and weakened nigro-striatal phasic dopamine release during symptomatic task performance. Collectively, these aberrations of striatal dopaminergic function underlie imbalance between direct and indirect basal ganglia pathways and lead to abnormal thalamo-motor-cortical hyperexcitability in dystonia.
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Affiliation(s)
- Kristina Simonyan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hyun Cho
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Azadeh Hamzehei Sichani
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Estee Rubien-Thomas
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Mantel T, Meindl T, Li Y, Jochim A, Gora-Stahlberg G, Kräenbring J, Berndt M, Dresel C, Haslinger B. Network-specific resting-state connectivity changes in the premotor-parietal axis in writer's cramp. NEUROIMAGE-CLINICAL 2017; 17:137-144. [PMID: 29085775 PMCID: PMC5650679 DOI: 10.1016/j.nicl.2017.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/12/2017] [Accepted: 10/02/2017] [Indexed: 12/03/2022]
Abstract
Background Writer's cramp is a task-specific dystonia impairing writing and sometimes other fine motor tasks. Neuroimaging studies using manifold designs have shown varying results regarding the nature of changes in the disease. Objective To clarify and extend the knowledge of underlying changes by investigating functional connectivity (FC) in intrinsic connectivity networks with putative sensorimotor function at rest in an increased number of study subjects. Methods Resting-state functional magnetic resonance imaging with independent component analysis was performed in 26/27 writer's cramp patients/healthy controls, and FC within and between resting state networks with putative sensorimotor function was compared. Additionally, voxel-based morphometry was carried out on the subjects' structural images. Results Patients displayed increased left- and reduced right-hemispheric primary sensorimotor FC in the premotor-parietal network. Mostly bilaterally altered dorsal/ventral premotor FC, as well as altered parietal FC were observed within multiple sensorimotor networks and showed differing network-dependent directionality. Beyond within-network FC changes and reduced right cerebellar grey matter volume in the structural analysis, the positive between-network FC of the cerebellar network and the basal ganglia network was reduced. Conclusions Abnormal resting-state FC in multiple networks with putative sensorimotor function may act as basis of preexisting observations made during task-related neuroimaging. Further, altered connectivity between the cerebellar and basal ganglia network underlines the important role of these structures in the disease. Investigation of FC changes in various sensorimotor ICNs at rest in writer's cramp. We saw multiple, network-specific FC changes in primary/higher sensorimotor cortices. This may act as basis of the varying nature of sensorimotor changes during task-fMRI. Further, findings supporting disrupted cerebellar-basal ganglia interaction were made. An additional morphometric analysis demonstrated structural cerebellar abnormality.
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Key Words
- ADDS, arm dystonia disability scale
- BGN, basal ganglia network
- BOLD, blood oxygen level-dependent
- CN, cerebellar network
- CONTR, healthy controls
- Cerebellum
- Dystonia
- FC, functional connectivity
- FHD, focal hand dystonia
- FWHM, full width at half maximum
- FoV, field of view
- Functional connectivity
- GM, grey matter
- IC, independent component
- ICA, independent component analysis
- ICN, intrinsic connectivity network
- IPS, intraparietal sulcus
- M1, primary motor cortex
- PAT, writer's cramp patients
- PCA, principal component analysis
- PMd/v, dorsal/ventral premotor cortex
- PPN, premotor parietal network
- Premotor cortex
- ROI, region of interest
- Resting state
- S1, primary somatosensory cortex
- S2, secondary somatosensory cortex
- SM1, primary sensorimotor cortex
- SMA, supplementary motor area
- SMG, supramarginal gyrus
- SPC, superior parietal cortex
- TIV, total intracranial volume
- WC, writer's cramp
- WCRS, writer's cramp rating scale
- rsfMRI, resting state functional magnetic resonance imaging
- v/dSMN, ventral/dorsal sensorimotor network
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Tobias Meindl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Gina Gora-Stahlberg
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Jona Kräenbring
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany; Department of Psychiatry, Isar-Amper-Klinikum München-Ost, Vockestrasse 72, Haar, Germany
| | - Maria Berndt
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany
| | - Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany; Department of Neurology, Johannes Gutenberg University, School of Medicine, Langenbeckstrasse 1, Mainz, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, Munich, Germany.
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Haslinger B, Noé J, Altenmüller E, Riedl V, Zimmer C, Mantel T, Dresel C. Changes in resting-state connectivity in musicians with embouchure dystonia. Mov Disord 2016; 32:450-458. [PMID: 27911020 DOI: 10.1002/mds.26893] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/21/2016] [Accepted: 11/09/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Embouchure dystonia is a highly disabling task-specific dystonia in professional brass musicians leading to spasms of perioral muscles while playing the instrument. As they are asymptomatic at rest, resting-state functional magnetic resonance imaging in these patients can reveal changes in functional connectivity within and between brain networks independent from dystonic symptoms. METHODS We therefore compared embouchure dystonia patients to healthy musicians with resting-state functional magnetic resonance imaging in combination with independent component analyses. RESULTS Patients showed increased functional connectivity of the bilateral sensorimotor mouth area and right secondary somatosensory cortex, but reduced functional connectivity of the bilateral sensorimotor hand representation, left inferior parietal cortex, and mesial premotor cortex within the lateral motor function network. Within the auditory function network, the functional connectivity of bilateral secondary auditory cortices, right posterior parietal cortex and left sensorimotor hand area was increased, the functional connectivity of right primary auditory cortex, right secondary somatosensory cortex, right sensorimotor mouth representation, bilateral thalamus, and anterior cingulate cortex was reduced. Negative functional connectivity between the cerebellar and lateral motor function network and positive functional connectivity between the cerebellar and primary visual network were reduced. CONCLUSIONS Abnormal resting-state functional connectivity of sensorimotor representations of affected and unaffected body parts suggests a pathophysiological predisposition for abnormal sensorimotor and audiomotor integration in embouchure dystonia. Altered connectivity to the cerebellar network highlights the important role of the cerebellum in this disease. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bernhard Haslinger
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jonas Noé
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Eckart Altenmüller
- Institut für Musikphysiologie und Musikermedizin, Hochschule für Musik, Theater und Medien Hannover, Hannover, Germany
| | - Valentin Riedl
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Claus Zimmer
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Tobias Mantel
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Christian Dresel
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Ioannou CI, Furuya S, Altenmüller E. Objective Evaluation of Performance Stress in Musicians With Focal Hand Dystonia: A Case Series. J Mot Behav 2016; 48:562-572. [PMID: 27715491 DOI: 10.1080/00222895.2016.1161590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Five musicians suffering from focal dystonia participated in a pilot study that examined the feasibility of an experimental protocol designed to assess musicians' motor performance under stress. Electrocardiography, free cortisol levels, and subjective assessments were used to monitor alterations of the hypothalamic-pituitary-adrenal axis. As measures of motor outcome, temporal variability of finger movements and muscular cocontraction of the wrist flexor and extensor were assessed. Findings suggest that the specific experimental design could be successfully applied. Several methodological issues such as carryover effects, the use of free cortisol, the inclusion of a double baseline, and the classification of dystonic patients into stress responders and nonresponders are analyzed and discussed.
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Affiliation(s)
- Christos I Ioannou
- a Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media , Hanover , Germany
| | - Shinichi Furuya
- b Department of Information and Communication Science , Sophia University , Tokyo , Japan
| | - Eckart Altenmüller
- a Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media , Hanover , Germany
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Erro R, Hirschbichler ST, Ricciardi L, Ryterska A, Antelmi E, Ganos C, Cordivari C, Tinazzi M, Edwards MJ, Bhatia KP. Mental rotation and working memory in musicians' dystonia. Brain Cogn 2016; 109:124-129. [PMID: 27693997 DOI: 10.1016/j.bandc.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mental rotation of body parts engages cortical-subcortical areas that are actually involved in the execution of a movement. Musicians' dystonia is a type of focal hand dystonia that is grouped together with writer's cramp under the rubric of "occupational dystonia", but it is unclear to which extent these two disorders share common pathophysiological mechanisms. Previous research has demonstrated patients with writer's cramp to have deficits in mental rotation of body parts. It is unknown whether patients with musicians' dystonia would display similar deficits, reinforcing the concept of shared pathophysiology. METHODS Eight patients with musicians' dystonia and eight healthy musicians matched for age, gender and musical education, performed a number of tasks assessing mental rotation of body parts and objects as well as verbal and spatial working memories abilities. RESULTS There were no differences between patients and healthy musicians as to accuracy and reaction times in any of the tasks. CONCLUSIONS Patients with musicians' dystonia have intact abilities in mentally rotating body parts, suggesting that this disorder relies on a highly selective disruption of movement planning and execution that manifests only upon playing a specific instrument. We further demonstrated that mental rotation of body parts and objects engages, at least partially, different cognitive networks.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
| | - Stephanie T Hirschbichler
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Lucia Ricciardi
- Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Agata Ryterska
- School of Biological & Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Elena Antelmi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carla Cordivari
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Mark J Edwards
- Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
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Mantel T, Dresel C, Altenmüller E, Zimmer C, Noe J, Haslinger B. Activity and topographic changes in the somatosensory system in embouchure dystonia. Mov Disord 2016; 31:1640-1648. [PMID: 27273329 DOI: 10.1002/mds.26664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Embouchure dystonia is a highly disabling focal task-specific dystonia affecting professional brass players. OBJECTIVE This study was designed to analyze activity changes along with topographic representations in primary and nonprimary centers for somatosensory processing in patients with embouchure dystonia. METHODS We used event-related functional magnetic resonance imaging with automized tactile stimulation of dystonic (upper lip) and nondystonic (forehead and dorsal hand) body regions in 15 professional brass players with and without embouchure dystonia. Statistical analyses included whole-brain between-group comparisons of stimulation-induced activation and region-of-interest-based single patient analyses of topographic activation characteristics. RESULTS Affected musicians revealed increased stimulation-induced activity in contralateral primary and bilateral secondary somatosensory representations of dystonic and nondystonic body regions as well as in the cerebellum ipsilateral to the left dystonic upper lip. Changes of somatotopic organization with altered intracortical distances and between-group differences of the centers of representations were found in the right primary and the bilateral secondary somatosensory cortex and in the left cerebellum. Positional variability of dystonic and nondystonic body regions was reduced with an emphasis on face representations. CONCLUSIONS The present findings are supportive of the concept of an abnormal processing of somatosensory information in embouchure dystonia affecting multiple domains. The underlying neurophysiological mechanisms (eg, changes in inhibition, maladaptive plasticity, changes in baseline activity) remain unclear. The involvement of nondystonic body areas can be viewed in the context of possible compensation or an endophenotypic predisposition. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine, Hochschule für Musik, Theater und Medien Hannover, Hannover, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jonas Noe
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Waugh JL, Kuster JK, Levenstein JM, Makris N, Multhaupt-Buell TJ, Sudarsky LR, Breiter HC, Sharma N, Blood AJ. Thalamic Volume Is Reduced in Cervical and Laryngeal Dystonias. PLoS One 2016; 11:e0155302. [PMID: 27171035 PMCID: PMC4865047 DOI: 10.1371/journal.pone.0155302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dystonia, a debilitating movement disorder characterized by abnormal fixed positions and/or twisting postures, is associated with dysfunction of motor control networks. While gross brain lesions can produce secondary dystonias, advanced neuroimaging techniques have been required to identify network abnormalities in primary dystonias. Prior neuroimaging studies have provided valuable insights into the pathophysiology of dystonia, but few directly assessed the gross volume of motor control regions, and to our knowledge, none identified abnormalities common to multiple types of idiopathic focal dystonia. METHODS We used two gross volumetric segmentation techniques and one voxelwise volumetric technique (voxel based morphometry, VBM) to compare regional volume between matched healthy controls and patients with idiopathic primary focal dystonia (cervical, n = 17, laryngeal, n = 7). We used (1) automated gross volume measures of eight motor control regions using the FreeSurfer analysis package; (2) blinded, anatomist-supervised manual segmentation of the whole thalamus (also gross volume); and (3) voxel based morphometry, which measures local T1-weighted signal intensity and estimates gray matter density or volume at the level of single voxels, for both whole-brain and thalamus. RESULTS Using both automated and manual gross volumetry, we found a significant volume decrease only in the thalamus in two focal dystonias. Decreases in whole-thalamic volume were independent of head and brain size, laterality of symptoms, and duration. VBM measures did not differ between dystonia and control groups in any motor control region. CONCLUSIONS Reduced thalamic gross volume, detected in two independent analyses, suggests a common anatomical abnormality in cervical dystonia and spasmodic dysphonia. Defining the structural underpinnings of dystonia may require such complementary approaches.
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Affiliation(s)
- Jeff L. Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Child Neurology, Boston Children’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
- * E-mail:
| | - John K. Kuster
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Jacob M. Levenstein
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nikos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | | | - Lewis R. Sudarsky
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Hans C. Breiter
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Anne J. Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
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Ioannou CI, Furuya S, Altenmüller E. The impact of stress on motor performance in skilled musicians suffering from focal dystonia: Physiological and psychological characteristics. Neuropsychologia 2016; 85:226-36. [DOI: 10.1016/j.neuropsychologia.2016.03.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/19/2016] [Accepted: 03/23/2016] [Indexed: 01/21/2023]
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Obeso I, Cerasa A, Quattrone A. The Effectiveness of Transcranial Brain Stimulation in Improving Clinical Signs of Hyperkinetic Movement Disorders. Front Neurosci 2016; 9:486. [PMID: 26778947 PMCID: PMC4703824 DOI: 10.3389/fnins.2015.00486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/07/2015] [Indexed: 01/21/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a safe and painless method for stimulating cortical neurons. In neurological realm, rTMS has prevalently been applied to understand pathophysiological mechanisms underlying movement disorders. However, this tool has also the potential to be translated into a clinically applicable therapeutic use. Several available studies supported this hypothesis, but differences in protocols, clinical enrollment, and variability of rTMS effects across individuals complicate better understanding of efficient clinical protocols. The aim of this present review is to discuss to what extent the evidence provided by the therapeutic use of rTMS may be generalized. In particular, we attempted to define optimal cortical regions and stimulation protocols that have been demonstrated to maximize the effectiveness seen in the actual literature for the three most prevalent hyperkinetic movement disorders: Parkinson's disease (PD) with levodopa-induced dyskinesias (LIDs), essential tremor (ET) and dystonia. A total of 28 rTMS studies met our search criteria. Despite clinical and methodological differences, overall these studies demonstrated that therapeutic applications of rTMS to "normalize" pathologically decreased or increased levels of cortical activity have given moderate progress in patient's quality of life. Moreover, the present literature suggests that altered pathophysiology in hyperkinetic movement disorders establishes motor, premotor or cerebellar structures as candidate regions to reset cortico-subcortical pathways back to normal. Although rTMS has the potential to become a powerful tool for ameliorating the clinical outcome of hyperkinetic neurological patients, until now there is not a clear consensus on optimal protocols for these motor disorders. Well-controlled multicenter randomized clinical trials with high numbers of patients are urgently required.
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Affiliation(s)
- Ignacio Obeso
- Centro Integral en Neurociencias A. C. (CINAC), HM Hospitales – Puerta del Sur. MóstolesMadrid, Spain
- Center for Networked Biomedical Research on Neurodegenerative DiseasesMadrid, Spain
| | - Antonio Cerasa
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology - National Research CouncilGermaneto, Italy
| | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology - National Research CouncilGermaneto, Italy
- Neurology Unit, Institute of Neurology, University “Magna Graecia”Catanzaro, Italy
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Furuya S, Hanakawa T. The curse of motor expertise: Use-dependent focal dystonia as a manifestation of maladaptive changes in body representation. Neurosci Res 2015; 104:112-9. [PMID: 26689332 DOI: 10.1016/j.neures.2015.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 01/20/2023]
Abstract
Focal task-specific dystonia (FTSD) impairs not only motor dexterity, but also somatosensory perception involved in well-trained behavioral tasks. Occupations that carry a risk of developing FTSD include musician, writer, painter, surgeon, and golfer, which are characterized by repetitive and precise motor actions over a prolonged period. Behavioral studies have uncovered various undesirable effects of FTSD on sensorimotor functions, such as a loss of independent movement control, unintended muscular co-activation, awkward limb posture, and impairment of fine discrimination of tactile and proprioceptive sensations. Studies using neuroimaging and noninvasive brain stimulation techniques have related such sensorimotor malfunctions to maladaptive neuroplastic changes in the sensorimotor system, including the primary motor and somatosensory areas, premotor area, cerebellum, and basal ganglia. In this review, we summarize recent empirical findings regarding phenomenological and pathophysiological abnormalities associated with the development of FTSD. We particularly focused on maladaptive alterations of body representations underlying the degradation of fine motor control and somatosensory perception in FTSD patients.
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Affiliation(s)
- Shinichi Furuya
- Musical Skill and Injury Center (MuSIC), Sophia University, Japan; Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Japan.
| | - Takashi Hanakawa
- Musical Skill and Injury Center (MuSIC), Sophia University, Japan; Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Japan.
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Løkkegaard A, Herz DM, Haagensen BN, Lorentzen AK, Eickhoff SB, Siebner HR. Altered sensorimotor activation patterns in idiopathic dystonia-an activation likelihood estimation meta-analysis of functional brain imaging studies. Hum Brain Mapp 2015; 37:547-57. [PMID: 26549606 PMCID: PMC4738472 DOI: 10.1002/hbm.23050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 09/17/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022] Open
Abstract
Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. Functional neuroimaging studies have yielded abnormal task‐related sensorimotor activation in dystonia, but the results appear to be rather variable across studies. Further, study size was usually small including different types of dystonia. Here we performed an activation likelihood estimation (ALE) meta‐analysis of functional neuroimaging studies in patients with primary dystonia to test for convergence of dystonia‐related alterations in task‐related activity across studies. Activation likelihood estimates were based on previously reported regional maxima of task‐related increases or decreases in dystonia patients compared to healthy controls. The meta‐analyses encompassed data from 179 patients with dystonia reported in 18 functional neuroimaging studies using a range of sensorimotor tasks. Patients with dystonia showed bilateral increases in task‐related activation in the parietal operculum and ventral postcentral gyrus as well as right middle temporal gyrus. Decreases in task‐related activation converged in left supplementary motor area and left postcentral gyrus, right superior temporal gyrus and dorsal midbrain. Apart from the midbrain cluster, all between‐group differences in task‐related activity were retrieved in a sub‐analysis including only the 14 studies on patients with focal dystonia. For focal dystonia, an additional cluster of increased sensorimotor activation emerged in the caudal cingulate motor zone. The results show that dystonia is consistently associated with abnormal somatosensory processing in the primary and secondary somatosensory cortex along with abnormal sensorimotor activation of mesial premotor and right lateral temporal cortex. Hum Brain Mapp 37:547–557, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Annemette Løkkegaard
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Damian M. Herz
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Brian N. Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Anne K. Lorentzen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM‐1), Research Center JülichGermany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich‐Heine University DüsseldorfGermany
| | - Hartwig R. Siebner
- Department of NeurologyCopenhagen University Hospital BispebjergCopenhagenDenmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital HvidovreHvidovreDenmark
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Furuya S, Tominaga K, Miyazaki F, Altenmüller E. Losing dexterity: patterns of impaired coordination of finger movements in musician's dystonia. Sci Rep 2015; 5:13360. [PMID: 26289433 PMCID: PMC4542337 DOI: 10.1038/srep13360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/24/2015] [Indexed: 11/23/2022] Open
Abstract
Extensive training can bring about highly-skilled action, but may also impair motor dexterity by producing involuntary movements and muscular cramping, as seen in focal dystonia (FD) and tremor. To elucidate the underlying neuroplastic mechanisms of FD, the present study addressed the organization of finger movements during piano performance in pianists suffering from the condition. Principal component (PC) analysis identified three patterns of fundamental joint coordination constituting finger movements in both patients and controls. The first two coordination patterns described less individuated movements between the “dystonic” finger and key-striking fingers for patients compared to controls. The third coordination pattern, representing the individuation of movements between the middle and ring fingers, was evident during a sequence of strikes with these fingers in controls, which was absent in the patients. Consequently, rhythmic variability of keystrokes was more pronounced during this sequence of strikes for the patients. A stepwise multiple-regression analysis further identified greater variability of keystrokes for individuals displaying less individuated movements between the affected and striking fingers. The findings suggest that FD alters dexterous joint coordination so as to lower independent control of finger movements, and thereby degrades fine motor control.
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Affiliation(s)
- Shinichi Furuya
- Institute for Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Emmichplatz 1, Hanover, Germany 30175.,Department of Information and Communication Sciences, Sophia University, Tokyo, Japan, 1020081
| | - Kenta Tominaga
- Department of Engineering Science, Osaka University, Osaka, Japan, 5608531
| | - Fumio Miyazaki
- Department of Engineering Science, Osaka University, Osaka, Japan, 5608531
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Emmichplatz 1, Hanover, Germany 30175
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Avanzino L, Tinazzi M, Ionta S, Fiorio M. Sensory-motor integration in focal dystonia. Neuropsychologia 2015; 79:288-300. [PMID: 26164472 DOI: 10.1016/j.neuropsychologia.2015.07.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/04/2015] [Accepted: 07/07/2015] [Indexed: 01/24/2023]
Abstract
Traditional definitions of focal dystonia point to its motor component, mainly affecting planning and execution of voluntary movements. However, focal dystonia is tightly linked also to sensory dysfunction. Accurate motor control requires an optimal processing of afferent inputs from different sensory systems, in particular visual and somatosensory (e.g., touch and proprioception). Several experimental studies indicate that sensory-motor integration - the process through which sensory information is used to plan, execute, and monitor movements - is impaired in focal dystonia. The neural degenerations associated with these alterations affect not only the basal ganglia-thalamic-frontal cortex loop, but also the parietal cortex and cerebellum. The present review outlines the experimental studies describing impaired sensory-motor integration in focal dystonia, establishes their relationship with changes in specific neural mechanisms, and provides new insight towards the implementation of novel intervention protocols. Based on the reviewed state-of-the-art evidence, the theoretical framework summarized in the present article will not only result in a better understanding of the pathophysiology of dystonia, but it will also lead to the development of new rehabilitation strategies.
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Affiliation(s)
- Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, 16132 genoa, Italy
| | - Michele Tinazzi
- Department of Neurological and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Silvio Ionta
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Mirta Fiorio
- Department of Neurological and Movement Sciences, University of Verona, 37131 Verona, Italy.
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27
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Gallea C, Balas M, Bertasi E, Valabregue R, García-Lorenzo D, Coynel D, Bonnet C, Grabli D, Pélégrini-Issac M, Doyon J, Benali H, Roze E, Vidailhet M, Lehericy S. Increased cortico-striatal connectivity during motor practice contributes to the consolidation of motor memory in writer's cramp patients. NEUROIMAGE-CLINICAL 2015; 8:180-92. [PMID: 26106542 PMCID: PMC4473821 DOI: 10.1016/j.nicl.2015.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 01/19/2023]
Abstract
Sensorimotor representations of movements are created in the sensorimotor network through repeated practice to support successful and effortless performance. Writer's cramp (WC) is a disorder acquired through extensive practice of finger movements, and it is likely associated with the abnormal acquisition of sensorimotor representations. We investigated (i) the activation and connectivity changes in the brain network supporting the acquisition of sensorimotor representations of finger sequences in patients with WC and (ii) the link between these changes and consolidation of motor performance 24 h after the initial practice. Twenty-two patients with WC and 22 age-matched healthy volunteers practiced a complex sequence with the right (pathological) hand during functional MRI recording. Speed and accuracy were measured immediately before and after practice (day 1) and 24 h after practice (day 2). The two groups reached equivalent motor performance on day 1 and day 2. During motor practice, patients with WC had (i) reduced hippocampal activation and hippocampal-striatal functional connectivity; and (ii) overactivation of premotor-striatal areas, whose connectivity correlated with motor performance after consolidation. These results suggest that patients with WC use alternative networks to reach equiperformance in the acquisition of new motor memories.
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Key Words
- BA, Brodmann area
- CD, consolidation dependent
- CV-RT, coefficient of variation for reaction time
- DT1, dual task 1
- DT2, dual task 2
- FA, fractional anisotropy
- FHD, focal hand dystonia
- Focal dystonia
- HV, healthy volunteers
- Hippocampus
- LD, longitudinal diffusivity
- MRI
- Motor cortex
- PD, practice dependent
- PMd, dorsal premotor cortex
- PMv, ventral premotor cortex
- PPI, psychophysiological interaction
- RD, radial diffusivity
- Striatum
- WC, writer's cramp
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Affiliation(s)
- C Gallea
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
| | - M Balas
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France ; Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - E Bertasi
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France
| | - R Valabregue
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France
| | - D García-Lorenzo
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France
| | - D Coynel
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - C Bonnet
- Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Centre d'Investigation Clinique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - D Grabli
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Pélégrini-Issac
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - J Doyon
- Unité de Neuroimagerie Fonctionnelle et Département de Psychologie, Université de Montréal, Québec, Canada
| | - H Benali
- Laboratoire d'Imagerie NeuroFonctionnelle, Université Pierre et Marie Curie (UPMC Univ Paris 6), Inserm U678, Paris, France
| | - E Roze
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Vidailhet
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - S Lehericy
- Université Pierre et Marie Curie (UPMC Univ Paris 6), Institut du Cerveau et de la Moelle épinière - ICM, UMR-S975, Inserm, U975, CNRS, UMR 7225, Paris, France ; Centre de Neuroimagerie de Recherche, CENIR, Institut du Cerveau et de la Moelle épinière - ICM, Paris, France ; Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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28
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Tateya I, Omori K, Kojima H, Naito Y, Hirano S, Yamashita M, Ito J. Type II thyroplasty changes cortical activation in patients with spasmodic dysphonia. Auris Nasus Larynx 2015; 42:139-44. [PMID: 25199736 DOI: 10.1016/j.anl.2014.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Koichi Omori
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | | | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Juichi Ito
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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29
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Zeuner KE, Knutzen A, Granert O, Götz J, Wolff S, Jansen O, Dressler D, Hefter H, Hallett M, Deuschl G, van Eimeren T, Witt K. Increased volume and impaired function: the role of the basal ganglia in writer's cramp. Brain Behav 2015; 5:e00301. [PMID: 25642386 PMCID: PMC4309880 DOI: 10.1002/brb3.301] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The pathophysiology of writer's cramp, a task-specific dystonia, remains unclear. The objective of this study was to investigate the basal ganglia circuit and the cerebellum during a complex motor sequence learning task carried out with the nonaffected hand in writer's cramp patients. METHODS We applied structural and functional imaging in 22 writer's cramp patients and 28 matched controls using 3T MRI. With the asymptomatic left hand all participants learned a complex, sequential, five-element sequence-tapping task as accurately and quickly as possible. Functional imaging was measured during a repeated (15 times), fixed block design with tapping (30 sec) and rest (30 sec). Additionally, gray matter volume of the basal ganglia was analyzed using voxel-based morphometry (VBM). RESULTS While behavior was comparable between groups, after small volume correction the anterior part of the right putamen and the left globus pallidus exhibited reduced blood oxygen level-dependent (BOLD) activity in patients during the sequential finger-tapping task. VBM analysis showed larger gray matter volume bilateral in the posterior part of the putamen and globus pallidus. There were no group differences in the cerebellum. CONCLUSION The results indicate an impairment of anterior basal ganglia loops involved in producing complex sequential movements of the unaffected hand. These findings are in line with previous reports of reduced neuronal activity in the globus pallidus internus. Higher gray matter volume of the putamen and globus pallidus may stem from elevated activity of the direct pathway, which could reflect a compensatory phenomenon or a primary predisposition, that is, endophenotypic trait.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University Kiel, Germany
| | | | - Julia Götz
- Department of Neurology, Kiel University Kiel, Germany
| | - Stephan Wolff
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Olav Jansen
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School Hannover, Germany
| | - Harald Hefter
- Department of Neurology, University of Düsseldorf Düsseldorf, Germany
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland
| | | | | | - Karsten Witt
- Department of Neurology, Kiel University Kiel, Germany
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Karimi M, Perlmutter JS. The role of dopamine and dopaminergic pathways in dystonia: insights from neuroimaging. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:280. [PMID: 25713747 PMCID: PMC4314610 DOI: 10.7916/d8j101xv] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/03/2015] [Indexed: 12/14/2022]
Abstract
Background Dystonia constitutes a heterogeneous group of movement abnormalities, characterized by sustained or intermittent muscle contractions causing abnormal postures. Overwhelming data suggest involvement of basal ganglia and dopaminergic pathways in dystonia. In this review, we critically evaluate recent neuroimaging studies that investigate dopamine receptors, endogenous dopamine release, morphology of striatum, and structural or functional connectivity in cortico-basal ganglia-thalamo-cortical and related cerebellar circuits in dystonia. Method A PubMed search was conducted in August 2014. Results Positron emission tomography (PET) imaging offers strong evidence for altered D2/D3 receptor binding and dopaminergic release in many forms of idiopathic dystonia. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data reveal likely involvement of related cerebello-thalamo-cortical and sensory-motor networks in addition to basal ganglia. Discussion PET imaging of dopamine receptors or transmitter release remains an effective means to investigate dopaminergic pathways, yet may miss factors affecting dopamine homeostasis and related subcellular signaling cascades that could alter the function of these pathways. fMRI and DTI methods may reveal functional or anatomical changes associated with dysfunction of dopamine-mediated pathways. Each of these methods can be used to monitor target engagement for potential new treatments. PET imaging of striatal phosphodiesterase and development of new selective PET radiotracers for dopamine D3-specific receptors and Mechanistic target of rampamycin (mTOR) are crucial to further investigate dopaminergic pathways. A multimodal approach may have the greatest potential, using PET to identify the sites of molecular pathology and magnetic resonance methods to determine their downstream effects.
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Affiliation(s)
- Morvarid Karimi
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA ; Department of Radiology, Neurobiology, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
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31
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Kukke SN, de Campos AC, Damiano D, Alter KE, Patronas N, Hallett M. Cortical activation and inter-hemispheric sensorimotor coherence in individuals with arm dystonia due to childhood stroke. Clin Neurophysiol 2014; 126:1589-98. [PMID: 25499610 DOI: 10.1016/j.clinph.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dystonia is a disabling motor disorder often without effective therapies. To better understand the genesis of dystonia after childhood stroke, we analyzed electroencephalographic (EEG) recordings in this population. METHODS Resting spectral power of EEG signals over bilateral sensorimotor cortices (Powrest), resting inter-hemispheric sensorimotor coherence (Cohrest), and task-related changes in power (TRPow) and coherence (TRCoh) during wrist extension were analyzed in individuals with dystonia (age 20±3years) and healthy volunteers (age 17±5years). RESULTS Ipsilesional TRPow decrease was significantly lower in patients than controls during the more affected wrist task. Force deficits of the affected wrist correlated with reduced alpha TRPow decrease on the ipsilesional and not the contralesional hemisphere. Cohrest was significantly lower in patients than controls, and correlated with more severe dystonia and poorer hand function. Powrest and TRCoh were similar between groups. CONCLUSIONS The association between weakness and cortical activation during wrist extension highlights the importance of ipsilesional sensorimotor activation on function. Reduction of Cohrest in patients reflects a loss of inter-hemispheric connectivity that may result from structural changes and neuroplasticity, potentially contributing to the development of dystonia. SIGNIFICANCE Cortical and motor dysfunction are correlated in patients with childhood stroke and may in part explain the genesis of dystonia.
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Affiliation(s)
- Sahana N Kukke
- Biomedical Engineering Department, The Catholic University of America, USA; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA
| | | | - Diane Damiano
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, USA
| | - Katharine E Alter
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, USA; Mount Washington Pediatric Hospital, USA
| | - Nicholas Patronas
- Radiology Department, National Institutes of Health Clinical Center, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA.
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32
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Dresel C, Li Y, Wilzeck V, Castrop F, Zimmer C, Haslinger B. Multiple changes of functional connectivity between sensorimotor areas in focal hand dystonia. J Neurol Neurosurg Psychiatry 2014; 85:1245-52. [PMID: 24706945 DOI: 10.1136/jnnp-2013-307127] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Task-specific focal hand dystonia impairs the control of arm muscles during fine motor skills such as writing (writer's cramp (WC)). Functional imaging found abnormal task-related activation of sensorimotor areas in this disorder, but little is known on their functional connectivity (FC). METHODS Resting-state fMRI and regions of interest (ROI)-voxel cross-correlation analyses were used for systematically analysing the FC between multiple ROIs within the cerebello-basal ganglia-thalamocortical network in 15 patients with right-sided WC and 15 healthy volunteers. RESULTS Patients with WC showed a lower positive FC of several seed ROIs (left lateral premotor cortex, left thalamus, left/right pallidum) to the symptomatic left primary sensorimotor cortex compared with controls. The FC of the left primary motor cortex to prefrontal areas, pre- supplementary motor area and right somatosensory cortex was reduced and correlated with disease severity. Several cerebellar seed ROIs (right dentate nucleus, right crus I and bilateral crus II) revealed a stronger negative FC to primary and secondary sensorimotor areas. CONCLUSIONS An increase of negative cerebello-cortical FC at rest is in line with the hypothesis of a pathogenetic role of the cerebellum in dystonia. The deficit of positive subcortico-cortical FC indicates more generalised changes within the basal ganglia-thalamocortical motor loops beyond primary sensorimotor areas in WC. As patients with WC are asymptomatic during rest, these functional network changes could reflect an underlying abnormality or compensatory neuroplastic changes of network architecture in this disorder.
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Affiliation(s)
- Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Verena Wilzeck
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Florian Castrop
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
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Delnooz CCS, Pasman JW, van de Warrenburg BPC. Dynamic cortical gray matter volume changes after botulinum toxin in cervical dystonia. Neurobiol Dis 2014; 73:327-33. [PMID: 25447226 DOI: 10.1016/j.nbd.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/15/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Previous electrophysiological and functional imaging studies in focal dystonia have reported on cerebral reorganization after botulinum toxin (BoNT) injections. With the exception of microstructural changes, alterations in gray matter volume after BoNT have not been explored. In this study, we sought to determine whether BoNT influences gray matter volume in a group of cervical dystonia (CD) patients. We analyzed whole brain gray matter volume in a sample of CD patients with VBM analysis. In patients, scans were repeated immediately before and some weeks after BoNT injections; controls were only scanned once. We analyzed 1) BoNT-related gray matter volume changes within patients; 2) gray matter volume differences between patients and controls; and 3) correlations between gray matter volume and disease duration and disease severity. The pre- and post-BoNT treatment analysis revealed an increase of gray matter volume within the right precentral sulcus, at the lateral border of the premotor cortex. In comparison to healthy controls, CD patients had reduced gray matter volume in area 45 functionally corresponding to the left ventral premotor cortex. No gray matter volume increase was found for CD patients in comparison to controls. Gray matter volume of the left supramarginal gyrus and left premotor cortex correlated positively with disease duration, and that of the right inferior parietal lobule correlated negatively with disease severity. We have identified structural, yet dynamic gray matter volume changes in CD. There were specific gray matter volume changes related to BoNT injections, illustrating indirect central consequences of modified peripheral sensory input. As differences were exclusively seen in higher order motor areas relevant to motor planning and spatial cognition, these observations support the hypothesis that deficits in these cognitive processes are crucial in the pathophysiology of CD.
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Affiliation(s)
- Cathérine C S Delnooz
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - Jaco W Pasman
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - Bart P C van de Warrenburg
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands.
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Perruchoud D, Murray MM, Lefebvre J, Ionta S. Focal dystonia and the Sensory-Motor Integrative Loop for Enacting (SMILE). Front Hum Neurosci 2014; 8:458. [PMID: 24999327 PMCID: PMC4064702 DOI: 10.3389/fnhum.2014.00458] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022] Open
Abstract
Performing accurate movements requires preparation, execution, and monitoring mechanisms. The first two are coded by the motor system, the latter by the sensory system. To provide an adaptive neural basis to overt behaviors, motor and sensory information has to be properly integrated in a reciprocal feedback loop. Abnormalities in this sensory-motor loop are involved in movement disorders such as focal dystonia, a hyperkinetic alteration affecting only a specific body part and characterized by sensory and motor deficits in the absence of basic motor impairments. Despite the fundamental impact of sensory-motor integration mechanisms on daily life, the general principles of healthy and pathological anatomic–functional organization of sensory-motor integration remain to be clarified. Based on the available data from experimental psychology, neurophysiology, and neuroimaging, we propose a bio-computational model of sensory-motor integration: the Sensory-Motor Integrative Loop for Enacting (SMILE). Aiming at direct therapeutic implementations and with the final target of implementing novel intervention protocols for motor rehabilitation, our main goal is to provide the information necessary for further validating the SMILE model. By translating neuroscientific hypotheses into empirical investigations and clinically relevant questions, the prediction based on the SMILE model can be further extended to other pathological conditions characterized by impaired sensory-motor integration.
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Affiliation(s)
- David Perruchoud
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
| | - Micah M Murray
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland ; The Electroencephalography Brain Mapping Core, Center for Biomedical Imaging Lausanne, Switzerland
| | - Jeremie Lefebvre
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
| | - Silvio Ionta
- Laboratory for Investigative Neurophysiology, Department of Radiology and Department of Clinical Neurosciences, University Hospital Center and University of Lausanne Lausanne, Switzerland
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Psychological characteristics in musician׳s dystonia: a new diagnostic classification. Neuropsychologia 2014; 61:80-8. [PMID: 24946316 DOI: 10.1016/j.neuropsychologia.2014.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/17/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022]
Abstract
Numerous studies suggest that dysfunctional basal ganglia-thalamo-cortical circuits are involved in both movement disorders and psychiatric impairments. The current exploratory investigation explored possible psychological differences, firstly between 24 healthy musicians (HM) and 24 musicians diagnosed with focal dystonia (FDM) (Study I), and secondly among 35 FDM patients only (Study II). Results revealed that FDM patients are six times more likely to exhibit elevated anxiety, perfectionistic and stress characteristics than HM. These psychological conditions might contribute as aggravating risk factors to the development of FDM. However, half of the FDM patients did not demonstrate any signs of anxiety, perfectionism or stress. The findings point to the clear existence of two different psychological profiles among FDM patients. We suggest that this psychological distinction might reflect two different mal-adaptive processes mediated via different circuits of the cortico-basal ganglia-thalamicloops. The new classification of FDM patients will contribute to the reinforcement of the diagnostic repertoire, necessary for the selection of more specific treatment methods.
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Kimberley TJ, Borich MR, Arora S, Siebner HR. Multiple sessions of low-frequency repetitive transcranial magnetic stimulation in focal hand dystonia: clinical and physiological effects. Restor Neurol Neurosci 2014; 31:533-42. [PMID: 23340117 DOI: 10.3233/rnn-120259] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The ability of low-frequency repetitive transcranial magnetic stimulation (rTMS) to enhance intracortical inhibition has motivated its use as a potential therapeutic intervention in focal hand dystonia (FHD). In this preliminary investigation, we assessed the physiologic and behavioral effects of multiple sessions of rTMS in FHD. METHODS 12 patients with FHD underwent five daily-sessions of 1 Hz rTMS to contralateral dorsal premotor cortex (dPMC). Patients held a pencil and made movements that did not elicit dystonic symptoms during rTMS. We hypothesized that an active but non-dystonic motor state would increase beneficial effects of rTMS. Five additional patients received sham-rTMS protocol. The area under curve (AUC) of the motor evoked potentials and the cortical silent period (CSP) were measured to assess changes in corticospinal excitability and intracortical inhibition, respectively. Behavioral measures included pen force and velocity during handwriting and subjective report. RESULTS Multiple-session rTMS strengthened intracortical inhibition causing a prolongation of CSP after 3 days of intervention and pen force was reduced at day 1 and 5, leaving other measures unchanged. 68% of patients self-reported as 'responders' at day 5, and 58% at follow-up. Age predicted responders. CONCLUSIONS A strong therapeutic potential of this rTMS paradigm in FHD was not supported but findings warrant further investigation.
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Affiliation(s)
- Teresa Jacobson Kimberley
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN 55455, USA.
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Altered striatal and pallidal connectivity in cervical dystonia. Brain Struct Funct 2013; 220:513-23. [PMID: 24259114 DOI: 10.1007/s00429-013-0671-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/31/2013] [Indexed: 12/30/2022]
Abstract
Cervical dystonia is a neurological movement disorder characterized by involuntary, abnormal movements of the head and neck. Injecting the overactive muscles with botulinum toxin is the gold standard treatment, supported by good evidence (Delnooz and van de Warrenburg in Ther Adv Neurol Disord 5:221-240, 2012). Current views on its pathophysiology support a role for the basal ganglia, although there are probably more widespread abnormalities in brain networks in which the basal ganglia are important nodes. Their precise role in cervical dystonia is unknown. We sought to address this issue by examining alterations in the functional connectivity of the basal ganglia. Using resting-state functional MRI and functional parcellations, we investigated functional connectivity in cervical dystonia patients and age- and gender-matched healthy controls. We mapped connectivity voxel-wise across the striatum and the globus pallidus for a set of brain masks, defined from well-known resting-state networks. Scans were repeated before and after botulinum toxin injections to see whether connectivity abnormalities were perhaps restored. We found that in cervical dystonia (1) the right mid-dorsal putamen and right external globus pallidus have reduced connectivity with a network comprising left fronto-parietal regions; and (2) the bilateral anterior putamen shows a trend towards enhanced connectivity with a network comprising sensorimotor areas. We observed that botulinum toxin treatment induces reorganization between a network comprising mainly (pre)frontal areas and (1) the right mid-ventral striatum and (2) the right external globus pallidus. Cervical dystonia patients have altered functional connectivity between the basal ganglia and some cortical regions that are part of specific brain networks that in part are influenced by botulinum toxin treatment. These connectivity abnormalities may be primary as well as secondary, perhaps compensatory, phenomena.
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Jankowski J, Paus S, Scheef L, Bewersdorff M, Schild HH, Klockgether T, Boecker H. Abnormal movement preparation in task-specific focal hand dystonia. PLoS One 2013; 8:e78234. [PMID: 24167610 PMCID: PMC3805688 DOI: 10.1371/journal.pone.0078234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 09/10/2013] [Indexed: 11/25/2022] Open
Abstract
Electrophysiological and behavioral studies in primary dystonia suggest abnormalities during movement preparation, but this crucial phase preceding movement onset has not yet been studied specifically with functional magnetic resonance imaging (fMRI). To identify abnormalities in brain activation during movement preparation, we used event-related fMRI to analyze behaviorally unimpaired sequential finger movements in 18 patients with task-specific focal hand dystonia (FHD) and 18 healthy subjects. Patients and controls executed self-initiated or externally cued prelearnt four-digit sequential movements using either right or left hands. In FHD patients, motor performance of the sequential finger task was not associated with task-related dystonic posturing and their activation levels during motor execution were highly comparable with controls. On the other hand reduced activation was observed during movement preparation in the FHD patients in left premotor cortex / precentral gyrus for all conditions, and for self-initiation additionally in supplementary motor area, left mid-insula and anterior putamen, independent of effector side. Findings argue for abnormalities of early stages of motor control in FHD, manifesting during movement preparation. Since deficits map to regions involved in the coding of motor programs, we propose that task-specific dystonia is characterized by abnormalities during recruitment of motor programs: these do not manifest at the behavioral level during simple automated movements, however, errors in motor programs of complex movements established by extensive practice (a core feature of FHD), trigger the inappropriate movement patterns observed in task-specific dystonia.
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Affiliation(s)
- Jakob Jankowski
- FE Funktionelle Neurobildgebung, Radiologische Universitätsklinik, Universität Bonn, Bonn, Germany
| | - Sebastian Paus
- Neurologische Universitätsklinik, Universität Bonn, Bonn, Germany
| | - Lukas Scheef
- FE Funktionelle Neurobildgebung, Radiologische Universitätsklinik, Universität Bonn, Bonn, Germany
| | - Malte Bewersdorff
- FE Funktionelle Neurobildgebung, Radiologische Universitätsklinik, Universität Bonn, Bonn, Germany
| | - Hans H. Schild
- Radiologische Universitätsklinik, Universität Bonn, Bonn, Germany
| | - Thomas Klockgether
- Neurologische Universitätsklinik, Universität Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Henning Boecker
- FE Funktionelle Neurobildgebung, Radiologische Universitätsklinik, Universität Bonn, Bonn, Germany
- * E-mail:
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Berman BD, Hallett M, Herscovitch P, Simonyan K. Striatal dopaminergic dysfunction at rest and during task performance in writer's cramp. ACTA ACUST UNITED AC 2013; 136:3645-58. [PMID: 24148273 DOI: 10.1093/brain/awt282] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Writer's cramp is a task-specific focal hand dystonia characterized by involuntary excessive muscle contractions during writing. Although abnormal striatal dopamine receptor binding has been implicated in the pathophysiology of writer's cramp and other primary dystonias, endogenous dopamine release during task performance has not been previously investigated in writer's cramp. Using positron emission tomography imaging with the D2/D3 antagonist 11C-raclopride, we analysed striatal D2/D3 availability at rest and endogenous dopamine release during sequential finger tapping and speech production tasks in 15 patients with writer's cramp and 15 matched healthy control subjects. Compared with control subjects, patients had reduced 11C-raclopride binding to D2/D3 receptors at rest in the bilateral striatum, consistent with findings in previous studies. During the tapping task, patients had decreased dopamine release in the left striatum as assessed by reduced change in 11C-raclopride binding compared with control subjects. One cluster of reduced dopamine release in the left putamen during tapping overlapped with a region of reduced 11C-raclopride binding to D2/D3 receptors at rest. During the sentence production task, patients showed increased dopamine release in the left striatum. No overlap between altered dopamine release during speech production and reduced 11C-raclopride binding to D2/D3 receptors at rest was seen. Striatal regions where D2/D3 availability at rest positively correlated with disease duration were lateral and non-overlapping with striatal regions showing reduced D2/D3 receptor availability, except for a cluster in the left nucleus accumbens, which showed a negative correlation with disease duration and overlapped with striatal regions showing reduced D2/D3 availability. Our findings suggest that patients with writer's cramp may have divergent responses in striatal dopamine release during an asymptomatic motor task involving the dystonic hand and an unrelated asymptomatic task, sentence production. Our voxel-based results also suggest that writer's cramp may be associated with reduced striatal dopamine release occuring in the setting of reduced D2/D3 receptor availability and raise the possibility that basal ganglia circuits associated with premotor cortices and those associated with primary motor cortex are differentially affected in primary focal dystonias.
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Affiliation(s)
- Brian D Berman
- 1 Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, CO USA
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Abstract
Focal dystonias such as writer's cramp or blepharospasm are treatable with botulinum toxin injections and medications, but both therapies provide largely symptomatic relief. Because the basic abnormality in dystonia is at the synaptic level, brain modulating therapies with repetitive transcranial magnetic stimulation (rTMS) may well be able to produce lasting clinical improvement. Low-frequency threshold or subthreshold rTMS over the premotor cortex or anterior cingulate cortex, for hand dystonia and blepharospasm, respectively, could in the future become a more curative treatment, perhaps in conjunction with the current therapies.
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Affiliation(s)
- Kaji Ryuji
- Department of Neurology, Institute of Health-Bioscience, Tokushima University, Tokushima, Japan.
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Veugen LC, Hoffland BS, Stegeman DF, van de Warrenburg BP. Inhibition of the dorsal premotor cortex does not repair surround inhibition in writer's cramp patients. Exp Brain Res 2012. [PMID: 23192337 DOI: 10.1007/s00221-012-3350-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Writer's cramp is a task-specific form of focal dystonia, characterized by abnormal movements and postures of the hand and arm during writing. Two consistent abnormalities in its pathophysiology are a loss of surround inhibition and overactivity of the dorsal premotor cortex (PMd). This study aimed to assess a possible link between these two phenomena by investigating whether PMd inhibition leads to an improvement of surround inhibition, in parallel with previously demonstrated writing improvement. Fifteen writer's cramp patients and ten controls performed a simple motor hand task during which surround inhibition was measured using transcranial magnetic stimulation. Motor cortical excitability was measured of the active and surround muscles at three phases of the task. Surround inhibition and writing performance were assessed before and after PMd inhibitory continuous theta burst stimulation. In contrast to healthy controls, patients did not show inhibition of the abductor digiti minimi muscle during movement initiation of the first dorsal interosseus muscle, confirming the loss of surround inhibition. PMd inhibition led to an improvement of writing speed in writer's cramp patients. However, in both groups, no changes in surround inhibition were observed. The results confirm a role for the PMd in the pathophysiology of writer's cramp. We show that PMd inhibition does not lead to restoration of the surround inhibition defect in writer's cramp, despite the improvement in writing. This questions the involvement of the PMd in the loss of surround inhibition, and perhaps also the direct link between surround inhibition and dystonia.
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Affiliation(s)
- Lidwien C Veugen
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
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Hinkley LBN, Dolberg R, Honma S, Findlay A, Byl NN, Nagarajan SS. Aberrant Oscillatory Activity during Simple Movement in Task-Specific Focal Hand Dystonia. Front Neurol 2012; 3:165. [PMID: 23226140 PMCID: PMC3508423 DOI: 10.3389/fneur.2012.00165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022] Open
Abstract
In task-specific focal hand dystonia (tspFHD), the temporal dynamics of cortical activity in the motor system and how these processes are related to impairments in sensory and motor function are poorly understood. Here, we use time-frequency reconstructions of magnetoencephalographic (MEG) data to elaborate the temporal and spatial characteristics of cortical activity during movement. A self-paced finger tapping task during MEG recording was performed by 11 patients with tspFHD and 11 matched healthy controls. In both groups robust changes in beta (12-30 Hz) and high gamma (65-90 Hz) oscillatory activity were identified over sensory and motor cortices during button press. A significant decrease [p < 0.05, 1% False Discovery Rate (FDR) corrected] in high gamma power during movements of the affected hand was identified over ipsilateral sensorimotor cortex in the period prior to (-575 ms) and following (725 ms) button press. Furthermore, an increase (p < 0.05, 1% FDR corrected) in beta power suppression following movement of the affected hand was identified over visual cortex in patients with tspFHD. For movements of the unaffected hand, a significant (p < 0.05, 1% FDR corrected) increase in beta power suppression was identified over secondary somatosensory cortex (S2) in the period following button press in patients with tspFHD. Oscillatory activity within in the tspFHD group was however not correlated with clinical measures. Understanding these aberrant oscillatory dynamics can provide the groundwork for interventions that focus on modulating the timing of this activity.
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Affiliation(s)
- Leighton B. N. Hinkley
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, CA, USA
| | - Rebecca Dolberg
- Department of Physical Therapy and Rehabilitation Science, University of CaliforniaSan Francisco, CA, USA
| | - Susanne Honma
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, CA, USA
| | - Anne Findlay
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, CA, USA
| | - Nancy N. Byl
- Department of Physical Therapy and Rehabilitation Science, University of CaliforniaSan Francisco, CA, USA
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of CaliforniaSan Francisco, CA, USA
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Karp BI. Botulinum toxin physiology in focal hand and cranial dystonia. Toxins (Basel) 2012; 4:1404-14. [PMID: 23202323 PMCID: PMC3509715 DOI: 10.3390/toxins4111404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/24/2012] [Accepted: 11/09/2012] [Indexed: 11/16/2022] Open
Abstract
The safety and efficacy of botulinum toxin for the treatment of focal hand and cranial dystonias are well-established. Studies of these adult-onset focal dystonias reveal both shared features, such as the dystonic phenotype of muscle hyperactivity and overflow muscle contraction and divergent features, such as task specificity in focal hand dystonia which is not a common feature of cranial dystonia. The physiologic effects of botulinum toxin in these 2 disorders also show both similarities and differences. This paper compares and contrasts the physiology of focal hand and cranial dystonias and of botulinum toxin in the management of these disorders.
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Affiliation(s)
- Barbara Illowsky Karp
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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Moore RD, Gallea C, Horovitz SG, Hallett M. Individuated finger control in focal hand dystonia: an fMRI study. Neuroimage 2012; 61:823-31. [PMID: 22484405 PMCID: PMC3376234 DOI: 10.1016/j.neuroimage.2012.03.066] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 03/19/2012] [Accepted: 03/21/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To better understand deficient selective motor control in focal hand dystonia by determining changes in striatal activation and connectivity in patients performing individuated finger control. METHODS Functional imaging with a 3-Tesla magnetic resonance scanner was performed on 18 patients and 17 controls during non-symptom producing tasks requiring right-handed individuated or coupled finger control. A global linear model and psychophysiologic interaction model compared individuated to coupled tasks for patients and controls separately, and the results were submitted to a group analysis. The sensorimotor (posterior) and associative (anterior) parts of the putamen were considered as seed regions for the connectivity analysis. RESULTS Compared to controls, patients had significant differences in activations and connectivity during individuated compared to coupled tasks: (i) decreased activations in the bilateral postcentral gyri, right associative posterior parietal areas, right cerebellum and left posterior putamen, while activations in the left anterior putamen were not different; (ii) increased connectivity of the left posterior putamen with the left cerebellum and left sensorimotor cortex; and (iii) increased connectivity of the left anterior putamen with bilateral supplementary motor areas, the left premotor cortex, and left cerebellum. INTERPRETATION Decreased activations in the sensorimotor putamen and cerebellum controlling the affected hand might underlie low levels of surround inhibition during individuated tasks. For identical motor performance in both groups, increased connectivity of sensorimotor and associative striato-cortical circuits in FHD suggests that both affected and unaffected territories of the striatum participate in compensatory processes.
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Affiliation(s)
- Ryan D Moore
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Building 10, Room 7D37, 10 Center Drive, MSC 1428, Bethesda, MD 20892-1428
| | - Cecile Gallea
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Building 10, Room 7D37, 10 Center Drive, MSC 1428, Bethesda, MD 20892-1428
| | - Silvina G Horovitz
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Building 10, Room 7D37, 10 Center Drive, MSC 1428, Bethesda, MD 20892-1428
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Building 10, Room 7D37, 10 Center Drive, MSC 1428, Bethesda, MD 20892-1428
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Catalan MJ, Ishii K, Bara-Jimenez W, Hallett M. Reorganization of the human somatosensory cortex in hand dystonia. J Mov Disord 2012; 5:5-8. [PMID: 24868405 PMCID: PMC4027675 DOI: 10.14802/jmd.12002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 04/09/2012] [Accepted: 04/09/2012] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Abnormalities of finger representations in the somatosensory cortex have been identified in patients with focal hand dystonia. Measuring blood flow with positron emission tomography (PET) can be use to demonstrate functional localization of receptive fields. Methods: A vibratory stimulus was applied to the right thumb and little finger of six healthy volunteers and six patients with focal hand dystonia to map their receptive fields using H215O PET. Results: The cortical finger representations in the primary somatosensory cortex were closer to each other in patients than in normal subjects. No abnormalities were found in secondary somatosensory cortex, but the somatotopy there is less well distinguished. Conclusions: These data confirm prior electrophysiological and functional neuroimaging observations showing abnormalities of finger representations in somatosensory cortex of patients with focal hand dystonia.
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Affiliation(s)
- Maria Jose Catalan
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892 USA
| | - Kenji Ishii
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892 USA
| | - William Bara-Jimenez
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892 USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892 USA
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Castrop F, Dresel C, Hennenlotter A, Zimmer C, Haslinger B. Basal ganglia-premotor dysfunction during movement imagination in writer's cramp. Mov Disord 2012; 27:1432-9. [PMID: 22328061 DOI: 10.1002/mds.24944] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/05/2011] [Accepted: 01/12/2012] [Indexed: 11/06/2022] Open
Abstract
The pathophysiology of idiopathic focal hand dystonia (writer's cramp) is characterized by deficient inhibitory basal ganglia function and altered cortical sensorimotor processing. To explore if this is already a primary finding in dystonia for internal movement simulation independent of dystonic motor output or abnormal sensory input, we investigated the neural correlates of movement imagination and observation in patients with writer's cramp. Event-related fMRI was applied during kinesthetic motor imagery of drawing simple geometric figures (imagination task) and passively observing videos of hands drawing identical figures (observation task). Compared with healthy controls, patients with writer's cramp showed deficient activation of the left primary sensorimotor cortex, mesial and left dorsal premotor cortex, bilateral putamen, and bilateral thalamus during motor imagery. No significant signal differences between both groups were found during the observation task. We conclude that internal movement simulation and planning as tested during imagination of hand movements appear to be dysfunctional in patients with writer's cramp, whereas visual signal processing and observation-induced activation are unaffected. Deficient basal ganglia-premotor activation could be a correlate of impaired basal ganglia inhibition and focusing during the selection of motor programs in dystonia. This finding seems to be an intrinsic deficit, as it is found during motor imagery in the absence of dystonic symptoms.
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Affiliation(s)
- Florian Castrop
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
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Houdayer E, Beck S, Karabanov A, Poston B, Hallett M. The differential modulation of the ventral premotor-motor interaction during movement initiation is deficient in patients with focal hand dystonia. Eur J Neurosci 2012; 35:478-85. [PMID: 22288483 PMCID: PMC3270366 DOI: 10.1111/j.1460-9568.2011.07960.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A major feature of focal hand dystonia (FHD) pathophysiology is the loss of inhibition. One inhibitory process, surround inhibition, for which the cortical mechanisms are still unknown, is abnormal in FHD. As the ventral premotor cortex (PMv) plays a key role in the sensorimotor processing involved in shaping finger movements and has many projections onto the primary motor cortex (M1), we hypothesized that the PMv-M1 connections might play a role in surround inhibition. A paired-pulse transcranial magnetic stimulation paradigm was used in order to evaluate and compare the PMv-M1 interactions during different phases (rest, preparation and execution) of an index finger movement in patients with FHD and controls. A sub-threshold conditioning pulse (80% resting motor threshold) was applied to the PMv at 6 ms before M1 stimulation. The right abductor pollicis brevis, a surround muscle, was the target muscle. In healthy controls, the results showed that PMv stimulation induced an ipsilateral ventral premotor-motor inhibition at rest. This cortico-cortical interaction changed into an early facilitation (100 ms before movement onset) and turned back to inhibition 50 ms later. In patients with FHD, this PMv-M1 interaction and its modulation were absent. Our results show that, although the ipsilateral ventral premotor-motor inhibition does not play a key role in the genesis of surround inhibition, PMv has a dynamic influence on M1 excitability during the early steps of motor execution. The impaired cortico-cortical interactions observed in patients with FHD might contribute, at least in part, to the abnormal motor command.
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Affiliation(s)
- Elise Houdayer
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892, USA
| | - Sandra Beck
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892, USA
- Department of Neurology and Clinical Neurophysiology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anke Karabanov
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892, USA
| | - Brach Poston
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892, USA
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Delnooz CCS, Helmich RC, Medendorp WP, Van de Warrenburg BPC, Toni I. Writer's cramp: increased dorsal premotor activity during intended writing. Hum Brain Mapp 2011; 34:613-25. [PMID: 22113948 DOI: 10.1002/hbm.21464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/01/2011] [Accepted: 08/15/2011] [Indexed: 12/29/2022] Open
Abstract
Simple writer's cramp (WC) is a task-specific form of dystonia, characterized by abnormal movements and postures of the hand during writing. It is extremely task-specific, since dystonic symptoms can occur when a patient uses a pencil for writing, but not when it is used for sharpening. Maladaptive plasticity, loss of inhibition, and abnormal sensory processing are important pathophysiological elements of WC. However, it remains unclear how those elements can account for its task-specificity. We used fMRI to isolate cerebral alterations associated with the task-specificity of simple WC. Subjects (13 simple WC patients, 20 matched controls) imagined grasping a pencil to either write with it or sharpen it. On each trial, we manipulated the pencil's position and the number of imagined movements, while monitoring variations in motor output with electromyography. We show that simple WC is characterized by abnormally increased activity in the dorsal premotor cortex (PMd) when imagined actions are specifically related to writing. This cerebral effect was independent from the known deficits in dystonia in generating focal motor output and in processing somatosensory feedback. This abnormal activity of the PMd suggests that the task-specific element of simple WC is primarily due to alterations at the planning level, in the computations that transform a desired action outcome into the motor commands leading to that action. These findings open the way for testing the therapeutic value of interventions that take into account the computational substrate of task-specificity in simple WC, e.g. modulations of PMd activity during the planning phase of writing.
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Affiliation(s)
- Cathérine C S Delnooz
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brian, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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"Visual sensory trick" in patient with cervical dystonia. Neurol Sci 2011; 33:665-7. [PMID: 22071793 DOI: 10.1007/s10072-011-0831-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
Sensory tricks are clinical maneuvers that may partially relieve dystonic contractions. Any clinical maneuver that modulates afferent sensory and efferent motor pathways could be used as a sensory trick in patients with cervical dystonia. Although various sensory tricks have been described to reduce cervical dystonia, little is known about the exact mechanisms by which they operate. We report a case of cervical dystonia that was alleviated through the use of a visual-sensory trick. Our findings suggest that visual stimulation might be an effective sensory trick in cervical dystonia by compensating for a defective sensory system, or because visual pathways might be also affected by sensory interactions in cervical dystonia.
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Andréu JL, Otón T, Silva-Fernández L, Sanz J. Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors. Best Pract Res Clin Rheumatol 2011; 25:31-42. [PMID: 21663848 DOI: 10.1016/j.berh.2010.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 12/23/2010] [Indexed: 12/26/2022]
Abstract
Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS).
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Affiliation(s)
- José-Luis Andréu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquin Rodrigo, Majadahonda, Madrid, Spain.
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