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Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia. Acta Neurochir (Wien) 2016; 158:171-80; discussion 180. [PMID: 26611690 DOI: 10.1007/s00701-015-2646-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between phasic-type and tonic-type cervical dystonia have not been reported. METHODS This study included a retrospective cohort of 30 patients with primary cervical dystonia who underwent GPi DBS. Age, disease duration, dystonia direction, movement types, employment status, relevant life events, and neuropsychological examinations were analyzed with respect to clinical outcomes following GPi DBS. RESULTS The only significant factor affecting clinical outcomes was movement type (phasic or tonic). Sequential changes in clinical outcomes showed significant differences between phasic- and tonic-type cervical dystonia. A delayed benefit was found in both phasic- and tonic-type dystonia. CONCLUSIONS The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.
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252
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Liu YB, Tewari A, Salameh J, Arystarkhova E, Hampton TG, Brashear A, Ozelius LJ, Khodakhah K, Sweadner KJ. A dystonia-like movement disorder with brain and spinal neuronal defects is caused by mutation of the mouse laminin β1 subunit, Lamb1. eLife 2015; 4. [PMID: 26705335 PMCID: PMC4749547 DOI: 10.7554/elife.11102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022] Open
Abstract
A new mutant mouse (lamb1t) exhibits intermittent dystonic hindlimb movements and postures when awake, and hyperextension when asleep. Experiments showed co-contraction of opposing muscle groups, and indicated that symptoms depended on the interaction of brain and spinal cord. SNP mapping and exome sequencing identified the dominant causative mutation in the Lamb1 gene. Laminins are extracellular matrix proteins, widely expressed but also known to be important in synapse structure and plasticity. In accordance, awake recording in the cerebellum detected abnormal output from a circuit of two Lamb1-expressing neurons, Purkinje cells and their deep cerebellar nucleus targets, during abnormal postures. We propose that dystonia-like symptoms result from lapses in descending inhibition, exposing excess activity in intrinsic spinal circuits that coordinate muscles. The mouse is a new model for testing how dysfunction in the CNS causes specific abnormal movements and postures.
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Affiliation(s)
- Yi Bessie Liu
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Johnny Salameh
- Department of Neurology, University of Massachusetts Medical School, Worcester, United States
| | - Elena Arystarkhova
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Thomas G Hampton
- Neuroscience Discovery Core, Mouse Specifics Inc., Framingham, United States
| | - Allison Brashear
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, United States
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, United States
| | - Kathleen J Sweadner
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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253
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Cheng FPH, Eddy ML, Ruiz MH, Großbach M, Altenmüller EO. Sensory feedback - Dependent neural de-orchestration: The effect of altered sensory feedback on Musician's Dystonia. Restor Neurol Neurosci 2015; 34:55-65. [PMID: 26638834 DOI: 10.3233/rnn-150554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Musician's dystonia (MD) is a task-specific movement disorder related to extensive expert music performance training. Similar to other forms of focal dystonia, MD involves sensory deficits and abnormal patterns of sensorimotor integration. The present study investigated the impaired cortical sensorimotor network of pianists who suffer from MD by employing altered auditory and tactile feedback during scale playing with multichannel EEG. METHODS 9 healthy professional pianists and 9 professional pianists suffering from right hand MD participated in an experiment that required repeated scale playing on a MIDI piano under altered sensory feedback while EEG was measured. RESULTS The comparison of EEG data in healthy pianists and pianists suffering from MD revealed a higher degree of inter-regional phase synchronisation between the frontal and parietal regions and between the temporal and central regions in the patient group and in conditions that are relevant to the long-trained auditory-motor coupling (normal auditory feedback and complete deprivation of auditory feedback), but such abnormalities decreased in conditions with delayed auditory feedback and altered tactile feedback. CONCLUSIONS These findings support the hypothesis that the impaired sensorimotor integration of MD patients is specific to the type of overtrained task that the patients were trained for and can be modified with altered sensory feedback.
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Affiliation(s)
- F P-H Cheng
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama, and Media, Hannover, Germany
| | - M-L Eddy
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama, and Media, Hannover, Germany
| | - M Herrojo Ruiz
- Department of Neurology, Charité University of Medicine, Berlin, Germany
| | - M Großbach
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama, and Media, Hannover, Germany
| | - E O Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama, and Media, Hannover, Germany
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254
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Richter A, Hamann M, Wissel J, Volk HA. Dystonia and Paroxysmal Dyskinesias: Under-Recognized Movement Disorders in Domestic Animals? A Comparison with Human Dystonia/Paroxysmal Dyskinesias. Front Vet Sci 2015; 2:65. [PMID: 26664992 PMCID: PMC4672229 DOI: 10.3389/fvets.2015.00065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/13/2015] [Indexed: 12/17/2022] Open
Abstract
Dystonia is defined as a neurological syndrome characterized by involuntary sustained or intermittent muscle contractions causing twisting, often repetitive movements, and postures. Paroxysmal dyskinesias are episodic movement disorders encompassing dystonia, chorea, athetosis, and ballism in conscious individuals. Several decades of research have enhanced the understanding of the etiology of human dystonia and dyskinesias that are associated with dystonia, but the pathophysiology remains largely unknown. The spontaneous occurrence of hereditary dystonia and paroxysmal dyskinesia is well documented in rodents used as animal models in basic dystonia research. Several hyperkinetic movement disorders, described in dogs, horses and cattle, show similarities to these human movement disorders. Although dystonia is regarded as the third most common movement disorder in humans, it is often misdiagnosed because of the heterogeneity of etiology and clinical presentation. Since these conditions are poorly known in veterinary practice, their prevalence may be underestimated in veterinary medicine. In order to attract attention to these movement disorders, i.e., dystonia and paroxysmal dyskinesias associated with dystonia, and to enhance interest in translational research, this review gives a brief overview of the current literature regarding dystonia/paroxysmal dyskinesia in humans and summarizes similar hereditary movement disorders reported in domestic animals.
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Affiliation(s)
- Angelika Richter
- Faculty of Veterinary Medicine, Institute of Pharmacology, Pharmacy and Toxicology, University of Leipzig, Leipzig, Germany
| | - Melanie Hamann
- Department of Veterinary Medicine, Institute of Pharmacology and Toxicology, Free University Berlin, Berlin, Germany
| | - Jörg Wissel
- Department of Neurological Rehabilitation and Physical Therapy, Vivantes Hospital Spandau and Humboldt Hospital, Berlin, Germany
- Department of Neurology, Vivantes Hospital Spandau and Humboldt Hospital, Berlin, Germany
| | - Holger A. Volk
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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255
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Harrington A, Hammond-Tooke GD. Theta Burst Stimulation of the Cerebellum Modifies the TMS-Evoked N100 Potential, a Marker of GABA Inhibition. PLoS One 2015; 10:e0141284. [PMID: 26529225 PMCID: PMC4631469 DOI: 10.1371/journal.pone.0141284] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/05/2015] [Indexed: 01/07/2023] Open
Abstract
Theta burst stimulation (TBS) of the cerebellum, a potential therapy for neurological disease, can modulate corticospinal excitability via the dentato-thalamo-cortical pathway, but it is uncertain whether its effects are mediated via inhibitory or facilitatory networks. The aim of this study was to investigate the effects of 30Hz cerebellar TBS on the N100 waveform of the TMS-evoked potential (TEP), a marker of intracortical GABAB-mediated inhibition. 16 healthy participants (aged 18–30 years; 13 right handed and 3 left handed) received 30Hz intermittent TBS (iTBS), continuous TBS (cTBS) or sham stimulation over the right cerebellum, in three separate sessions. The first 8 participants received TBS at a stimulus intensity of 80% of active motor threshold (AMT), while the remainder received 90% of AMT. Motor evoked potentials (MEP) and TEP were recorded before and after each treatment, by stimulating the first dorsal interosseus area of the left motor cortex. Analysis of the 13 right handed participants showed that iTBS at 90% of AMT increased the N100 amplitude compared to sham and cTBS, without significantly altering MEP amplitude. cTBS at 80% of active motor threshold decreased the N100 amplitude and cTBS overall reduced resting MEP amplitude. The study demonstrates effects of 30Hz cerebellar TBS on inhibitory cortical networks that may be useful for treatment of neurological conditions associated with dysfunctional intracortical inhibition.
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Affiliation(s)
| | - Graeme David Hammond-Tooke
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Department of Neurology, Dunedin Hospital, Dunedin, New Zealand
- * E-mail:
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256
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Bönstrup M, Hagemann J, Gerloff C, Sauseng P, Hummel FC. Alpha oscillatory correlates of motor inhibition in the aged brain. Front Aging Neurosci 2015; 7:193. [PMID: 26528179 PMCID: PMC4602091 DOI: 10.3389/fnagi.2015.00193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/25/2015] [Indexed: 01/01/2023] Open
Abstract
Exerting inhibitory control is a cognitive ability mediated by functions known to decline with age. The goal of this study is to add to the mechanistic understanding of cortical inhibition during motor control in aged brains. Based on behavioral findings of impaired inhibitory control with age we hypothesized that elderly will show a reduced or a lack of EEG alpha-power increase during tasks that require motor inhibition. Since inhibitory control over movements has been shown to rely on prior motor memory formation, we investigated cortical inhibitory processes at two points in time—early after learning and after an overnight consolidation phase and hypothesized an overnight increase of inhibitory capacities. Young and elderly participants acquired a complex finger movement sequence and in each experimental session brain activity during execution and inhibition of the sequence was recorded with multi-channel EEG. We assessed cortical processes of sustained inhibition by means of task-induced changes of alpha oscillatory power. During inhibition of the learned movement, young participants showed a significant alpha power increase at the sensorimotor cortices whereas elderly did not. Interestingly, for both groups, the overnight consolidation phase improved up-regulation of alpha power during sustained inhibition. This points to deficits in the generation and enhancement of local inhibitory mechanisms at the sensorimotor cortices in aged brains. However, the alpha power increase in both groups implies neuroplastic changes that strengthen the network of alpha power generation over time in young as well as elderly brains.
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Affiliation(s)
- Marlene Bönstrup
- Brain Imaging and Neurostimulation Laboratory, Department of Neurology, University Medical Centre Hamburg-Eppendorf Hamburg, Germany
| | - Julian Hagemann
- Brain Imaging and Neurostimulation Laboratory, Department of Neurology, University Medical Centre Hamburg-Eppendorf Hamburg, Germany
| | - Christian Gerloff
- Brain Imaging and Neurostimulation Laboratory, Department of Neurology, University Medical Centre Hamburg-Eppendorf Hamburg, Germany
| | - Paul Sauseng
- Department of Psychology, Ludwig-Maximilians-University Munich Munich, Germany
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation Laboratory, Department of Neurology, University Medical Centre Hamburg-Eppendorf Hamburg, Germany
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257
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Bhanpuri NH, Bertucco M, Young SJ, Lee AA, Sanger TD. Multiday Transcranial Direct Current Stimulation Causes Clinically Insignificant Changes in Childhood Dystonia: A Pilot Study. J Child Neurol 2015; 30:1604-15. [PMID: 25792428 DOI: 10.1177/0883073815575369] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/31/2015] [Indexed: 11/16/2022]
Abstract
Abnormal motor cortex activity is common in dystonia. Cathodal transcranial direct current stimulation may alter cortical activity by decreasing excitability while anodal stimulation may increase motor learning. Previous results showed that a single session of cathodal transcranial direct current stimulation can improve symptoms in childhood dystonia. Here we performed a 5-day, sham-controlled, double-blind, crossover study, where we measured tracking and muscle overflow in a myocontrol-based task. We applied cathodal and anodal transcranial direct current stimulation (2 mA, 9 minutes per day). For cathodal transcranial direct current stimulation (7 participants), 3 subjects showed improvements whereas 2 showed worsening in overflow or tracking error. The effect size was small (about 1% of maximum voluntary contraction) and not clinically meaningful. For anodal transcranial direct current stimulation (6 participants), none showed improvement, whereas 5 showed worsening. Thus, multiday cathodal transcranial direct current stimulation reduced symptoms in some children but not to a clinically meaningful extent, whereas anodal transcranial direct current stimulation worsened symptoms. Our results do not support transcranial direct current stimulation as clinically viable for treating childhood dystonia.
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Affiliation(s)
- Nasir H Bhanpuri
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Matteo Bertucco
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Scott J Young
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Annie A Lee
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Terence D Sanger
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA Department of Neurology, University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, USA Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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258
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Kiziltan ME, Gunduz A, Apaydın H, Ertan S, Kiziltan G. Auditory startle reflex and startle reflex to somatosensory inputs in generalized dystonia. Clin Neurophysiol 2015; 126:1740-5. [DOI: 10.1016/j.clinph.2014.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
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259
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Bleton JP, Touzé E, Soulez-la-Rivière L, Baizabal-Carvallo JF, Guignier F, Cambriel C, Sangla S, Grabli D, Roze E, Mesure S, Vidailhet M. Baseline Features Influencing the Effectiveness of Retraining Therapy for Writer's Cramp. Mov Disord Clin Pract 2015; 2:232-236. [DOI: 10.1002/mdc3.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/26/2014] [Accepted: 12/26/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jean-Pierre Bleton
- INSERM U894; Centre Psychiatrie-Neurosciences; Hôpital Sainte-Anne; Université Paris Descartes; Paris France
- Aix-Marseille Université-CNRS Institut des Sciences du Mouvement, UMR 7287; Marseille France
| | - Emmanuel Touzé
- INSERM U894; Centre Psychiatrie-Neurosciences; Hôpital Sainte-Anne; Université Paris Descartes; Paris France
- Inserm U919; GIP Cycéron; CHU Côte de Nacre; Service de Neurologie; Université de Caen Basse Normandie; Caen France
| | | | - José Fidel Baizabal-Carvallo
- AP-HP; Département de Neurologie; Hôpital Pitié-Salpêtrière; UPMC Université Pierre et Marie Curie; Paris France
| | - Françoise Guignier
- INSERM U894; Centre Psychiatrie-Neurosciences; Hôpital Sainte-Anne; Université Paris Descartes; Paris France
| | - Claire Cambriel
- INSERM U894; Centre Psychiatrie-Neurosciences; Hôpital Sainte-Anne; Université Paris Descartes; Paris France
| | - Sophie Sangla
- AP-HP; Département de Neurologie; Hôpital Pitié-Salpêtrière; UPMC Université Pierre et Marie Curie; Paris France
| | - David Grabli
- AP-HP; Département de Neurologie; Hôpital Pitié-Salpêtrière; UPMC Université Pierre et Marie Curie; Paris France
- ICM UPMC/INSERM UMR 1127 CNRS UMR7225 Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM); Paris France
| | - Emmanuel Roze
- AP-HP; Département de Neurologie; Hôpital Pitié-Salpêtrière; UPMC Université Pierre et Marie Curie; Paris France
- ICM UPMC/INSERM UMR 1127 CNRS UMR7225 Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM); Paris France
| | - Serge Mesure
- Aix-Marseille Université-CNRS Institut des Sciences du Mouvement, UMR 7287; Marseille France
| | - Marie Vidailhet
- AP-HP; Département de Neurologie; Hôpital Pitié-Salpêtrière; UPMC Université Pierre et Marie Curie; Paris France
- ICM UPMC/INSERM UMR 1127 CNRS UMR7225 Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM); Paris France
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260
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Cerebellar synaptogenesis is compromised in mouse models of DYT1 dystonia. Exp Neurol 2015; 271:457-67. [DOI: 10.1016/j.expneurol.2015.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 12/16/2022]
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261
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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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262
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Abstract
The dystonias are a group of disorders characterized by excessive involuntary muscle contractions leading to abnormal postures and/or repetitive movements. A careful assessment of the clinical manifestations is helpful for identifying syndromic patterns that focus diagnostic testing on potential causes. If a cause is identified, specific etiology-based treatments may be available. In most cases, a specific cause cannot be identified, and treatments are based on symptoms. Treatment options include counseling, education, oral medications, botulinum toxin injections, and several surgical procedures. A substantial reduction in symptoms and improved quality of life is achieved in most patients by combining these options.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA; Department of Human Genetics, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA.
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, 6300 Woodruff Memorial Research Building, 101 Woodruff Circle, Emory University, Atlanta, GA 30322, USA
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263
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Suppa A, Marsili L, Giovannelli F, Di Stasio F, Rocchi L, Upadhyay N, Ruoppolo G, Cincotta M, Berardelli A. Abnormal motor cortex excitability during linguistic tasks in adductor-type spasmodic dysphonia. Eur J Neurosci 2015; 42:2051-60. [PMID: 26061279 DOI: 10.1111/ejn.12977] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/16/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
In healthy subjects (HS), transcranial magnetic stimulation (TMS) applied during 'linguistic' tasks discloses excitability changes in the dominant hemisphere primary motor cortex (M1). We investigated 'linguistic' task-related cortical excitability modulation in patients with adductor-type spasmodic dysphonia (ASD), a speech-related focal dystonia. We studied 10 ASD patients and 10 HS. Speech examination included voice cepstral analysis. We investigated the dominant/non-dominant M1 excitability at baseline, during 'linguistic' (reading aloud/silent reading/producing simple phonation) and 'non-linguistic' tasks (looking at non-letter strings/producing oral movements). Motor evoked potentials (MEPs) were recorded from the contralateral hand muscles. We measured the cortical silent period (CSP) length and tested MEPs in HS and patients performing the 'linguistic' tasks with different voice intensities. We also examined MEPs in HS and ASD during hand-related 'action-verb' observation. Patients were studied under and not-under botulinum neurotoxin-type A (BoNT-A). In HS, TMS over the dominant M1 elicited larger MEPs during 'reading aloud' than during the other 'linguistic'/'non-linguistic' tasks. Conversely, in ASD, TMS over the dominant M1 elicited increased-amplitude MEPs during 'reading aloud' and 'syllabic phonation' tasks. CSP length was shorter in ASD than in HS and remained unchanged in both groups performing 'linguistic'/'non-linguistic' tasks. In HS and ASD, 'linguistic' task-related excitability changes were present regardless of the different voice intensities. During hand-related 'action-verb' observation, MEPs decreased in HS, whereas in ASD they increased. In ASD, BoNT-A improved speech, as demonstrated by cepstral analysis and restored the TMS abnormalities. ASD reflects dominant hemisphere excitability changes related to 'linguistic' tasks; BoNT-A returns these excitability changes to normal.
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Affiliation(s)
- A Suppa
- Neuromed Institute, Pozzilli, IS, Italy
| | - L Marsili
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - F Giovannelli
- Unit of Neurology, Florence Health Authority, Florence, Italy
| | - F Di Stasio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - L Rocchi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - N Upadhyay
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - G Ruoppolo
- Otorhinolaryngology Section, Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - M Cincotta
- Unit of Neurology, Florence Health Authority, Florence, Italy
| | - A Berardelli
- Neuromed Institute, Pozzilli, IS, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
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264
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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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Dysgraphia as a Mild Expression of Dystonia in Children with Absence Epilepsy. PLoS One 2015; 10:e0130883. [PMID: 26132164 PMCID: PMC4488862 DOI: 10.1371/journal.pone.0130883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background Absence epilepsy (AE) is etiologically heterogeneous and has at times been associated with idiopathic dystonia. Objectives Based on the clinical observation that children with AE often exhibit, interictally, a disorder resembling writer’s cramp but fully definable as dysgraphia, we tested the hypothesis that in this particular population dysgraphia would represent a subtle expression of dystonia. Methods We ascertained the prevalence of dysgraphia in 82 children with AE (mean age 9.7) and average intelligence and compared them with 89 age-, gender- and class-matched healthy children (mean age 10.57) using tests for handwriting fluency and quality, based on which we divided patients and controls into four subgroups: AE/dysgraphia, AE without dysgraphia, controls with dysgraphia and healthy controls. We compared the blink reflex recovery cycle in children belonging to all four subgroups. Results We identified dysgraphia in 17/82 children with AE and in 7/89 controls (20.7 vs 7.8%; P = 0.016) with the former having a 3.4-times higher risk of dysgraphia regardless of age and gender (odd ratio: 3.49; 95% CI 1.2, 8.8%). The AE/dysgraphia subgroup performed worse than controls with dysgraphia in one test of handwriting fluency (P = 0.037) and in most trials testing handwriting quality (P< 0.02). In children with AE/dysgraphia the blink reflex showed no suppression at short interstimulus intervals, with a difference for each value emerging when comparing the study group with the three remaining subgroups (P<0.001). Conclusions In children with AE, dysgraphia is highly prevalent and has a homogeneous, distinctive pathophysiological substrate consistent with idiopathic dystonia.
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Recessive mutations in the α3 (VI) collagen gene COL6A3 cause early-onset isolated dystonia. Am J Hum Genet 2015; 96:883-93. [PMID: 26004199 DOI: 10.1016/j.ajhg.2015.04.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/16/2015] [Indexed: 12/13/2022] Open
Abstract
Isolated dystonia is a disorder characterized by involuntary twisting postures arising from sustained muscle contractions. Although autosomal-dominant mutations in TOR1A, THAP1, and GNAL have been found in some cases, the molecular mechanisms underlying isolated dystonia are largely unknown. In addition, although emphasis has been placed on dominant isolated dystonia, the disorder is also transmitted as a recessive trait, for which no mutations have been defined. Using whole-exome sequencing in a recessive isolated dystonia-affected kindred, we identified disease-segregating compound heterozygous mutations in COL6A3, a collagen VI gene associated previously with muscular dystrophy. Genetic screening of a further 367 isolated dystonia subjects revealed two additional recessive pedigrees harboring compound heterozygous mutations in COL6A3. Strikingly, all affected individuals had at least one pathogenic allele in exon 41, including an exon-skipping mutation that induced an in-frame deletion. We tested the hypothesis that disruption of this exon is pathognomonic for isolated dystonia by inducing a series of in-frame deletions in zebrafish embryos. Consistent with our human genetics data, suppression of the exon 41 ortholog caused deficits in axonal outgrowth, whereas suppression of other exons phenocopied collagen deposition mutants. All recessive mutation carriers demonstrated early-onset segmental isolated dystonia without muscular disease. Finally, we show that Col6a3 is expressed in neurons, with relevant mRNA levels detectable throughout the adult mouse brain. Taken together, our data indicate that loss-of-function mutations affecting a specific region of COL6A3 cause recessive isolated dystonia with underlying neurodevelopmental deficits and highlight the brain extracellular matrix as a contributor to dystonia pathogenesis.
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267
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Sinclair CF, Simonyan K, Brin MF, Blitzer A. Negative dystonia of the palate: a novel entity and diagnostic consideration in hypernasal speech. Laryngoscope 2015; 125:1426-32. [PMID: 25646795 PMCID: PMC4718549 DOI: 10.1002/lary.25165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/22/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To present the first documented series of patients with negative dystonia (ND) of the palate, including clinical symptoms, functional MRI findings, and management options. STUDY DESIGN Case series ascertained from clinical research centers that evaluated patients with both hyperkinetic and hypokinetic movement disorders. METHODS Between July 1983 and March 2013, data was collected on patient demographics, disease characteristics, functional MRI findings, long-term management options, and outcomes. We sought patients whose clinical examination demonstrated absent palatal movement on speaking, despite normal palatal activity on other activities. RESULTS Five patients (2 males, 3 females) met clinical criteria. All patients presented with hypernasal speech without associated dysphagia. Clinical examination revealed absent palatal movement on speaking despite intact gag reflexes, normal palate elevation on swallowing, and normal cranial nerve examinations. Other cranial and/or limb dystonias were present in four patients (80.0%). Three patients (60.0%) had previously failed oral pharmacologic therapy. Two patients underwent functional magnetic resonance imaging (fMRI) studies, which demonstrated an overall decrease of cortical and subcortical activation during production of symptomatic syllables and asymptomatic coughing. Management included speech therapy (all patients) and palatal lift (2 patients) with limited improvement. Calcium hydroxyapatite injection (1 patient) into the soft palate and Passavants' ridge was beneficial. CONCLUSIONS This is the first report of ND of the palate. Characteristic findings were task-specific absent palatal movement with speech, despite normal movement on swallowing, coughing, and an intact gag reflex, as well as disorder-specific decreased brain activation on functional MRI. A diagnosis of ND of the palate should be considered for patients who present with hypernasal speech. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Catherine F Sinclair
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, Mount Sinai Icahn School of Medicine, New York, New York, U.S.A
- New York Center for Voice and Swallowing Disorders, Mount Sinai Icahn School of Medicine, New York, New York, U.S.A
| | - Kristina Simonyan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, Mount Sinai Icahn School of Medicine, New York, New York, U.S.A
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mitchell F Brin
- Department of Neurology, University of California, Irvine, Irvine, California, U.S.A
| | - Andrew Blitzer
- New York Center for Voice and Swallowing Disorders, Mount Sinai Icahn School of Medicine, New York, New York, U.S.A
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
- Department of Otolaryngology, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
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Neumann WJ, Jha A, Bock A, Huebl J, Horn A, Schneider GH, Sander TH, Litvak V, Kühn AA. Cortico-pallidal oscillatory connectivity in patients with dystonia. Brain 2015; 138:1894-906. [PMID: 25935723 DOI: 10.1093/brain/awv109] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/26/2015] [Indexed: 12/12/2022] Open
Abstract
Primary dystonia has been associated with an underlying dysfunction of a wide network of brain regions including the motor cortex, basal ganglia, cerebellum, brainstem and spinal cord. Dystonia can be effectively treated by pallidal deep brain stimulation although the mechanism of this effect is not well understood. Here, we sought to characterize cortico-basal ganglia functional connectivity using a frequency-specific measure of connectivity-coherence. We recorded direct local field potentials from the human pallidum simultaneously with whole head magnetoencephalography to characterize functional connectivity in the cortico-pallidal oscillatory network in nine patients with idiopathic dystonia. Three-dimensional cortico-pallidal coherence images were compared to surrogate images of phase shuffled data across patients to reveal clusters of significant coherence (family-wise error P < 0.01, voxel extent 1000). Three frequency-specific, spatially-distinct cortico-pallidal networks have been identified: a pallido-temporal source of theta band (4-8 Hz) coherence, a pallido-cerebellar source of alpha band (7-13 Hz) coherence and a cortico-pallidal source of beta band (13-30 Hz) coherence over sensorimotor areas. Granger-based directionality analysis revealed directional coupling with the pallidal local field potentials leading in the theta and alpha band and the magnetoencephalographic cortical source leading in the beta band. The degree of pallido-cerebellar coupling showed an inverse correlation with dystonic symptom severity. Our data extend previous findings in patients with Parkinson's disease describing motor cortex-basal ganglia oscillatory connectivity in the beta band to patients with dystonia. Source coherence analysis revealed two additional frequency-specific networks involving the temporal cortex and the cerebellum. Pallido-cerebellar oscillatory connectivity and its association with dystonic symptoms provides further confirmation of cerebellar involvement in dystonia that has been recently reported using functional magnetic resonance imaging and fibre tracking.
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Affiliation(s)
- Wolf-Julian Neumann
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany 2 The Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London WC1N 3BG, UK
| | - Ashwani Jha
- 3 Sobell Department of Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Antje Bock
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Julius Huebl
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Andreas Horn
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Gerd-Helge Schneider
- 4 Department of Neurosurgery, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany
| | - Tillmann H Sander
- 5 Physikalisch-Technische Bundesanstalt, Institut Berlin, Abbestr. 2-12, 10587 Berlin, Germany
| | - Vladimir Litvak
- 2 The Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, 12 Queen Square, London WC1N 3BG, UK
| | - Andrea A Kühn
- 1 Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1,13353 Berlin, Germany 6 Berlin School of Mind and Brain, Charité - University Medicine Berlin, Unter den Linden 6, 10099 Berlin,Germany Berlin, Germany 7 NeuroCure, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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269
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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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270
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Kim JH, Kim D, Kim JB, Suh S, Koh S. Thalamic involvement in paroxysmal kinesigenic dyskinesia: a combined structural and diffusion tensor MRI analysis. Hum Brain Mapp 2015; 36:1429-41. [PMID: 25504906 PMCID: PMC6869556 DOI: 10.1002/hbm.22713] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/14/2014] [Accepted: 11/30/2014] [Indexed: 11/08/2022] Open
Abstract
Alteration of basal ganglia-thalamocortical circuit has been hypothesized to play a role in the pathophysiology underlying paroxysmal kinesigenic dyskinesia (PKD). We investigated macrostructural and microstructural changes in PKD patients using structural and diffusion tensor magnetic resonance imaging (MRI) analyses. Twenty-five patients with idiopathic PKD and 25 control subjects were prospectively studied on a 3T magnetic resonance (MR) scanner. Cortical thickness analysis was used to evaluate cortical gray matter (GM) changes, and automated volumetry and shape analysis were used to assess volume changes and shape deformation of the subcortical GM structures, respectively. Tract-based spatial statistics (TBSS) was used to evaluate white matter integrity changes in a whole-brain manner, and region-of-interest (ROI) analysis of diffusion tensor metrics was performed in subcortical GM structures. Compared to controls, PKD patients exhibited a reduction in volume of bilateral thalami and regional shape deformation mainly localized to the anterior and medial aspects of bilateral thalami. TBSS revealed an increase in fractional anisotropy (FA) of bilateral thalami and right anterior thalamic radiation in patients relative to controls. ROI analysis also showed an increase in FA of bilateral thalami in patients compared to controls. We have shown evidence for thalamic abnormalities of volume reduction, regional shape deformation, and increased FA in patients with PKD. Our novel findings of concomitant macrostructural and microstructural abnormalities in the thalamus lend further support to previous observations indicating causal relationship between a preferential lesion in the thalamus and development of PKD, thus providing neuroanatomical basis for the involvement of thalamus within the basal ganglia-thalamocortical pathway in PKD.
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Affiliation(s)
- Ji Hyun Kim
- Department of NeurologyKorea University Guro Hospital, Korea University College of MedicineSeoulKorea
| | - Dong‐Wook Kim
- Department of NeurologyKonkuk University Hospital, Konkuk University College of MedicineSeoulKorea
| | - Jung Bin Kim
- Department of NeurologyKorea University Guro Hospital, Korea University College of MedicineSeoulKorea
| | - Sang‐il Suh
- Department of RadiologyKorea University Guro Hospital, Korea University College of MedicineSeoulKorea
| | - Seong‐Beom Koh
- Department of NeurologyKorea University Guro Hospital, Korea University College of MedicineSeoulKorea
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271
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Pettorossi VE, Panichi R, Botti FM, Biscarini A, Filippi GM, Schieppati M. Long-lasting effects of neck muscle vibration and contraction on self-motion perception of vestibular origin. Clin Neurophysiol 2015; 126:1886-900. [PMID: 25812729 DOI: 10.1016/j.clinph.2015.02.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To show that neck proprioceptive input can induce long-term effects on vestibular-dependent self-motion perception. METHODS Motion perception was assessed by measuring the subject's error in tracking in the dark the remembered position of a fixed target during whole-body yaw asymmetric rotation of a supporting platform, consisting in a fast rightward half-cycle and a slow leftward half-cycle returning the subject to the initial position. Neck muscles were relaxed or voluntarily contracted, and/or vibrated. Whole-body rotation was administered during or at various intervals after the vibration train. The tracking position error (TPE) at the end of the platform rotation was measured during and after the muscle conditioning maneuvers. RESULTS Neck input produced immediate and sustained changes in the vestibular perceptual response to whole-body rotation. Vibration of the left sterno-cleido-mastoideus (SCM) or right splenius capitis (SC) or isometric neck muscle effort to rotate the head to the right enhanced the TPE by decreasing the perception of the slow rotation. The reverse effect was observed by activating the contralateral muscle. The effects persisted after the end of SCM conditioning, and slowly vanished within several hours, as tested by late asymmetric rotations. The aftereffect increased in amplitude and persistence by extending the duration of the vibration train (from 1 to 10min), augmenting the vibration frequency (from 5 to 100Hz) or contracting the vibrated muscle. Symmetric yaw rotation elicited a negligible TPE, upon which neck muscle vibrations were ineffective. CONCLUSIONS Neck proprioceptive input induces enduring changes in vestibular-dependent self-motion perception, conditional on the vestibular stimulus feature, and on the side and the characteristics of vibration and status of vibrated muscles. This shows that our perception of whole-body yaw-rotation is not only dependent on accurate vestibular information, but is modulated by proprioceptive information related to previously experienced position of head with respect to trunk. SIGNIFICANCE Tonic proprioceptive inflow, as might occur as a consequence of enduring or permanent head postures, can induce adaptive plastic changes in vestibular-dependent motion sensitiveness. These changes might be counteracted by vibration of selected neck muscles.
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Affiliation(s)
| | - Roberto Panichi
- Department of Experimental Medicine, University of Perugia, Italy
| | | | - Andrea Biscarini
- Department of Experimental Medicine, University of Perugia, Italy
| | | | - Marco Schieppati
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy; Centro Studi Attività Motorie, Fondazione Salvatore Maugeri (IRCCS), Pavia, Italy.
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272
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Ren J, Lei D, Yang T, An D, Xiao F, Li L, Huang X, Gong Q, Zhou D. Increased interhemispheric resting-state functional connectivity in paroxysmal kinesigenic dyskinesia: a resting-state fMRI study. J Neurol Sci 2015; 351:93-98. [PMID: 25783010 DOI: 10.1016/j.jns.2015.02.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder. The underlying neural mechanisms have not been fully understood. This study aimed to examine the alteration of resting-state functional connectivity (RSFC) between interhemispheric homotopic regions in PKD using a technique called "voxel-mirrored homotopic connectivity" (VMHC). METHODS The VMHC analysis was performed on resting-state functional MRI data from 11 PKD patients and 17 age and gender matched healthy subjects. Comparison between the two groups was conducted. The correlation relationship between VMHC and illness duration was analyzed. RESULTS Compared with healthy subjects, PKD patients showed increased interhemispheric RSFC in bilateral putamen, primary motor cortex, supplementary motor area, dorsal lateral prefrontal cortex, primary somatosensory cortex, superior and middle occipital gyri, as well as cerebellar tonsil. Besides, negative correlation was detected between illness duration and VMHC in bilateral putamen and the insular cortex. CONCLUSION The present study provided preliminary evidence of increased interhemispheric RSFC in PKD mainly in the basal ganglia-thalamo-cortical circuitry and cerebellum. A negative correlation between VMHC and illness duration was also detected. These findings could further enhance our understandings of the pathophysiology of PKD.
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Affiliation(s)
- Jiechuan Ren
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tianhua Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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273
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Striatal cholinergic dysfunction as a unifying theme in the pathophysiology of dystonia. Prog Neurobiol 2015; 127-128:91-107. [PMID: 25697043 DOI: 10.1016/j.pneurobio.2015.02.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/05/2015] [Accepted: 02/07/2015] [Indexed: 01/06/2023]
Abstract
Dystonia is a movement disorder of both genetic and non-genetic causes, which typically results in twisted posturing due to abnormal muscle contraction. Evidence from dystonia patients and animal models of dystonia indicate a crucial role for the striatal cholinergic system in the pathophysiology of dystonia. In this review, we focus on striatal circuitry and the centrality of the acetylcholine system in the function of the basal ganglia in the control of voluntary movement and ultimately clinical manifestation of movement disorders. We consider the impact of cholinergic interneurons (ChIs) on dopamine-acetylcholine interactions and examine new evidence for impairment of ChIs in dysfunction of the motor systems producing dystonic movements, particularly in animal models. We have observed paradoxical excitation of ChIs in the presence of dopamine D2 receptor agonists and impairment of striatal synaptic plasticity in a mouse model of DYT1 dystonia, which are improved by administration of recently developed M1 receptor antagonists. These findings have been confirmed across multiple animal models of DYT1 dystonia and may represent a common endophenotype by which to investigate dystonia induced by other types of genetic and non-genetic causes and to investigate the potential effectiveness of pharmacotherapeutics and other strategies to improve dystonia.
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274
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Leijnse JNAL, Hallett M, Sonneveld GJ. A multifactorial conceptual model of peripheral neuromusculoskeletal predisposing factors in task-specific focal hand dystonia in musicians: etiologic and therapeutic implications. BIOLOGICAL CYBERNETICS 2015; 109:109-123. [PMID: 25323627 PMCID: PMC7299354 DOI: 10.1007/s00422-014-0631-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/04/2014] [Indexed: 05/28/2023]
Abstract
A model is presented showing how peripheral factors may cause a process of movement adaptation that leads to task-specific focal hand dystonia in musicians (FHDM). To acquire a playing technique, the hand must find effective and physiologically sustainable movements within a complex set of functional demands and anatomic, ergonomic, and physiological constraints. In doing so, individually discriminating constraints may become effective, such as limited anatomic independence of finger muscles/tendons, limited joint ranges of motion, or (subclinical) neuromusculoskeletal defects. These factors may, depending on the instrument-specific playing requirements, compromise or exclude functional playing movements. The controller (i.e., the brain) then needs to develop alternative motions to execute the task, which is called compensation. We hypothesize that, if this compensation process does not converge to physiologically sustainable muscle activation patterns that satisfy all constraints, compensation could increase indefinitely under the pressure of practice. Dystonic symptoms would become manifest when overcompensation occurs, resulting in motor patterns that fail in proper task execution. The model presented in this paper only concerns the compensatory processes preceding such overcompensations and does not aim to explain the nature of the dystonic motions themselves. While the model considers normal learning processes in the development of compensations, neurological predispositions could facilitate developing overcompensations or further abnormal motor programs. The model predicts that if peripheral factors are involved, FHDM symptoms would be preceded by long-term gradual changes in playing movements, which could be validated by prospective studies. Furthermore, the model implies that treatment success might be enhanced by addressing the conflict between peripheral factors and playing tasks before decompensating/retraining the affected movements.
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Affiliation(s)
- J N A L Leijnse
- Department of Bio-, Electro- and Mechanical Systems (BEAMS), Faculty of Applied Sciences, Université Libre de Bruxelles, Av. Fr. Roosevelt 50, 1050, Brussels, Belgium,
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275
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Bharath RD, Biswal BB, Bhaskar MV, Gohel S, Jhunjhunwala K, Panda R, George L, Gupta AK, Pal PK. Repetitive transcranial magnetic stimulation induced modulations of resting state motor connectivity in writer's cramp. Eur J Neurol 2015; 22:796-805, e53-4. [PMID: 25623591 DOI: 10.1111/ene.12653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Writer's cramp (WC) is a focal task-specific dystonia of the hand which is increasingly being accepted as a network disorder. Non-invasive cortical stimulation using repetitive transcranial magnetic stimulation (rTMS) has produced therapeutic benefits in some of these patients. This study aimed to visualize the motor network abnormalities in WC and also its rTMS induced modulations using resting state functional magnetic resonance imaging (rsfMRI). METHODS Nineteen patients with right-sided WC and 20 matched healthy controls (HCs) were prospectively evaluated. All patients underwent a single session of rTMS and rsfMRI was acquired before (R1) and after (R2) rTMS. Seed-based functional connectivity analysis of several regions in the motor network was performed for HCs, R1 and R2 using SPM8 software. Thresholded (P < 0.05, false discovery rate corrected) group level mean correlation maps were used to derive significantly connected region of interest pairs. RESULTS Writer's cramp showed a significant reduction in resting state functional connectivity in comparison with HCs involving the left cerebellum, thalamus, globus pallidus, putamen, bilateral supplementary motor area, right medial prefrontal lobe and right post central gyrus. After rTMS there was a significant increase in the contralateral resting state functional connectivity through the left thalamus-right globus pallidus-right thalamus-right prefrontal lobe network loop. CONCLUSIONS It is concluded that WC is a network disorder with widespread dysfunction much larger than clinically evident and changes induced by rTMS probably act through subcortical and trans-hemispheric unaffected connections. Longitudinal studies with therapeutic rTMS will be required to ascertain whether such information could be used to select patients prior to rTMS therapy.
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Affiliation(s)
- R D Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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276
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Santello M, Lang CE. Are movement disorders and sensorimotor injuries pathologic synergies? When normal multi-joint movement synergies become pathologic. Front Hum Neurosci 2015; 8:1050. [PMID: 25610391 PMCID: PMC4285090 DOI: 10.3389/fnhum.2014.01050] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system’s ability to control movement.
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Affiliation(s)
- Marco Santello
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University , Tempe, AZ , USA
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine in St. Louis , St. Louis, MO , USA
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277
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Baizabal-Carvallo JF, Cardoso F, Jankovic J. Myorhythmia: Phenomenology, etiology, and treatment. Mov Disord 2014; 30:171-9. [DOI: 10.1002/mds.26093] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/28/2014] [Accepted: 11/01/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic; Department of Neurology; Baylor College of Medicine; Houston Texas USA
| | - Francisco Cardoso
- Movement Disorders Clinic; Neurology Service; Department of Internal Medicine; The Federal University of Minas Gerais; Belo Horizonte MG Brazil
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic; Department of Neurology; Baylor College of Medicine; Houston Texas USA
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278
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Avanzino L, Fiorio M. Proprioceptive dysfunction in focal dystonia: from experimental evidence to rehabilitation strategies. Front Hum Neurosci 2014; 8:1000. [PMID: 25538612 PMCID: PMC4260499 DOI: 10.3389/fnhum.2014.01000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/25/2014] [Indexed: 11/13/2022] Open
Abstract
Dystonia has historically been considered a disorder of the basal ganglia, mainly affecting planning and execution of voluntary movements. This notion comes from the observation that most lesions responsible for secondary dystonia involve the basal ganglia. However, what emerges from recent research is that dystonia is linked to the dysfunction of a complex neural network that comprises basal ganglia–thalamic–frontal cortex, but also the inferior parietal cortex and the cerebellum. While dystonia is clearly a motor problem, it turned out that sensory aspects are also fundamental, especially those related to proprioception. We outline experimental evidence for proprioceptive dysfunction in focal dystonia from intrinsic sensory abnormalities to impaired sensorimotor integration, which is the process by which sensory information is used to plan and execute volitional movements. Particularly, we will focus on proprioceptive aspects of dystonia, including: (i) processing of vibratory input, (ii) temporal discrimination of two passive movements, (iii) multimodal integration of visual-tactile and proprioceptive inputs, and (iv) motor control in the absence of visual feedback. We suggest that these investigations contribute not only to a better understanding of dystonia pathophysiology, but also to develop rehabilitation strategies aimed at facilitating the processing of proprioceptive input.
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Affiliation(s)
- Laura Avanzino
- Section of Human Physiology, Department of Experimental Medicine, Centro Polifunzionale di Scienze Motorie, University of Genoa , Genoa , Italy
| | - Mirta Fiorio
- Department of Neurological and Movement Sciences, University of Verona , Verona , Italy
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279
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Quartarone A, Rizzo V, Terranova C, Milardi D, Bruschetta D, Ghilardi MF, Girlanda P. Sensory abnormalities in focal hand dystonia and non-invasive brain stimulation. Front Hum Neurosci 2014; 8:956. [PMID: 25538594 PMCID: PMC4257013 DOI: 10.3389/fnhum.2014.00956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022] Open
Abstract
It has been proposed that synchronous and convergent afferent input arising from repetitive motor tasks may play an important role in driving the maladaptive cortical plasticity seen in focal hand dystonia (FHD). This hypothesis receives support from several sources. First, it has been reported that in subjects with FHD, paired associative stimulation produces an abnormal increase in corticospinal excitability, which was not confined to stimulated muscles. These findings provide support for the role of excessive plasticity in FHD. Second, the genetic contribution to the dystonias is increasingly recognized indicating that repetitive, stereotyped afferent inputs may lead to late-onset dystonia, such as FHD, more rapidly in genetically susceptible individuals. It can be postulated, according to the two factor hypothesis that dystonia is triggered and maintained by the concurrence of environmental factors such as repetitive training and subtle abnormal mechanisms of plasticity within somatosensory loop. In the present review, we examine the contribution of sensory-motor integration in the pathophysiology of primary dystonia. In addition, we will discuss the role of non-invasive brain stimulation as therapeutic approach in FHD.
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Affiliation(s)
- Angelo Quartarone
- Department of Neurosciences, Psychiatry and Anaesthesiological Sciences, University of Messina , Messina , Italy ; Department of Physiology, Pharmacology and Neuroscience, City University of New York (CUNY) Medical School , New York, NY , USA
| | - Vincenzo Rizzo
- Department of Neurosciences, Psychiatry and Anaesthesiological Sciences, University of Messina , Messina , Italy
| | - Carmen Terranova
- Department of Neurosciences, Psychiatry and Anaesthesiological Sciences, University of Messina , Messina , Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy ; Department of Biomedical Science and Morphological and Functional Images, University of Messina , Messina , Italy
| | - Daniele Bruschetta
- Department of Biomedical Science and Morphological and Functional Images, University of Messina , Messina , Italy
| | - Maria Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, City University of New York (CUNY) Medical School , New York, NY , USA
| | - Paolo Girlanda
- Department of Neurosciences, Psychiatry and Anaesthesiological Sciences, University of Messina , Messina , Italy
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280
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Jinnah H, Albanese A. The New Classification System for the Dystonias: Why Was it Needed and How was it Developed? Mov Disord Clin Pract 2014; 1:280-284. [PMID: 25485288 PMCID: PMC4254809 DOI: 10.1002/mdc3.12100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/18/2022] Open
Affiliation(s)
- H.A. Jinnah
- Departments of Neurology, Human Genetics and PediatricsEmory UniversityAtlantaGeorgia30322USA
| | - Alberto Albanese
- Department of NeurologyCatholic UniversityMilanItaly
- Department of NeurologyCarlo Besta Institute of NeurologyMilanItaly
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Lin JP, Lumsden DE, Gimeno H, Kaminska M. The impact and prognosis for dystonia in childhood including dystonic cerebral palsy: a clinical and demographic tertiary cohort study. J Neurol Neurosurg Psychiatry 2014; 85:1239-44. [PMID: 24591458 DOI: 10.1136/jnnp-2013-307041] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND METHODS The impact of dystonia in childhood is poorly understood. We report our experience of referrals between 2005 and 2012. RESULTS Of 294/315 assessable children, 15/294 had pure spasticity, leaving 279/294 with dystonia classified as primary (30/279:10.7%); primary-plus (19/279:6.8%) and secondary (230/279:82.4%) dystonia, including heredodegenerative dystonia (29/279:10.3%); 150/279 (53.7%) with cerebral palsy and 51/279 (18.2%) acquired brain injury. Definitive diagnoses were available in 222/294 (79.6%), but lower in primary/primary-plus compared with secondary groups (11/49 vs 211/230: Fisher's exact test p<0.0001). Spasticity comorbidity was present in 79/230 (34.3%) children. Median age (interquartile years) at referral was 9.75 (6.58-13), not significantly differing by aetiology (Kruskal-Wallis test p>0.05); dystonia-onset age was 3 (0.5-7.0) for primary/primary-plus and 0.25 (0.08-0.8) in the secondary/CP groups. Dystonia duration at referral was 4.75 years (3.0-10.33) for primary/primary-plus groups and 7.83 (5.4-11) in the secondary group. The mean (interquartile range) proportion of life lived with dystonia, derived as dystonia duration normalised to age was 0.68 (0.31-0.96); 0.59 (0.35-0.8); 0.75 (0.62-0.95)and 0.9 (0.92-0.99) for primary, primary-plus, heredodegenerative and secondary-static dystonias respectively. Only 91/279 (32.6%) experienced a period of normal motor development. Carers perceived dystonia deterioration in 168/279 (60.2%), stabilisation in 88/279 (31.5%) and improvement in 23/279 (8.2%). Dystonia occurred in 26/225 (11.6%) siblings: 14/26 secondary and 5/26 heredodegenerative dystonia. Comorbidities were identified in 176/279 (63.1%) cases. Gross Motor Function Classification System (GMFCS) levels I-III were commoner in primary/primary-plus (37/49: 75%) compared with secondary/CP (29/230:13%) cases, χ(2) p<0.0001). DISCUSSION In this selective cohort, childhood dystonia is severe, presenting early before worsening without remission. Secondary dystonias spend a higher proportion of life living with dystonia and lower functional capacity. Despite referral bias, services offering neurosurgical interventions and health service planning agencies should understand the context and predicament of life with childhood dystonia.
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Affiliation(s)
- Jean-Pierre Lin
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Daniel E Lumsden
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK Rayne Institute, King's College London, London, UK
| | - Hortensia Gimeno
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Margaret Kaminska
- Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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282
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Pirio Richardson S. Enhanced dorsal premotor-motor inhibition in cervical dystonia. Clin Neurophysiol 2014; 126:1387-91. [PMID: 25468241 DOI: 10.1016/j.clinph.2014.10.140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/29/2014] [Accepted: 10/12/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aims to understand whether the enhanced dPMI, seen in writer's cramp patients previously, extends to other populations of focal dystonia patients (e.g. cervical dystonia) as an endophenotypic marker. METHODS We studied 9 healthy subjects and 9 patients with CD. dPMI was tested by applying conditioning transcranial magnetic stimulation to the left dorsal premotor cortex and then a test pulse to the ipsilateral motor cortex at an interval of 6ms. We also looked at the duration of the cortical silent period (CSP)-a measure of cortical excitability. RESULTS CD patients had enhanced dPMI at rest (mean 57.0%, SD 16.2) in contrast to healthy volunteers (mean 124.1%, SD 35.7) (p<0.001). CSP latencies (in ms) in CD patients (mean 108.0, SD 33.1) were significantly shorter than in healthy volunteers (mean 159.1, SD 55.2) (p<0.05). CONCLUSIONS CD patients showed enhanced dPMI in a hand muscle-distant from their affected body part-similar to writer's cramp patients. This enhanced inhibition was independent of disease severity and neck posture. This suggests that enhanced dPMI may be an endophenotypic marker of dystonia. SIGNIFICANCE The abnormal dorsal premotor-motor connection in cervical dystonia is a potential novel and important avenue for therapeutic targeting.
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Affiliation(s)
- Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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283
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Barow E, Neumann WJ, Brücke C, Huebl J, Horn A, Brown P, Krauss JK, Schneider GH, Kühn AA. Deep brain stimulation suppresses pallidal low frequency activity in patients with phasic dystonic movements. ACTA ACUST UNITED AC 2014; 137:3012-3024. [PMID: 25212852 DOI: 10.1093/brain/awu258] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep brain stimulation of the globus pallidus internus alleviates involuntary movements in patients with dystonia. However, the mechanism is still not entirely understood. One hypothesis is that deep brain stimulation suppresses abnormally enhanced synchronized oscillatory activity within the motor cortico-basal ganglia network. Here, we explore deep brain stimulation-induced modulation of pathological low frequency (4-12 Hz) pallidal activity that has been described in local field potential recordings in patients with dystonia. Therefore, local field potentials were recorded from 16 hemispheres in 12 patients undergoing deep brain stimulation for severe dystonia using a specially designed amplifier allowing simultaneous high frequency stimulation at therapeutic parameter settings and local field potential recordings. For coherence analysis electroencephalographic activity (EEG) over motor areas and electromyographic activity (EMG) from affected neck muscles were recorded before and immediately after cessation of high frequency stimulation. High frequency stimulation led to a significant reduction of mean power in the 4-12 Hz band by 24.8 ± 7.0% in patients with predominantly phasic dystonia. A significant decrease of coherence between cortical EEG and pallidal local field potential activity in the 4-12 Hz range was revealed for the time period of 30 s after switching off high frequency stimulation. Coherence between EMG activity and pallidal activity was mainly found in patients with phasic dystonic movements where it was suppressed after high frequency stimulation. Our findings suggest that high frequency stimulation may suppress pathologically enhanced low frequency activity in patients with phasic dystonia. These dystonic features are the quickest to respond to high frequency stimulation and may thus directly relate to modulation of pathological basal ganglia activity, whereas improvement in tonic features may depend on long-term plastic changes within the motor network.
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Affiliation(s)
- Ewgenia Barow
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Julius Huebl
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medical University Hannover, MHH, Hannover, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
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Abstract
Recent advances in structural and functional imaging have greatly improved our ability to assess normal functions of the basal ganglia, diagnose parkinsonian syndromes, understand the pathophysiology of parkinsonism and other movement disorders, and detect and monitor disease progression. Radionuclide imaging is the best way to detect and monitor dopamine deficiency, and will probably continue to be the best biomarker for assessment of the effects of disease-modifying therapies. However, advances in magnetic resonance enable the separation of patients with Parkinson's disease from healthy controls, and show great promise for differentiation between Parkinson's disease and other akinetic-rigid syndromes. Radionuclide imaging is useful to show the dopaminergic basis for both motor and behavioural complications of Parkinson's disease and its treatment, and alterations in non-dopaminergic systems. Both PET and MRI can be used to study patterns of functional connectivity in the brain, which is disrupted in Parkinson's disease and in association with its complications, and in other basal-ganglia disorders such as dystonia, in which an anatomical substrate is not otherwise apparent. Functional imaging is increasingly used to assess underlying pathological processes such as neuroinflammation and abnormal protein deposition. This imaging is another promising approach to assess the effects of treatments designed to slow disease progression.
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Affiliation(s)
- A Jon Stoessl
- Pacific Parkinson's Research Centre and National Parkinson Foundation Centre of Excellence, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada.
| | - Stephane Lehericy
- Institut National de la Santé et de la Recherche Médicale, U 1127, F-75013, Paris, France; Centre National de la Recherche Scientifique, Unite Mixte de Recherche 7225, F-75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Unite Mixte de Recherche S 1127, F-75013, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM (Centre de NeuroImagerie de Recherche, CENIR), F-75013, Paris, France; Assistance Publique, Hopitaux de Paris, Hôpital de la Pitié Salpêtrière, Service de Neuroradiologie F-75013, Paris, France
| | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit and E J Safra Parkinson Disease Program, University of Toronto, Toronto, ON, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Hospital and Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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286
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Comparative characterization of single cell activity in the globus pallidus internus of patients with dystonia or Tourette syndrome. J Neural Transm (Vienna) 2014; 122:687-99. [DOI: 10.1007/s00702-014-1277-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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287
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Gündüz A, Ergin H, Kızıltan ME. Long latency trigemino-cervical reflex in patients with cervical dystonia. Neurol Sci 2014; 36:103-8. [PMID: 25056194 DOI: 10.1007/s10072-014-1893-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
Trigemino-cervical reflex (TCR) is elicited by stimulation of face using various modalities. TCR reflects the interaction between trigeminal system and cervical motoneurons. Such a specific interaction is assumed to play role in development of cervical dystonia (CD) through superior colliculus. In this study, we aimed to investigate alterations of the functional relationship between those structures in CD and in a subgroup with dystonic tremor. A total of consecutive 23 patients with primary CD (7 men, 16 women) and 16 age and sex matched control subjects (7 men, 9 women) were included in this study. TCR was obtained after percutaneous electrical stimulation (with duration of 0.5 ms) of infraorbital branch of trigeminal nerve while recording over splenius capitis and sternocleidomastoid muscles. Presence and onset latencies of TCR did not differ significantly between patients with CD and controls, and same pattern of muscle activation occurred in both groups. Responses of patient group seemed to have higher amplitudes and to be more persistent. There were no significant side-to-side differences of TCR probability, latency, amplitude or duration with respect to the side of head deviation in CD. Increased amplitudes and durations of responses probably reflect increased excitability of the reflex circuit. We suggest that similar latencies and response pattern in comparison to healthy individuals decrease the possibility of structural disturbance. TCR is probably under bilateral basal ganglia and dopaminergic control. Alterations of trigemino-cervical pathway are more extensive and are not solely due to local changes of brainstem interneurons.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Cerrahpasa School of Medicine, Istanbul University, K.M. Pasa, 34098, Istanbul, Turkey,
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Genetic animal models of dystonia: common features and diversities. Prog Neurobiol 2014; 121:91-113. [PMID: 25034123 DOI: 10.1016/j.pneurobio.2014.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 01/13/2023]
Abstract
Animal models are pivotal for studies of pathogenesis and treatment of disorders of the central nervous system which in its complexity cannot yet be modeled in vitro or using computer simulations. The choice of a specific model to test novel therapeutic strategies for a human disease should be based on validity of the model for the approach: does the model reflect symptoms, pathogenesis and treatment response present in human patients? In the movement disorder dystonia, prior to the availability of genetically engineered mice, spontaneous mutants were chosen based on expression of dystonic features, including abnormal muscle contraction, movements and postures. Recent discovery of a number of genes and gene products involved in dystonia initiated research on pathogenesis of the disorder, and the creation of novel models based on gene mutations. Here we present a review of current models of dystonia, with a focus on genetic rodent models, which will likely be first choice in the future either for pathophysiological or for preclinical drug testing or both. In order to help selection of a model depending on expression of a specific feature of dystonia, this review is organized by symptoms and current knowledge of pathogenesis of dystonia. We conclude that albeit there is increasing need for research on pathogenesis of the disease and development of improved models, current models do replicate features of dystonia and are useful tools to develop urgently demanded treatment for this debilitating disorder.
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289
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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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290
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Sadnicka A, Hamada M, Bhatia KP, Rothwell JC, Edwards MJ. A reflection on plasticity research in writing dystonia. Mov Disord 2014; 29:980-7. [DOI: 10.1002/mds.25908] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/21/2014] [Accepted: 04/11/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anna Sadnicka
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - Masashi Hamada
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
- Department of Neurology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London; London UK
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291
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Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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292
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Abstract
This chapter focuses on neurodevelopmental diseases that are tightly linked to abnormal function of the striatum and connected structures. We begin with an overview of three representative diseases in which striatal dysfunction plays a key role--Tourette syndrome and obsessive-compulsive disorder, Rett's syndrome, and primary dystonia. These diseases highlight distinct etiologies that disrupt striatal integrity and function during development, and showcase the varied clinical manifestations of striatal dysfunction. We then review striatal organization and function, including evidence for striatal roles in online motor control/action selection, reinforcement learning, habit formation, and action sequencing. A key barrier to progress has been the relative lack of animal models of these diseases, though recently there has been considerable progress. We review these efforts, including their relative merits providing insight into disease pathogenesis, disease symptomatology, and basal ganglia function.
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293
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Dystonia as a network disorder: what is the role of the cerebellum? Neuroscience 2013; 260:23-35. [PMID: 24333801 DOI: 10.1016/j.neuroscience.2013.11.062] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 01/02/2023]
Abstract
The dystonias are a group of disorders defined by sustained or intermittent muscle contractions that result in involuntary posturing or repetitive movements. There are many different clinical manifestations and causes. Although they traditionally have been ascribed to dysfunction of the basal ganglia, recent evidence has suggested dysfunction may originate from other regions, particularly the cerebellum. This recent evidence has led to an emerging view that dystonia is a network disorder that involves multiple brain regions. The new network model for the pathogenesis of dystonia has raised many questions, particularly regarding the role of the cerebellum. For example, if dystonia may arise from cerebellar dysfunction, then why are there no cerebellar signs in dystonia? Why are focal cerebellar lesions or degenerative cerebellar disorders more commonly associated with ataxia rather than dystonia? Why is dystonia more commonly associated with basal ganglia lesions rather than cerebellar lesions? Can answers obtained from animals be extrapolated to humans? Is there any evidence that the cerebellum is not involved? Finally, what is the practical value of this new model of pathogenesis for the neuroscientist and clinician? This article explores potential answers to these questions.
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294
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Lerner RP, Niethammer M, Eidelberg D. Understanding the anatomy of dystonia: determinants of penetrance and phenotype. Curr Neurol Neurosci Rep 2013; 13:401. [PMID: 24114145 PMCID: PMC3883436 DOI: 10.1007/s11910-013-0401-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The dystonias comprise a group of syndromes characterized by prolonged involuntary muscle contractions resulting in repetitive movements and abnormal postures. Primary dystonia has been associated with over 14 different genotypes, most of which follow an autosomal dominant inheritance pattern with reduced penetrance. Independent of etiology, the disease is characterized by extensive variability in disease phenotype and clinical severity. Recent neuroimaging studies investigating this phenomenon in manifesting and non-manifesting genetic carriers of dystonia have discovered microstructural integrity differences in the cerebello-thalamo-cortical tract in both groups related to disease penetrance. Further study suggests these differences to be specific to subrolandic white matter regions somatotopically related to clinical phenotype. Clinical severity was correlated to the degree of microstructural change. These findings suggest a mechanism for the penetrance and clinical variability observed in dystonia and may represent a novel therapeutic target for patients with refractory limb symptoms.
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Affiliation(s)
- Renata P Lerner
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
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295
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Jinnah HA, DeLong M, Hallett M. The dystonias: past, present, and future. Mov Disord 2013; 28:849-50. [PMID: 23893441 PMCID: PMC3787865 DOI: 10.1002/mds.25564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- H. A. Jinnah
- Departments of Neurology, Human Genetics & Pediatrics, Emory University, Atlanta GA, USA
| | - Mahlon DeLong
- Department of Neurology, Pediatrics & Psychiatry, Emory University, Atlanta GA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD, USA
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296
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Jinnah HA, Berardelli A, Comella C, Defazio G, Delong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR. The focal dystonias: current views and challenges for future research. Mov Disord 2013; 28:926-43. [PMID: 23893450 PMCID: PMC3733486 DOI: 10.1002/mds.25567] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/11/2022] Open
Abstract
The most common forms of dystonia are those that develop in adults and affect a relatively isolated region of the body. Although these adult-onset focal dystonias are most prevalent, knowledge of their etiologies and pathogenesis has lagged behind some of the rarer generalized dystonias, in which the identification of genetic defects has facilitated both basic and clinical research. This summary provides a brief review of the clinical manifestations of the adult-onset focal dystonias, focusing attention on less well understood clinical manifestations that need further study. It also provides a simple conceptual model for the similarities and differences among the different adult-onset focal dystonias as a rationale for lumping them together as a class of disorders while at the same time splitting them into subtypes. The concluding section outlines some of the most important research questions for the future. Answers to these questions are critical for advancing our understanding of this group of disorders and for developing novel therapeutics.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia 30322, USA.
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