1
|
Quattrone A, Latorre A, Magrinelli F, Mulroy E, Rajan R, Neo RJ, Quattrone A, Rothwell JC, Bhatia KP. A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment. Mov Disord Clin Pract 2023; 10:1243-1252. [PMID: 37772299 PMCID: PMC10525069 DOI: 10.1002/mdc3.13798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 09/30/2023] Open
Abstract
In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.
Collapse
Affiliation(s)
- Andrea Quattrone
- Institute of NeurologyUniversity “Magna Graecia”CatanzaroItaly
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Ray Jen Neo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of NeurologyHospital Kuala LumpurKuala LumpurMalaysia
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Graecia”CatanzaroItaly
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| |
Collapse
|
2
|
Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins (Basel) 2021; 13:toxins13040282. [PMID: 33923397 PMCID: PMC8071570 DOI: 10.3390/toxins13040282] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia.
Collapse
|
3
|
Abstract
Writer's cramp is the most common form of focal, task-specific dystonia. Symptoms frequently evolve in the setting of repetitive hand movements and increased writing demands, and clinical presentations demonstrate a variety of different dystonic patterns of the upper extremity such as while writing or holding a writing utensil. However, why writer's cramp develops still remains much of a mystery. Clinical evaluation of patients with writer's cramp and various theories regarding its pathophysiology are reviewed. Treatment can be challenging and often involves a combination of pharmacologic (e.g., oral medications, botulinum toxin injections) and non-pharmacologic approaches (e.g., neurosurgical or neurostimulatory interventions, rehabilitation therapies, adaptive devices). Management strategies for writer's cramp using both of these approaches will be discussed.
Collapse
Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, USA.
| |
Collapse
|
4
|
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]
|
5
|
Fasano A, Bologna M, Iezzi E, Pavone L, Srour M, Di Biasio F, Grillea G, Rouleau GA, Levert A, Sebastiano F, Colonnese C, Berardelli A. Congenital Mirror Movements in a New Italian Family. Mov Disord Clin Pract 2014; 1:180-187. [PMID: 30713853 DOI: 10.1002/mdc3.12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/05/2014] [Accepted: 05/17/2014] [Indexed: 11/09/2022] Open
Abstract
Mirror movements (MMs) occur on the contralateral side of a limb being used intentionally. Because few families with congenital MMs and no other neurological signs have been reported, the underlying mechanisms of MMs are still not entirely clear. We report on the clinical, genetic, neurophysiological and neuroimaging findings of 10 of 26 living members of a novel four-generation family with congenital MMs. DCC and RAD51 were sequenced in affected members of the family. Five of the ten subjects with MMs underwent neurophysiological and neuroimaging evaluations. The neurophysiological evaluation consisted of electromyographic (EMG) mirror recordings, investigations of corticospinal excitability, and analysis of interhemispheric inhibition using transcranial magnetic stimulation techniques. The neuroimaging evaluation included functional MRI during finger movements. Eight (all females) of the ten members examined presented MMs of varying degrees at the clinical assessment. Transmission of MMs appears to have occurred according to an autosomal-dominant fashion with variable expression. No mutation in DCC or RAD51 was identified. EMG mirror activity was higher in MM subjects than in healthy controls. Short-latency interhemispheric inhibition was reduced in MM subjects. Ipsilateral motor-evoked potentials were detectable in the most severe case. The neuroimaging evaluation did not disclose any significant abnormalities in MM subjects. The variability of the clinical features of this family, and the lack of known genetic abnormalities, suggests that MMs are heterogeneous disorders. The pathophysiological mechanisms of MMs include abnormalities of transcallosal inhibition and corticospinal decussation.
Collapse
Affiliation(s)
- Alfonso Fasano
- Movement Disorders Center TWH, UHN, Division of Neurology University of Toronto Toronto Ontario Canada
| | | | - Ennio Iezzi
- Neuromed Institute IRCCS Pozzilli (IS) Italy
| | - Luigi Pavone
- Innomed srl Pozzilli (IS) Italy.,Neurone" Foundation for Research in Neuropsychobiology and Clinical Neurosciences Rome Italy
| | - Myriam Srour
- Sainte Justine Hospital Research Center Montréal Québec Canada.,Montréal Children's Hospital Department of Neurology and Neurosurgery McGill University Montréal Québec Canada
| | | | | | - Guy A Rouleau
- Montréal Neurological Institute Department of Neurology and Neurosurgery McGill University Montréal Québec Canada
| | - Annie Levert
- Montréal Neurological Institute Department of Neurology and Neurosurgery McGill University Montréal Québec Canada
| | | | - Claudio Colonnese
- Neuromed Institute IRCCS Pozzilli (IS) Italy.,Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Alfredo Berardelli
- Neuromed Institute IRCCS Pozzilli (IS) Italy.,Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| |
Collapse
|
6
|
Waissman FQB, Orsini M, Nascimento OJM, Leite MAA, Pereira JS. Sensitive Training Through Body Awareness to Improve the Writing of Patients with Writer's Cramp. Neurol Int 2013; 5:e24. [PMID: 24416488 PMCID: PMC3883069 DOI: 10.4081/ni.2013.e24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this article is to evaluate if body awareness is important to improve the writing ability before using the splints. Twelve patients with writer's cramp were evaluated by a specialist in movement disorders. The Burke-Fahn-Marsden Scale (BFM), the Jedynak Protocol and the Analog Pain Scale were used. The rehabilitation training was administered over an eight-week period, in two phases of four weeks each, twice a week. Each session would last 60 minutes. A significant improvement was shown, not only in the motor, but also in the pain perception, through the BFM scale, the Jedynak Protocol and the Analog Pain Scale. Therefore, we conclude that the motor training, thanks to the body awareness and immobilization by splints of the affected dystonic musculature, led to an important improvement in the writer's cramp writing.
Collapse
Affiliation(s)
- Flavia Quadros Boisson Waissman
- Neurology Department, Fluminense Federal University - UFF , Niteroi ; Movement Disorders Section, Neurology Service, Pedro Ernesto University Hospital , The Rio de Janeiro State University - UERJ
| | - Marco Orsini
- Neurology Department, Fluminense Federal University - UFF , Niteroi ; Science Reabilitation, University Center Augusto Motta - UNISUAM , Bonsucesso, Brazil
| | | | | | - João Santos Pereira
- Neurology Department, Fluminense Federal University - UFF , Niteroi ; Movement Disorders Section, Neurology Service, Pedro Ernesto University Hospital , The Rio de Janeiro State University - UERJ
| |
Collapse
|
7
|
Sivadasan A, Sanjay M, Alexander M, Devasahayam SR, Srinivasa BK. Utility of multi-channel surface electromyography in assessment of focal hand dystonia. Muscle Nerve 2013; 48:415-22. [PMID: 23861190 DOI: 10.1002/mus.23762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2012] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Surface electromyography (SEMG) allows objective assessment and guides selection of appropriate treatment in focal hand dystonia (FHD). METHODS Sixteen-channel SEMG obtained during different phases of a writing task was used to study timing, activation patterns, and spread of muscle contractions in FHD compared with normal controls. Customized software was developed to acquire and analyze EMG signals. RESULTS SEMG of FHD subjects (20) showed "early onset" during motor imagery, rapid proximal muscle recruitment, agonist-antagonist co-contraction involving proximal muscle groups, "delayed offset" after stopping writing, higher rectified mean amplitudes, and mirror activity in contralateral limb compared with controls (16). Muscle activation latencies were heterogenous in FHD. CONCLUSIONS Anticipation, delayed relaxation, and mirror EMG activation were noted in FHD. A clear pattern of muscle activation cannot be ascertained. Multi-channel SEMG can aid in objective assessment of temporal-spatial distribution of activity and can refine targeted therapies like chemodenervation and biofeedback.
Collapse
Affiliation(s)
- Ajith Sivadasan
- Department of Neurological Sciences, Christian Medical College, Vellore, India, 632004
| | | | | | | | | |
Collapse
|
8
|
Kushnir T, Arzouan Y, Karni A, Manor D. Brain activation associated with practiced left hand mirror writing. BRAIN AND LANGUAGE 2013; 125:38-46. [PMID: 23454072 DOI: 10.1016/j.bandl.2012.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 12/10/2012] [Accepted: 12/15/2012] [Indexed: 06/01/2023]
Abstract
Mirror writing occurs in healthy children, in various pathologies and occasionally in healthy adults. There are only scant experimental data on the underlying brain processes. Eight, right-handed, healthy young adults were scanned (BOLD-fMRI) before and after practicing left-hand mirror-writing (lh-MW) over seven sessions. They wrote dictated words, using either the right hand with regularly oriented writing or lh-MW. An MRI compatible stylus-point recording system was used and online visual feedback was provided. Practice resulted in increased speed and readability of lh-MW but the number of movement segments was unchanged. Post-training signal increases occurred in visual, right lateral and medial premotor areas, and in right anterior and posterior peri-sylvian areas corresponding to language areas. These results suggest that lh-MW may constitute a latent ability that can be reinstated by a relatively brief practice experience. Concurrently, right hemisphere language processing areas may emerge, reflecting perhaps a reduction in trans-hemispheric suppression.
Collapse
Affiliation(s)
- T Kushnir
- Dept. of Diagnostic Imaging, MRI Unit, The Sheba Medical Center, Tel Hashomer 52621, Israel.
| | | | | | | |
Collapse
|
9
|
Cox BC, Cincotta M, Espay AJ. Mirror movements in movement disorders: a review. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-59-398-1. [PMID: 23440079 PMCID: PMC3569961 DOI: 10.7916/d8vq31dz] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 12/30/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mirror movements (MM) are involuntary movements of homologous muscles during voluntary movements of contralateral body regions. While subtle mirroring can be present in otherwise healthy adults, overt MM may be common in many movement disorders. Examining these collective findings may further our understanding of MM and help define their usefulness as a clinical sign. METHODS We sought to review English language research articles examining the presence, clinical significance, and/or pathophysiology of MM in Parkinson's disease (PD), corticobasal syndrome (CBS), essential tremor (ET), focal hand dystonia, Creutzfeldt-Jakob's disease (CJD), and Huntington's disease. When available, MM in these disorders were compared with those of healthy age-matched controls and congenital disorders such as Klippel-Feil syndrome and X-linked Kallman's syndrome. RESULTS Clinical presentation of MM is common in asymmetric parkinsonian disorders (early PD, CBS) and manifests differently depending on the side affected (less affected hand in PD, more affected hand in CBS, either hand in ET, and both hands in healthy adults and congenital disorders), stage of disease (early, asymmetric PD and CJD), and presence of concomitant mirror-like overflow phenomena (focal dystonia and CBS-associated alien hand). In general, uncrossed descending corticospinal projections (congenital MM) and/or abnormal activation of the motor cortex ipsilateral to the voluntary task (most acquired MM), i.e., activation of the normal crossed corticospinal pathway, are required for the generation of MM. DISCUSSION MM are common motor phenomena and present differently in several acquired (mostly neurodegenerative) and congenital movement disorders. Future studies on MM will enhance the clinical diagnosis of selected movement disorders and contribute to our understanding of the normal physiology of bimanual coordination.
Collapse
Affiliation(s)
- Benjamin C. Cox
- University of Cincinnati Neuroscience Institute, Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, United States of America
| | | | - Alberto J. Espay
- University of Cincinnati Neuroscience Institute, Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, United States of America
| |
Collapse
|
10
|
Volkmann J. The Wilson films--Parkinson's disease. Mov Disord 2011; 26:2475-6. [PMID: 22170273 DOI: 10.1002/mds.24031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Short sequences in the Wilson film illustrate clinical aspects of bradykinesia and tremor in Parkinson's disease. What might have been the motivation of Wilson to capture these symptoms, and how would we view them today?
Collapse
Affiliation(s)
- Jens Volkmann
- Klinik für Neurologie, Universitätsklinikum Würzburg, Würzburg, Germany.
| |
Collapse
|
11
|
Marinelli L, Bonzano L, Saitta L, Trompetto C, Abbruzzese G. Continuous involuntary hand movements and schizencephaly: epilepsia partialis continua or dystonia? Neurol Sci 2011; 33:335-8. [PMID: 21720895 DOI: 10.1007/s10072-011-0674-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 06/20/2011] [Indexed: 11/29/2022]
Abstract
Schizencephaly is regarded as a malformation of cortical development (due to abnormal neuronal organization) and may be associated with continuous involuntary hand movements. The mechanisms underlying these movements are not clear and both dystonia and epilepsia partialis continua have been considered in previously reported cases. We describe a young patient affected by schizencephaly and continuous involuntary movements of the contralateral hand. Functional MRI showed bilateral cerebral activation, while the subject performed tapping movements with the affected hand and no significant difference in the activation pattern after diazepam infusion. Standard and back-averaged EEG showed no alterations. The results obtained from these investigations and the clinical features of the involuntary movements are not in favor of an epileptic genesis, while support the diagnosis of secondary dystonia.
Collapse
Affiliation(s)
- Lucio Marinelli
- Department of Neurosciences Ophthalmology and Genetics, Institute of Neurology, University of Genova, Largo Daneo 3, 16132 Genoa, Italy.
| | | | | | | | | |
Collapse
|
12
|
Beck S, Shamim EA, Richardson SP, Schubert M, Hallett M. Inter-hemispheric inhibition is impaired in mirror dystonia. Eur J Neurosci 2009; 29:1634-40. [PMID: 19419426 DOI: 10.1111/j.1460-9568.2009.06710.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surround inhibition, a neural mechanism relevant for skilled motor behavior, has been shown to be deficient in the affected primary motor cortex (M1) in patients with focal hand dystonia (FHD). Even in unilateral FHD, however, electrophysiological and neuroimaging studies have provided evidence for bilateral M1 abnormalities. Clinically, the presence of mirror dystonia, dystonic posturing when the opposite hand is moved, also suggests abnormal interhemispheric interaction. To assess whether a loss of inter-hemispheric inhibition (IHI) may contribute to the reduced surround inhibition, IHI towards the affected or dominant M1 was examined in 13 patients with FHD (seven patients with and six patients without mirror dystonia, all affected on the right hand) and 12 right-handed, age-matched healthy controls (CON group). IHI was tested at rest and during three different phases of a right index finger movement in a synergistic, as well as in a neighboring, relaxed muscle. There was a trend for a selective loss of IHI between the homologous surrounding muscles in the phase 50 ms before electromyogram onset in patients with FHD. Post hoc analysis revealed that this effect was due to a loss of IHI in the patients with FHD with mirror dystonia, while patients without mirror dystonia did not show any difference in IHI modulation compared with healthy controls. We conclude that mirror dystonia may be due to impaired IHI towards neighboring muscles before movement onset. However, IHI does not seem to play a major role in the general pathophysiology of FHD.
Collapse
Affiliation(s)
- S Beck
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA.
| | | | | | | | | |
Collapse
|
13
|
Sitburana O, Wu LJC, Sheffield JK, Davidson A, Jankovic J. Motor overflow and mirror dystonia. Parkinsonism Relat Disord 2009; 15:758-61. [PMID: 19505838 DOI: 10.1016/j.parkreldis.2009.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/07/2009] [Accepted: 05/09/2009] [Indexed: 12/01/2022]
Abstract
Motor overflow is an unintentional muscle contraction which accompanies, but is anatomically distinct from the primary dystonic movement. This phenomenological nosology has not been systematically studied in focal hand dystonia (FHD). We conducted a prospective, case-control study to characterize motor overflow and mirror dystonia in patients with FHD. We compared the performance of 30 patients with FHD and 40 healthy controls on a variety of motor tasks, such as writing, drawing a spiral, straight line and a sine wave, repetitive wrist flexion-extension, finger tapping, hand grasping, hand pronation-supination, and a finger-to-nose task with each hand. The assessments were videotaped, the edited video segments were randomized, and an independent investigator who was "blind" to the subject's diagnosis rated the ipsilateral and contralateral overflow and mirror dystonia twice, 6 months apart. Using the mean of the two ratings, ipsilateral overflow was identified in 8.5 +/- 2.1 (28%) patients and in 1.5 +/- 0.7 (4%) controls (p < 0.001), contralateral overflow in 2.5 +/- 0.7 (8%) patients and in 1.5 +/- 0.7 (4%) of controls (p = 0.138), and mirror movement in 20.0 +/- 0.0 (67%) of patients and in 15.5 +/- 4.9 (39%) of controls (p = 0.001). There was a statistically significant correlation of dystonia and overflow score (Pearson's r 0.713, p < 0.001). The relatively high frequency of ipsilateral overflow and mirror dystonia in patients with FHD has both pathophysiological and therapeutic implications. In this study, the severity of dystonia was significantly correlated with motor overflow in multiple tasks.
Collapse
Affiliation(s)
- Oraporn Sitburana
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Department of Neurology, The Smith Tower, Suite 1801, Houston, TX 77030, USA
| | | | | | | | | |
Collapse
|
14
|
Rosset-Llobet J, Candia V, Fàbregas i Molas S, Dolors Rosinés i Cubells D, Pascual-Leone A. The challenge of diagnosing focal hand dystonia in musicians. Eur J Neurol 2009; 16:864-9. [PMID: 19473363 DOI: 10.1111/j.1468-1331.2009.02610.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians' cramp within the Spanish medical community. METHODS We used a brief questions' catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients' diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. RESULTS Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians' dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. CONCLUSIONS This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician's focal dystonia.
Collapse
Affiliation(s)
- J Rosset-Llobet
- Institut de Fisiologia i Medicina de l 'Art-Terrassa, Terrassa, Barcelona, Spain.
| | | | | | | | | |
Collapse
|
15
|
Abstract
OBJECTIVE Association of mirror movements with special kinds of neural tube defects, particularly cranial dermal sinus and cervical myelomeningocele, is extremely rare. We have tried to explain the probable pathophysiology underlying this rare condition. CLINICAL PRESENTATION Two cases are presented. Case 1: A right-handed 3-year-old boy brought to the outpatient clinic for evaluation of mirror movement had been operated on at 10 days of age to repair a cervical myelomeningocele. At examination, mirror movements were observed on both sides. Case 2: A right-handed 7-year-old boy referred for vertigo and occasional vomiting since 3 months of age. The mirror movements were present in the upper extremities, and reportedly had existed since early childhood. Brain magnetic resonance imaging disclosed the dermal sinus, tract, and midline dermoid tumor. CONCLUSION To describe a meaningful association between mirror movements and congenital abnormalities in 2 cases reported here, we propose development of an abnormality in the cervical spinal cord (case 1) and cervicomedullary junction (case 2) associated with gross anomalies in the affected areas.
Collapse
|
16
|
Sitburana O, Jankovic J. Focal hand dystonia, mirror dystonia and motor overflow. J Neurol Sci 2007; 266:31-3. [PMID: 17888455 DOI: 10.1016/j.jns.2007.08.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 07/11/2007] [Accepted: 08/16/2007] [Indexed: 11/23/2022]
Abstract
Focal hand dystonia (FHD) is a syndrome of sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures of the hand. Motor overflow, defined as unintentional muscle contraction that accompanies but is anatomically distinct from the primary dystonic movement, is a frequent but often unrecognized feature of FHD. In this series of eight patients with FHD, we describe two patterns of motor overflow, termed "ipsilateral overflow" and "contralateral overflow", and contrast it with the phenomenon termed "mirror dystonia". These findings extend the phenomenology and provide evidence for widespread abnormalities of motor control in patients with focal hand dystonia.
Collapse
Affiliation(s)
- Oraporn Sitburana
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
17
|
Floyd AG, Yu QP, Piboolnurak P, Wraith E, Patterson MC, Pullman SL. Kinematic analysis of motor dysfunction in Niemann-Pick type C. Clin Neurophysiol 2007; 118:1010-8. [PMID: 17329166 DOI: 10.1016/j.clinph.2007.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/09/2007] [Accepted: 01/11/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide the first descriptive analysis of upper limb motor physiology in Niemann-Pick Type C disease (NP-C). METHODS Fifteen patients with confirmed NP-C underwent motor physiology testing using accelerometry and surface EMG (sEMG). Tremor amplitude and frequency were quantified using accelerometry, and sEMG was examined for abnormal patterns consistent with various movement disorders. RESULTS Forty-seven percent of patients had postural tremor in the upper limbs, generally bilateral, with frequencies ranging from 0.3 to 3 Hz, and an average amplitude of 1.20+/-0.98 mm. Eighty-seven percent of patients had bilateral action tremor with frequencies ranging from 2.0 to 3.7 Hz, and an average amplitude of 5.25+/-3.76 mm. sEMG revealed long but variable duration, variable amplitude muscle burst discharges during action in some patients, as well as short high frequency irregularly timed bursts in others. CONCLUSIONS Accelerometric findings correlated with the clinical findings were most consistent with cerebellar outflow tremors. sEMG revealed a mix of dystonic, myoclonic and choreiform movements. SIGNIFICANCE These quantitative methods may serve as ancillary measures of disease pathophysiology, markers of change over time, and methods to evaluate efficacy, and side effects, of new treatments as they are developed.
Collapse
Affiliation(s)
- A G Floyd
- Clinical Motor Physiology Laboratory, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Mirror writing is an unusual script, in which the writing runs in the opposite direction to normal, with individual letters reversed, so that it is most easily read using a mirror. This writing is seen in healthy individuals; it is also associated with various focal lesions that most commonly involve the left hemisphere, as well as with certain diffuse cerebral disorders. Mirror writing is nearly always undertaken with the left hand, and left-handers, and those whose languages are written leftwards, have an unusual facility for this writing. Concerning possible underlying processes, the implications of using the left hand when writing are considered first. Motor pathways that may be important, the surrogate model of bimanual mirror movements and the contribution of the corpus callosum are then discussed. The reasons why left-handed writing is mirrored, and the factors that tend to inhibit mirroring, are outlined. After commenting on mirrored motor and visual engrams, the possibility that the right hemisphere may play an important part is entertained, and Leonardo da Vinci's unique, habitual mirror writing proves to be of unexpected relevance. Further investigations, ranging from epidemiological to functional imaging studies, may provide valuable insights into mirror writing.
Collapse
Affiliation(s)
- G D Schott
- National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| |
Collapse
|
19
|
Papapetropoulos S, Singer C. Bilateral mirror writing movements (mirror dystonia) in a patient with writer's cramp: Functional correlates. Mov Disord 2007; 22:149. [PMID: 17080466 DOI: 10.1002/mds.21175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|