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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Frucht SJ, George MC, Pantelyat A, Altenmueller E, Nmashie A, Jiao JM, Chen M, Feng D, Shin S, Kaku MC, Simpson D. Incobotulinum Toxin-A in Professional Musicians with Focal Task-Specific Dystonia: A Double Blind, Placebo Controlled, Cross-Over Study. Tremor Other Hyperkinet Mov (N Y) 2024; 14:32. [PMID: 38948014 PMCID: PMC11212776 DOI: 10.5334/tohm.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024] Open
Abstract
Background Musician's focal task-specific dystonia is a complex disorder of fine motor control, with incomplete understanding of its etiology. There have been relatively few trials of botulinum toxin in upper limb task-specific dystonia, and prior studies have yielded variable results, leading to skepticism regarding the utility of this approach in elite performers. Methods We conducted a double-blind, placebo-controlled, randomized, cross-over study of incobotulinum toxin-A in 21 professional musicians with focal upper extremity task-specific dystonia affecting performance on their instrument, using a novel paradigm of initial injections followed by booster injections at two- and four-week intervals. The primary outcome measure was the change in blinded dystonia rating of the active arm by two expert raters using a Clinical Global Impression numeric scale at week 8 compared to enrollment. Findings 19 men and 2 women with musicians' dystonia were enrolled over a six-year period. Nineteen patients completed the study. Analysis of the primary outcome measure in comparison to baseline revealed a change in dystonia severity of P = 0.04 and an improvement in overall musical performance of P = 0.027. No clinically significant weakness was observed, and neutralizing antibodies to toxin were not found. Interpretation Despite its small sample size, our study demonstrated a statistically significant benefit of incobotulinum toxin-A injections as a treatment for musicians' task-specific dystonia. Tailoring the use of toxin with booster injections allowed refinement of dosing strategy and outcomes, with benefits that were meaningful to patients clearly visible on videotaped evaluations. In addition to its application to musicians' dystonia, this approach may have relevance to optimize application of botulinum toxin in other forms of focal dystonia such as blepharospasm, cervical dystonia, writer's cramp, and spasmodic dysphonia.
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Affiliation(s)
| | | | | | - Eckart Altenmueller
- Institute of Music Physiology and Musicians’ Medicine of the University of Music, Drama and Media, Hannover, DE
| | | | | | | | - David Feng
- Icahn School of Medicine at Mount Sinai, US
| | - Susan Shin
- Icahn School of Medicine at Mount Sinai, US
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Kreisler A, Watel K, Defebvre L, Mortain L, Duhamel A. Does the guidance method affect the doses of botulinum toxin in writer's cramp? Rev Neurol (Paris) 2024; 180:548-558. [PMID: 38336523 DOI: 10.1016/j.neurol.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE Botulinum neurotoxin (BoNT) injections are the main medical treatment of writer's cramp. When the outcome is favourable, patients usually receive injections several times per year in the long-term. However, we know little about the course of BoNT doses and nothing about the impact of the guidance method on the clinical outcome or injection strategy. METHODS We studied, in the long-term, the doses of BoNT and the target muscles in a group of patients with writer's cramp, according to the guidance method (electrical stimulation or ultrasound). Patients received at least three injection cycles guided by electrical stimulation, followed by at least three injection cycles guided by ultrasound. RESULTS Twenty-four patients were included. More target muscles were injected after switching to ultrasound guidance, especially the flexor carpi ulnaris and the flexor carpi radialis. The mean dose by muscle was lower when ultrasound guidance was used. When using electrical stimulation guidance, the dose in the flexors of the fingers decreased in the long-term, but increased in the flexors of the wrist. The course of the BoNT doses and of the number of target muscles per cycle were not the same during the first period (electrical stimulation) and the second period (ultrasound). CONCLUSIONS Switching to ultrasound guidance, the BoNT dose decreased, mainly in the flexors of the wrist. Based on the results of our study, we suggest a starting dose in several muscles (flexor carpi ulnaris, flexor carpi radialis, flexor digitorum profundus and flexor pollicis longus).
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Affiliation(s)
- A Kreisler
- CHU de Lille, Movement Disorders Department, 59000 Lille, France.
| | - K Watel
- CHU de Lille, Movement Disorders Department, 59000 Lille, France.
| | - L Defebvre
- CHU de Lille, Movement Disorders Department, 59000 Lille, France.
| | - L Mortain
- Université de Lille, CHU de Lille, U2694 METRICS, 59000 Lille, France.
| | - A Duhamel
- Université de Lille, CHU de Lille, U2694 METRICS, 59000 Lille, France.
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Nijenhuis B, van Wensen E, Smit M, van Zutphen T, Zwerver J, Tijssen M. Treatment of task-specific dystonia in sports: A systematic review. Clin Park Relat Disord 2024; 10:100245. [PMID: 38456155 PMCID: PMC10918566 DOI: 10.1016/j.prdoa.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/30/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Task specific dystonia is a movement disorder only affecting a highly practiced skill and is found in a broad set of expert movements including in sports. Despite affecting many sports, there is no comprehensive review of treatment options, which is in contrast to better studied forms of task specific dystonia in musicians and writers. For this reason, studies involving an intervention to treat task specific dystonia in sports were systematically reviewed, with special attention for the quality of outcome measures. Methods The PICO systematic search strategy was employed on task-specific dystonia, and all synonyms. Inclusion criteria were peer reviewed published studies pertaining to sports, studies with a measurement and/or intervention in TSD, all in English. We excluded abstracts, expert opinions, narrative review articles, unpublished studies, dissertations and studies exclusively relating to choking. We included case reports, case studies and case-control studies. Results In April 2022 Pubmed, Embase, Web of Science, and Psychinfo were searched. Of the 7000 articles identified, 31 were included that described psychological and invasive and/or pharmacological interventions. There was a lack of formal standardized outcome measures in studies resulting in low quality evidence for the effectiveness of treatment options. A descriptive synthesis showed emotional regulation was effective, but was exclusively tried in golfers. Interventions like botulinum toxin or pharmacology had a similar effectiveness compared to studies in musicians dystonia, however there was almost no formal evidence for these treatments. Conclusion The quality of studies was low with a lack of standardized outcome measures. Future studies with larger cohorts and quantitative outcome measures are needed to improve understanding of treatments for task specific dystonia in athletes.
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Affiliation(s)
- B. Nijenhuis
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - E. van Wensen
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn and Sports Dystonia Centre, Apeldoorn, The Netherlands
| | - M. Smit
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T. van Zutphen
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - J. Zwerver
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Ioannou CI, Hodde-Chriske FL, Altenmüller E. Long-Term Muscular Atrophy and Weakness Following Cessation of Botulinum Toxin Type A Injections in the Flexor Digitorum Muscle of Musicians with Focal Hand Dystonia. Toxins (Basel) 2023; 15:toxins15040296. [PMID: 37104234 PMCID: PMC10144778 DOI: 10.3390/toxins15040296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
The present study assessed muscular atrophy and weakness of the flexor digitorum superficialis (FDS) and profundus (FDP) muscle as possible long-term side effects of botulinum toxin (BoNT) injections in hand dystonia patients after the termination of their treatment. For the assessment of both parameters, a group of 12 musicians diagnosed with focal hand dystonia was compared with a group of 12 healthy matched musicians. The minimum and maximum times since the last injection across patients were 0.5 to 3.5 years, respectively. The thickness and strength of the FDS and FDP were assessed via ultrasonography and a strength measurement device. Group differences were estimated through the calculation of the symmetry index between the dominant and non-dominant hand. The results revealed that compared to the control group, thickness and flexion strength of the injected FDS and FDP were decreased by 10.6% ± 5.3% (95% CI) and 12.5% ± 6.4% (95% CI), respectively, in the patient group. The amount of weakness and atrophy was predicted significantly by the total amount of BoNT injected throughout the entire treatment period. In contrast, the time after the last injection did not predict the amount of strength and muscle mass recovery after the cessation of the treatment. The current study revealed that even up to 3.5 years after the termination of BoNT injections, long-term side effects such as weakness and atrophy can still be observed. We suggest that the total BoNT dose should remain as small as possible to reduce long-lasting side effects to the minimum. Although side effects differ significantly among patients, a potential full recovery of atrophy and weakness after the cessation of BoNT treatment might be observed after periods longer than 3.5 years.
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Affiliation(s)
- Christos I Ioannou
- CYENS-Centre of Excellence, 1016 Nicosia, Cyprus
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
| | - Franziska L Hodde-Chriske
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
- Hanover Medical School, 30625 Hanover, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, 30175 Hanover, Germany
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Tibben MI, van Wensen E, Nijenhuis B, Zwerver J. Is Behavioural Therapy a New Treatment Option for Task-Specific Dystonia in Athletes? A Case Series. Tremor Other Hyperkinet Mov (N Y) 2023; 13:16. [PMID: 37187797 PMCID: PMC10178567 DOI: 10.5334/tohm.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Background Task-specific dystonia is a movement disorder of the central nervous system characterized by focal involuntary spasms and muscle contractions, which can negatively affect performance of a specific task. It can affect a wide range of fine motor skills, also in athletes. Current management of task-specific dystonia includes mainly prescribing drugs, exercise therapy or botulinum injections to the affected muscles. Psychological interventions for athletes suffering from task-specific dystonia have not been described extensively so far. Methods We present a case-series of 4 different advanced skill-level athletes with suspected task-specific dystonia, which had a major impact on their performance. They all received treatment consisting of a combination of standardized behavioural therapy and relaxation techniques in the form of hypnosis in a total of 8 sessions in a 16-week time period. Results After treatment, all athletes returned to their original high level of sport performance without further symptoms of their suspected task-specific dystonia. Discussion Behavioural therapy in combination with a relaxation technique seems to be a safe and promising treatment for athletes with suspected task-specific dystonia. Further studies in a larger, preferably randomized controlled trial, are warranted to evaluate if this treatment strategy is effective in athletes with suspected task-specific dystonia.
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Affiliation(s)
- Marleen Ieke Tibben
- HSK Expertise Center Functional Movement Disorders, Woerden, The Netherlands
| | - Erik van Wensen
- Gelre Hospital & Sports Dystonia Centre, Apeldoorn, The Netherlands
| | | | - Johannes Zwerver
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen and Department Sports and Exercise Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
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Safarpour D, Jabbari B. Botulinum toxin for motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:539-555. [PMID: 37620089 DOI: 10.1016/b978-0-323-98817-9.00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Botulinum neurotoxins are a group of biological toxins produced by the gram-negative bacteria Clostridium botulinum. After intramuscular injection, they produce dose-related muscle relaxation, which has proven useful in the treatment of a large number of motor and movement disorders. In this chapter, we discuss the utility of botulinum toxin treatment in three major and common medical conditions related to the dysfunction of the motor system, namely dystonia, tremor, and spasticity. A summary of the existing literature is provided along with different techniques of injection including those recommended by the authors.
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Affiliation(s)
- Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
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Impact of Depression on Cognitive Function and Disease Severity in Idiopathic Cervical Dystonia Patients: One-Center Data in Cross-Sectional Study. Medicina (B Aires) 2022; 58:medicina58121793. [PMID: 36556995 PMCID: PMC9781028 DOI: 10.3390/medicina58121793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Cervical dystonia is a highly disabling hyperkinetic movement disorder with a lot of nonmotor symptoms. One symptom with a high prevalence is depression, which may negatively affect dystonia patients. The aim of the study was to investigate the impact of depression on disease severity and cognitive functions in cervical dystonia patients. Methods: Patients with cervical dystonia were interviewed and divided into two groups, based on the Patient Health Questionnaire-9: those with no depression or mild depressive features and those with moderate, moderately severe, and severe depression. The severity of dystonia and cognitive functions were assessed and compared in both groups. Results: A total of 52 patients were investigated. Self-assessment of the disease was more negative in clinically significant depressive signs group (p = 0.004), with a tendency for patients with clinically significant depressive features to have a slightly higher score on objective dystonia scales (TSUI and TWSTRS), but without statistically significant differences (p = 0.387 and p = 0.244, respectively). Although not statistically significant, a slightly higher MoCA scale score was registered in cervical dystonia patients with clinically insignificant depressive signs. There was a tendency for worse results in the abstraction category in patients with clinically significant depression (p = 0.056). Conclusions: Patients with clinically significant depression have a more negative self-assessment of the disease and perform worse in abstraction tasks.
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Lungu C, Nmashie A, George MC, Karp BI, Alter K, Shin S, Tse W, Frucht SJ, Wu T, Koo V, Considine E, Norato G, Hallett M, Simpson DM. Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin-A Injections: A Randomized Crossover Study. Mov Disord Clin Pract 2022; 9:1055-1061. [PMID: 36523503 PMCID: PMC9631842 DOI: 10.1002/mdc3.13546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/11/2022] [Accepted: 07/24/2022] [Indexed: 09/09/2023] Open
Abstract
Background Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied. Objectives We compared 2 targeting techniques for onabotulinumtoxin-A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (E-stim) and ultrasound (US). Methods This was a 2-center, randomized, crossover, assessor-blinded trial. Participants with focal hand dystonia or upper limb spasticity, on stable onabotA therapy for at least 2 previous injection cycles, were randomly assigned to either E-stim or US with crossover at 3 months. The primary outcome was improvement in dystonia or spasticity severity on a visual analog scale (VAS; 0-100) measured 1 month after each injection. The secondary outcome was participant discomfort assessed on a VAS. Repeated-measures analysis of covariance was used with linear mixed-model covariate selection. Results A total of 19 participants (13 men) completed the study, 10 with upper limb spasticity and 9 with dystonia. Benefit was equivalent between the 2 techniques (VAS least-square mean [LSmean] 51.5 mm with US and 53.1 with E-stim). E-stim was perceived as more uncomfortable by participants (VAS LSmean 34.5 vs. 19.9 for E-stim and US, respectively). Procedure duration was similar with the 2 procedures. There were no serious adverse events related to either approach. Conclusions US and E-Stim localization guidance techniques provide equivalent efficacy in onabotA injections for spasticity and dystonia. US guidance injections are more comfortable for participants. Both techniques are effective guidance methods, with US potentially preferable based on participant comfort.
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Affiliation(s)
- Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMarylandUSA
| | - Alexandra Nmashie
- Department of PediatricsNew York Medical College/NYCHealth Hospitals/MetropolitanNew YorkNew YorkUSA
| | | | - Barbara I. Karp
- Division of Clinical Research, National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMarylandUSA
| | - Katharine Alter
- Department of Rehabilitation MedicineClinical Center, National Institutes of HealthBethesdaMarylandUSA
| | - Susan Shin
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Winona Tse
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Steven J. Frucht
- Department of NeurologyNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Tianxia Wu
- Clinical Trials UnitNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Vivian Koo
- Human Motor Control SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Elaine Considine
- Human Motor Control SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Gina Norato
- Clinical Trials UnitNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Mark Hallett
- Human Motor Control SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - David M. Simpson
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Gründahl J, Großbach M, Altenmüller E. Video-based long-term follow up of musician’s dystonia in pianists reveals similar improvements following different treatment strategies: a retrospective observational study. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2022. [PMCID: PMC8787894 DOI: 10.1186/s40734-021-00092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Musician’s Dystonia (MD) by impaired or complete loss of fine motor control in extensively trained movements at the instrument. In pianists, it frequently leads to involuntary flexion or extension of one or more fingers. Treatment remains challenging, although local injections with Botulinum toxin, anticholinergic medication and pedagogical retraining seem to be helpful in individual cases. Evaluation of therapies however is frequently hampered by lack of practicability, or validity. This retrospective observational study aims to assess the long-term development of MD and efficacy of therapies in keyboard players by means of a simple video-rating procedure by informed expert raters.
Methods
Video rating is characterisedwas done by 6 carefully instructed pianists, rating a total of 266 videos from 80 patients, recorded over a period of almost 20 years. These showed the affected hand playing a C-major scale as “regularly” as possible at a moderate tempo on a grand piano. Raters assessed the acoustic irregularity of scale playing and any visible movement impairment on visual analogue scales. Influence of patient-specific factors including applied treatment was estimated in a Bayesian multilevel beta regression.
Results
For ratings of irregularity and impairment intra-rater reliability was strong and inter-rater concordance was moderate. The average estimated improvement across all therapies was 14% in irregularity and 15% in impairment. Highest improvement rates in ratings of irregularity were found after the combined treatment with Botulinum toxin and Trihexyphenidyl (45%) as well as in retraining (29% improvement) as single therapy. In ratings of impairment the highest improvement was shown for retraining in combination with Trihexyphenidyl (36% improvement) as well as retraining as single therapy (23%).
Conclusions
This study provides a new perspective on the course of MD in keyboard players in a larger cohort using methods other than self-report. Video rating of scale-playing was shown to be a reliable and useful method to evaluate MD in keyboard players. Average improvement rates were different to previous studies using patient-subjective questionnaires. Treatment options showed different effects in the two rating criteria, with retraining showing the highest improvement rates in single and combined use.
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Zakin E, Simpson DM. Botulinum Toxin Therapy in Writer's Cramp and Musician's Dystonia. Toxins (Basel) 2021; 13:toxins13120899. [PMID: 34941736 PMCID: PMC8708945 DOI: 10.3390/toxins13120899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Task-specific focal dystonia is characterized by muscle contraction(s) during a specific task, resulting in abnormal postures or movements. Specifically, writer’s cramp involves the upper extremity during the act of writing. Musician’s dystonia has a highly variable presentation, and thus makes therapeutic options more limited. Treatments include oral pharmacologic agents, neuromodulation, surgery and, most often, botulinum toxin (BoNT) injection. Selection of target muscles for toxin injection continues to be an area of active research for these task-specific movements. We present a review of the literature selected from a predefined search of the MEDLINE and ClinicalTrials.gov databases. We include six controlled studies of botulinum toxin for the management of writer’s cramp and focal task-specific dystonia (FTSD), including musician’s dystonia. Overall, 139 patients were included across all studies, with 99 individuals injected for writer’s cramp and the remaining 40 individuals with FTSD. The age range of all patients was 18–80 years old. We included studies that utilized only the BoNT-A serotype. These studies utilized various severity scales to quantify response to toxin injection, with ratings of instrument or pen control included as subjective ratings. Of the included 139 patients in this review, pooled data for toxin response show that 73% of patients who received the drug demonstrated improvement. Specific techniques for muscle localization and targeting were difficult to study as variable methods were employed. This remains an area of ongoing exploration.
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Affiliation(s)
- Elina Zakin
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA
- Correspondence:
| | - David M. Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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Gupta N, Pandey S. Treatment of focal hand dystonia: current status. Neurol Sci 2021; 42:3561-3584. [PMID: 34213695 DOI: 10.1007/s10072-021-05432-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Focal hand dystonia (FHD) is usually adult-onset focal dystonia that can be associated with marked occupational and functional disability leading to reduced quality of life. METHODS Relevant studies on treatment options for FHD, their limitations, and current recommendations were reviewed using the PubMed search until March 31, 2021. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. RESULTS and conclusion Currently, botulinum toxin has the best evidence for treatment of FHD, and 20-90% of patients experience symptomatic improvement. However, its benefit is often limited by the reduction of muscle tonus acting on the muscle spindle. Different surgical modalities that have been used to treat focal hand dystonia include lesional surgery, deep brain stimulation, and magnetic resonance-guided focused ultrasound thalamotomy. Recent studies exploring the role of behavioral techniques, sensorimotor training, and neuromodulation for the treatment of focal hand dystonia have reported good outcomes, but larger studies are required before implementing these interventions in practice.
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Affiliation(s)
- Navnika Gupta
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, 110002, India.
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Svetel M, Tomić A, Kresojević N, Dragašević N, Kostić V. Perspectives on the pharmacological management of dystonia. Expert Opin Pharmacother 2021; 22:1555-1566. [PMID: 33904811 DOI: 10.1080/14656566.2021.1919083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Treatment of dystonia is particularly complex due to various etiologies and heterogeneous clinical manifestation, as well as different degrees of disability. In absence of causative treatment, all symptomatic therapy should be predominantly tailored to ameliorate those symptoms (motor and non/motor) that mostly affect patients' daily life and regular activities. Many different treatment options, including oral medications, neurosurgical interventions, physical and occupational therapy are available in treatment of dystonia.Areas covered: The aim of this perspective is to point out different possibilities in pharmacological management of dystonic movements. Due to pure clinical presentation, the authors concentrate mainly on the isolated dystonias, which are presented solely as dystonic movements. Combined and complex dystonias are not instructive due to compound clinical presentation and consequently, complicated treatment. The article is based on a literature search from sources including PubMed, the Cochrane Library, Web of Science, PiCarta, and PsycINFO.Expert opinion: Although dystonia therapy should be adapted according to the individual needs, severity, age, type, symptoms distribution and acceptable side-effect profile, certain principles should be followed to reach the optimal result. Furthermore, the authors believe that a better understanding of the pathophysiology of dystonia will bring with it the development of new and improved treatment approaches and medications.
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Affiliation(s)
- Marina Svetel
- Movement Disorders Department, Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Tomić
- Movement Disorders Department, Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Kresojević
- Movement Disorders Department, Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia
| | - Nataša Dragašević
- Movement Disorders Department, Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Kostić
- Movement Disorders Department, Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Lee A, Al-Sarea J, Altenmüller E. Nonlinear Changes in Botulinum Toxin Treatment of Task-Specific Dystonia during Long-Term Treatment. Toxins (Basel) 2021; 13:toxins13060371. [PMID: 34067306 PMCID: PMC8224565 DOI: 10.3390/toxins13060371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Botulinum toxin (BoTX) is the standard treatment for task-specific dystonias (TSDs) such as musician’s dystonia (MD). Our aim was to assess the long-term changes in BoTX treatment in a highly homogeneous and, to our knowledge, largest group of MD patients with respect to the following parameters: (1) absolute and (2) relative BoTX dosage, (3) number of treated muscles, and (4) inter-injection interval. We retrospectively assessed a treatment period of 20 years in 233 patients, who had received a cumulative dose of 68,540 MU of BoTX in 1819 treatment sessions, performed by two neurologists. Nonlinear correlation was used to analyze changes in the parameters over the course of repeated treatments. Post-hoc we applied a median-split to classify two subgroups (high-BoTX, low-BoTX) depending on the total amount of BoTX needed during treatment. Across all patients, we found a decrease of dosage for the first approximately 25 treatments with an increase afterwards. The number of muscles and inter-injection intervals increased with time with a discrete decrease of inter-injection intervals after about 35 treatments. Subgroup differences were observed in the amount of BoTX and inter-injection intervals, with continuously increasing inter-injection intervals and decreasing BoTX dosage in the low-BTX group. Both groups showed a continuously increasing number of injected muscles. In summary, we found nonlinear changes of BoTX dosage and inter-injection intervals and a continuously increasing number of injected muscles with treatment duration in TSD-patients. Furthermore, we, for the first time, identified two subgroups with distinct differences. Increasing inter-injection intervals and decreasing BoTX dosages in the low-BoTX group indicated improvement of symptoms with continued treatment. Continually increasing BoTX dosages with unchanged inter-injection intervals in the high-BoTX group indicated deterioration.
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Affiliation(s)
- André Lee
- Institute of Music Physiology and Musicians’ Medicine, University of Music, Drama and Media Hannover, Neues Haus 1, 30175 Hanover, Germany;
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 Munich, Germany
- Correspondence:
| | - Jabreel Al-Sarea
- Hanover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany;
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians’ Medicine, University of Music, Drama and Media Hannover, Neues Haus 1, 30175 Hanover, Germany;
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Anandan C, Jankovic J. Botulinum Toxin in Movement Disorders: An Update. Toxins (Basel) 2021; 13:42. [PMID: 33430071 PMCID: PMC7827923 DOI: 10.3390/toxins13010042] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022] Open
Abstract
Since its initial approval in 1989 by the US Food and Drug Administration for the treatment of blepharospasm and other facial spasms, botulinum toxin (BoNT) has evolved into a therapeutic modality for a variety of neurological and non-neurological disorders. With respect to neurologic movement disorders, BoNT has been reported to be effective for the treatment of dystonia, bruxism, tremors, tics, myoclonus, restless legs syndrome, tardive dyskinesia, and a variety of symptoms associated with Parkinson's disease. More recently, research with BoNT has expanded beyond its use as a powerful muscle relaxant and a peripherally active drug to its potential central nervous system applications in the treatment of neurodegenerative disorders. Although BoNT is the most potent biologic toxin, when it is administered by knowledgeable and experienced clinicians, it is one of the safest therapeutic agents in clinical use. The primary aim of this article is to provide an update on recent advances in BoNT research with a focus on novel applications in the treatment of movement disorders. This comprehensive review of the literature provides a critical review of evidence-based clinical trials and highlights recent innovative pilot studies.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA;
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Bledsoe IO, Viser AC, San Luciano M. Treatment of Dystonia: Medications, Neurotoxins, Neuromodulation, and Rehabilitation. Neurotherapeutics 2020; 17:1622-1644. [PMID: 33095402 PMCID: PMC7851280 DOI: 10.1007/s13311-020-00944-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 02/24/2023] Open
Abstract
Dystonia is a complex disorder with numerous presentations occurring in isolation or in combination with other neurologic symptoms. Its treatment has been significantly improved with the advent of botulinum toxin and deep brain stimulation in recent years, though additional investigation is needed to further refine these interventions. Medications are of critical importance in forms of dopa-responsive dystonia but can be beneficial in other forms of dystonia as well. Many different rehabilitative paradigms have been studied with variable benefit. There is growing interest in noninvasive stimulation as a potential treatment, but with limited long-term benefit shown to date, and additional research is needed. This article reviews existing evidence for treatments from each of these categories. To date, there are many examples of incomplete response to available treatments, and improved therapies are needed.
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Affiliation(s)
- Ian O. Bledsoe
- Weill Institute for Neurosciences, Movement Disorder and Neuromodulation Center, University of California, San Francisco, 1635 Divisadero St., Suite 520, San Francisco, CA 94115 USA
| | - Aaron C. Viser
- Weill Institute for Neurosciences, Movement Disorder and Neuromodulation Center, University of California, San Francisco, 1635 Divisadero St., Suite 520, San Francisco, CA 94115 USA
| | - Marta San Luciano
- Weill Institute for Neurosciences, Movement Disorder and Neuromodulation Center, University of California, San Francisco, 1635 Divisadero St., Suite 520, San Francisco, CA 94115 USA
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Kassavetis P, Lungu C, Ehrlich D, Alter K, Karp BI. Self-reported benefit and weakness after botulinum toxin in dystonia. Parkinsonism Relat Disord 2020; 80:10-11. [PMID: 32927341 DOI: 10.1016/j.parkreldis.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
With this retrospective, single center, chart review study, we investigate the self-reported benefit and weakness after botulinum toxin injections in three different types of dystonia: focal hand dystonia (FHD), blepharospasm and cervical dystonia. We found that the benefit lasts significantly longer in FHD compared to the other two groups.
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Affiliation(s)
| | - Codrin Lungu
- NIH/NINDS, Division of Clinical Research, Bethesda, MD, United States
| | - Debra Ehrlich
- NIH/NINDS, Parkinson's Disease Clinic, Office of the Clinical Director, Bethesda, MD, United States
| | - Katharine Alter
- NIH, Rehabilitation Medicine Department, Clinical Center, Bethesda, MD, United States
| | - Barbara I Karp
- NIH/NINDS, Division of Clinical Research, Bethesda, MD, United States
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Abstract
The dystonias are a large and heterogenous group of disorders characterized by excessive muscle contractions leading to abnormal postures and/or repetitive movements. Their clinical manifestations vary widely, and there are many potential causes. Despite the heterogeneity, helpful treatments are available for the vast majority of patients. Symptom-based therapies include oral medications, botulinum toxins, and surgical interventions. For some subtypes of dystonia, specific mechanism-based treatments are available. Advances in understanding the biological basis for many types of dystonia have led to numerous recent clinical trials, so additional treatments are likely to become available in the very near future.
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Abstract
PURPOSE OF REVIEW This article provides a summary of the state of the art in the diagnosis, classification, etiologies, and treatment of dystonia. RECENT FINDINGS Although many different clinical manifestations of dystonia have been recognized for decades, it is only in the past 5 years that a broadly accepted approach has emerged for classifying them into specific subgroups. The new classification system aids clinical recognition and diagnosis by focusing on key clinical features that help distinguish the many subtypes. In the past few years, major advances have been made in the discovery of new genes as well as advances in our understanding of the biological processes involved. These advances have led to major changes in strategies for diagnosis of the inherited dystonias. An emerging trend is to move away from heavy reliance on the phenotype to target diagnostic testing toward a broader approach that involves large gene panels or whole exome sequencing. SUMMARY The dystonias are a large family of phenotypically and etiologically diverse disorders. The diagnosis of these disorders depends on clinical recognition of characteristic clinical features. Symptomatic treatments are useful for all forms of dystonia and include oral medications, botulinum toxins, and surgical procedures. Determination of etiology is becoming increasingly important because the number of disorders is growing and more specific and sometimes disease-modifying therapies now exist.
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20
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Park JE, Shamim EA, Panyakaew P, Mathew P, Toro C, Sackett J, Karp B, Lungu C, Alter K, Wu T, Ahmad OF, Villegas M, Auh S, Hallett M. Botulinum toxin and occupational therapy for Writer's cramp. Toxicon 2019; 169:12-17. [PMID: 31351085 DOI: 10.1016/j.toxicon.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Writer's cramp (WC) is a form of focal hand dystonia, for which focal botulinum neurotoxin (BoNT) injections are the current best therapy. Past studies have shown that some types of rehabilitative therapy can be useful. We hypothesized that BoNT together with a specific type of occupational therapy would be better than BoNT alone for treating WC patients comparing the effects with a patient-rated subjective scale. METHODS Twelve WC patients were randomized to two groups. Six received only BoNT therapy and 6 received BoNT & occupational therapy. The occupational therapy involved specific exercises of finger movements in the direction opposite to the dystonic movements during writing. BoNT was injected by movement disorders neurologists in the affected muscles under electromyography-guidance. The primary outcome was the patient-rated subjective scale at 20 weeks. Secondary exploratory outcomes included the writer's cramp rating scale (WCRS), writer's cramp impairment scale (WCIS), the writer's cramp disability scale (WCDS), handgrip strength and kinetic parameters. RESULTS The patient-rated subjective scale scores at 20 weeks were not significantly different between the two groups. Significant objective improvement was noted in the BoNT & occupational therapy group, as noted by the decrease (28%) in WCIS scores. CONCLUSIONS Improvement of the primary outcome measure, the patient-rated subjective scale, was not achieved. However, significant improvement was found in the BoNT & occupational therapy group in a secondary measure of impairment. Our hypothesis-driven study results are likely limited by small sample size, and further large-scale studies of occupational therapy methods to improve the efficacy of BoNT seems worthwhile.
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Affiliation(s)
- Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ejaz A Shamim
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pattamon Panyakaew
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence on Parkinson Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pawan Mathew
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Camilo Toro
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan Sackett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Barbara Karp
- Combined Neuroscience Institutional Review Board, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, MD, USA
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- Clinical Neuroscience Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Omar F Ahmad
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Mount Carmel Neurology, Westerville, OH, USA
| | - Monica Villegas
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 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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Pirio Richardson S, Jinnah HA. New approaches to discovering drugs that treat dystonia. Expert Opin Drug Discov 2019; 14:893-900. [PMID: 31159587 DOI: 10.1080/17460441.2019.1623785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Dystonia consists of involuntary movements, abnormal posturing, and pain. In adults, dystonia presents in a particular region of the body and causes significant disability due to pain as well as impairment in activities of daily living and employment. The current gold standard treatment, botulinum toxin (BoNT), has limitations - painful, frequent injections due to 'wearing off' of treatment effect; expense; and expected side effects like swallowing difficulty and weakness. There is a clear therapeutic gap in our current treatment options for dystonia and also a clear need for an effective novel treatment. Testing any novel treatment is complicated because most adults with focal dystonia are treated with BoNT. Areas covered: This review focuses on establishing the need for novel therapeutics. It also suggests potential leads from preclinical studies; and, discusses the issue of clinical trial readiness in the dystonia field. Expert opinion: Identifying a novel therapeutic intervention for dystonia patients faces two major challenges. The first is acknowledging the therapeutic gap that currently exists. Second, shifting some of our research aims in dystonia to clinical trial readiness is imperative if we are to be ready to test novel therapeutic agents.
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Affiliation(s)
- Sarah Pirio Richardson
- a Department of Neurology, University of New Mexico Health Sciences Center , Albuquerque , NM , USA.,b Neurology Service, New Mexico Veterans Affairs Health Care System , Albuquerque , NM , USA
| | - H A Jinnah
- c Departments of Neurology, Human Genetics & Pediatrics, Emory University School of Medicine , Atlanta , Georgia
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Bravi R, Ioannou CI, Minciacchi D, Altenmüller E. Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: a pilot study. Clin Rehabil 2019; 33:1636-1648. [PMID: 31159569 DOI: 10.1177/0269215519852408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to explore the immediate and short-term effects of a Correction Kinesiotaping intervention on fine motor control in musicians with focal hand dystonia. DESIGN A single-blinded, single-arm repeated measures, pilot study. SETTING Medical outpatient clinic. SUBJECTS Seven musicians diagnosed with focal hand dystonia. INTERVENTIONS Musicians performed musical exercises under the following conditions: without Kinesiotape (baseline), during a Correction Kinesiotaping intervention and immediately after tape removal (block 1) and during a Sham Kinesiotaping intervention and immediately after tape removal (block 2). Blocks were randomly presented across participants. A tailored Correction Kinesiotaping intervention on affected fingers was provided based on the dystonic pattern that each patient manifested while playing. MAIN MEASURES Motor performance was video-documented and independent experts blindly assessed the general performance and fingers' posture on visual analogue scales. Also, musicians' self-reports of the musical abilities were evaluated. Finally, electromyographic activity and coactivation index of wrist antagonist muscles were analyzed. RESULTS No significant differences in effects between Correction Kinesiotaping and Sham Kinesiotaping were reported by the experts, either for general performance (P > 0.05) or for fingers' posture (P > 0.05); any subtle benefits observed during Correction Kinesiotaping were lost after the tape was removed. Musicians estimated that Correction Kinesiotaping was ineffective in improving their musical abilities. Also, no significant changes with respect to the coactivation index (P > 0.05) were found among the conditions. CONCLUSION Correction Kinesiotaping intervention may not be useful to reduce dystonic patterns, nor to improve playing ability, in musicians with focal hand dystonia.
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Affiliation(s)
- Riccardo Bravi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christos I Ioannou
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Diego Minciacchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
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Ashworth N, Aidoo H, Doroshenko A, Antle D, Els C, Flaschner DM, Gross DP, Guptill C, Potter P, Tan MC, Straube S. Botulinum Toxin for the Treatment of Focal Task-Specific Hand Dystonias: Systematic Review and Meta-Analysis. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:Botulinum Toxin (BTX) has become a widely used treatment in several dystonic conditions, but the evidence for its efficacy has largely come from open trials and expert opinion. This systematic review examined the efficacy and safety of BTX in the treatment of Focal Hand Dystonia (FHD) in Randomized Controlled Trials (RCTs).Methods:We searched Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORT Discus, SCOPUS, Web of Science, PEDro, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) for randomized, placebo-controlled trials on the use of BTX for FHD.Results:Of 1,116 publications retrieved from the databases searched, three publications were included. The evidence identified pertains to focal task-specific hand dystonias. Sixty-nine participants were involved in the three RCTs with a mean duration of symptoms of 7.5 years. Participants were assessed using a combination of self-reported and functional performance outcome measures following injections of BTX subtype A (BTX-A) or placebo. The Oxford Quality Scale was used to assess the included studies, and the three studies each scored 3/5 or above. The included studies reported no adverse events with BTX-A use, other than muscle weakness and pain at the injection sites.Conclusion:The number of participants included in these three trials is too small to draw dependable conclusions about the efficacy and safety of BTX-A for FHD. There is currently not enough evidence to recommend the routine use of BTX-A for FHD.
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Sadnicka A, Rosset-Llobet J. A motor control model of task-specific dystonia and its rehabilitation. PROGRESS IN BRAIN RESEARCH 2019; 249:269-283. [DOI: 10.1016/bs.pbr.2019.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Horisawa S, Ochiai T, Goto S, Nakajima T, Takeda N, Fukui A, Hanada T, Kawamata T, Taira T. Safety and long-term efficacy of ventro-oral thalamotomy for focal hand dystonia: A retrospective study of 171 patients. Neurology 2018; 92:e371-e377. [PMID: 30587520 PMCID: PMC6345121 DOI: 10.1212/wnl.0000000000006818] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To report the safety and long-term efficacy of ventro-oral thalamotomy for 171 consecutive patients with task-specific focal hand dystonia. Methods Between October 2003 and February 2017, 171 consecutive patients with task-specific focal hand dystonia underwent unilateral ventro-oral thalamotomy. Etiologies included writer's cramps (n = 92), musician's dystonias (n = 58), and other occupational task-related dystonias (n = 21). The task-specific focal hand dystonia scale was used to evaluate patients' neurologic conditions (range 1–5, high score indicated a better condition). The scores before surgery; at 1 week, 3 months, and 12 months postoperatively; and the last available follow-up period were determined. Postoperative complications and postoperative recurrence were also evaluated. Results The scores before surgery; at 1 week (1.72 ± 0.57, 4.33 ± 0.85 [p < 0.001]), 3 months (4.30 ± 1.06 [p < 0.001]), and 12 months (4.30 ± 1.13 [p < 0.001]); and the last available follow-up (4.39 ± 1.07 [p < 0.001]) postoperatively improved. The mean clinical follow-up period was 25.4 ± 32.1 months (range: 3–165). Permanent adverse events developed in 6 patients (3.5%). Eighteen patients developed recurrent dystonic symptoms postoperatively. Of these 18 patients, 9 underwent ventro-oral thalamotomy again, of which 7 achieved improvement. Conclusion Ventro-oral thalamotomy is a feasible and reasonable treatment for patients with refractory task-specific focal hand dystonias. Prospective, randomized, and blinded studies are warranted to clarify more accurate assessment of the safety and efficacy of ventro-oral thalamotomy for task-specific focal hand dystonia. Classification of evidence This study provides Class IV evidence that for patients with task-specific focal hand dystonia, ventro-oral thalamotomy improves dystonia.
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Affiliation(s)
- Shiro Horisawa
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Taku Ochiai
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Shinichi Goto
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takeshi Nakajima
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Nobuhiko Takeda
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Atsushi Fukui
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Tomoko Hanada
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takakazu Kawamata
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takaomi Taira
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan.
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Shimizu T, Maruo T, Miura S, Kishima H, Ushio Y, Goto S. Stereotactic Lesioning of the Thalamic Vo Nucleus for the Treatment of Writer's Cramp (Focal Hand Dystonia). Front Neurol 2018; 9:1008. [PMID: 30534112 PMCID: PMC6275197 DOI: 10.3389/fneur.2018.01008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Writer's cramp (focal hand dystonia) is a sporadic focal dystonia that affects a specific part of the upper limb causing excessive co-contraction of antagonistic muscles. It usually presents as a task-specific dystonia, including, among others, writing of a character or playing a musical instrument. Although treatments for writer's cramp exist, medical therapy often results in unsatisfactory outcomes in patients with this type of dystonia. However, accumulating evidence suggests that long-term and complete remission of various types of focal hand dystonia can be achieved with stereotactic ablation or deep brain stimulation of the thalamic ventral-oralis complex (Vo) nucleus, which includes both the ventralis oralis posterior and anterior nuclei of the thalamus. Following the striking therapeutic success of Vo thalamotomy in patients with medically-refractory writer's cramp, we here introduce the use of stereotactic lesioning of the thalamic Vo nucleus for the treatment of this focal type of dystonia. Our findings identified patients with disabling writer's cramp (i.e., it prevents their success in their professional careers) to be good candidates for positive outcome with this surgical technique.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoyuki Maruo
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shimpei Miura
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan
| | - Satoshi Goto
- Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Samizadeh S, De Boulle K. Botulinum neurotoxin formulations: overcoming the confusion. Clin Cosmet Investig Dermatol 2018; 11:273-287. [PMID: 29910630 PMCID: PMC5988049 DOI: 10.2147/ccid.s156851] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Botulinum toxin A is produced by anaerobic spore-forming bacteria and is used for various therapeutic and cosmetic purposes. Botulinum toxin A injections are the most popular nonsurgical procedure worldwide. Despite an increased demand for botulinum toxin A injections, the clinical pharmacology and differences in formulation of commonly available products are poorly understood. The various products available in the market are unique and vary in terms of units, chemical properties, biological activities, and weight, and are therefore not interchangeable. For safe clinical practice and to achieve optimal results, the practitioners need to understand the clinical issues of potency, conversion ratio, and safety issues (toxin spread and immunogenicity). In this paper, the basic clinical pharmacology of botulinum toxin A and differences between onabotulinum toxin A, abobotulinum toxin A, and incobotulinum toxin A are discussed.
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Sadnicka A, Kornysheva K, Rothwell JC, Edwards MJ. A unifying motor control framework for task-specific dystonia. Nat Rev Neurol 2018; 14:116-124. [PMID: 29104291 PMCID: PMC5975945 DOI: 10.1038/nrneurol.2017.146] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Task-specific dystonia is a movement disorder characterized by a painless loss of dexterity specific to a particular motor skill. This disorder is prevalent among writers, musicians, dancers and athletes. No current treatment is predictably effective, and the disorder generally ends the careers of affected individuals. Traditional disease models of dystonia have a number of limitations with regard to task-specific dystonia. We therefore discuss emerging evidence that the disorder has its origins within normal compensatory mechanisms of a healthy motor system in which the representation and reproduction of motor skill are disrupted. We describe how risk factors for task-specific dystonia can be stratified and translated into mechanisms of dysfunctional motor control. The proposed model aims to define new directions for experimental research and stimulate therapeutic advances for this highly disabling disorder.
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Affiliation(s)
- Anna Sadnicka
- Sobell Department for Motor Neuroscience, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK, and the Motor Control and movement Disorders Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Katja Kornysheva
- School of Psychology, Bangor University, Adeilad Brigantia, Penrallt Road, Gwynedd LL57 2AS, Wales, UK, and the Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
| | - John C Rothwell
- Sobell Department for Motor Neuroscience, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK
| | - Mark J Edwards
- Motor Control and Movement Disorders Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
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29
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Karp BI, Alter K. Muscle Selection for Focal Limb Dystonia. Toxins (Basel) 2017; 10:E20. [PMID: 29286305 PMCID: PMC5793107 DOI: 10.3390/toxins10010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 01/24/2023] Open
Abstract
Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.
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Affiliation(s)
- Barbara Illowsky Karp
- Combined NeuroScience IRB, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Katharine Alter
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD 20892, USA.
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30
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Pirio Richardson S, Altenmüller E, Alter K, Alterman RL, Chen R, Frucht S, Furuya S, Jankovic J, Jinnah HA, Kimberley TJ, Lungu C, Perlmutter JS, Prudente CN, Hallett M. Research Priorities in Limb and Task-Specific Dystonias. Front Neurol 2017; 8:170. [PMID: 28515706 PMCID: PMC5413505 DOI: 10.3389/fneur.2017.00170] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.
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Affiliation(s)
- Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine (IMMM), Hannover University of Music, Drama and Media, Hannover, Germany
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, USA
| | - Ron L Alterman
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Chen
- Division of Neurology, Department of Medicine (Neurology), Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Steven Frucht
- Robert and John M. Bendheim Parkinson and Movement Disorders Center, Mount Sinai Hospital, New York, NY, USA
| | - Shinichi Furuya
- Musical Skill and Injury Center (MuSIC), Sophia University, Tokyo, Japan
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Medicine, Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurosciences, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Cecília N Prudente
- Department of Rehabilitation Medicine, Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, 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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Focal task specific dystonia: a review and update. J Neurol 2016; 264:1536-1541. [PMID: 28039522 PMCID: PMC5502053 DOI: 10.1007/s00415-016-8373-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022]
Abstract
In this review, we summarize recent advances in understanding the etiology, risk factors and pathophysiology of focal task specific dystonia (FTSD), movement disorders characterized by abnormal motor activation during the performance of specific, repetitive actions. We focus on two common FTSD, musician’s dystonia and writer’s cramp. FTSD may pose a threat to the patient’s livelihood, and improved therapeutic treatments are needed.
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Jabbari B. History of Botulinum Toxin Treatment in Movement Disorders. Tremor Other Hyperkinet Mov (N Y) 2016; 6:394. [PMID: 27917308 PMCID: PMC5133258 DOI: 10.7916/d81836s1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/25/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The frontiers of clinical medicine constantly expand as a result of the innovative efforts of visionary researchers and keen observations of seasoned clinicians. In medicine, rarely has a therapeutic agent been found efficacious in the management of so many symptoms and in such a relatively short time as botulinum toxin. One of the most notable contributions of botulinum toxin therapy in clinical medicine is in the field of movement disorders. METHODS The English literature was searched using the Yale search engine including but not limited to PubMed and Ovid. The search includes articles from January 1 1980 to March 1 2016. RESULTS A total of 2055 articles were identified. Of these, 132 met the criteria for this review. DISCUSSION This historical review highlights early and seminal contributions that have introduced the application of botulinum toxins in the field of movement disorders and provides evidence-based contributions that have established botulinum toxin as an effective treatment for abnormal movements.
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Atashzar SF, Shahbazi M, Ward C, Samotus O, Delrobaei M, Rahimi F, Lee J, Jackman M, Jog MS, Patel RV. Haptic Feedback Manipulation During Botulinum Toxin Injection Therapy for Focal Hand Dystonia Patients: A Possible New Assistive Strategy. IEEE TRANSACTIONS ON HAPTICS 2016; 9:523-535. [PMID: 27552765 DOI: 10.1109/toh.2016.2601605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abnormality of sensorimotor integration in the basal ganglia and cortex has been reported in the literature for patients with task-specific focal hand dystonia (FHD). In this study, we investigate the effect of manipulation of kinesthetic input in people living with writer's cramp disorder (a major form of FHD). For this purpose, severity of dystonia is studied for 11 participants while the symptoms of seven participants have been tracked during five sessions of assessment and Botulinum toxin injection (BoNT-A) therapy (one of the current suggested therapies for dystonia). BoNT-A therapy is delivered in the first and the third session. The goal is to analyze the effect of haptic manipulation as a potential assistive technique during BoNT-A therapy. The trial includes writing, hovering, and spiral/sinusoidal drawing subtasks. In each session, the subtasks are repeated twice when (a) a participant uses a normal pen, and (b) when the participant uses a robotics-assisted system (supporting the pen) which provides a compliant virtual writing surface and manipulates the kinesthetic sensory input. The results show (p-value using one-sample t-tests) that reducing the writing surface rigidity significantly decreases the severity of dystonia and results in better control of grip pressure (an indicator of dystonic cramping). It is also shown that (p-value based on paired-samples t-test) using the proposed haptic manipulation strategy, it is possible to augment the effectiveness of BoNT-A therapy. The outcome of this study is then used in the design of an actuated pen as a writing-assistance tool that can provide compliant haptic interaction during writing for FHD patients.
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Cho HJ, Hallett M. Non-Invasive Brain Stimulation for Treatment of Focal Hand Dystonia: Update and Future Direction. J Mov Disord 2016; 9:55-62. [PMID: 27240806 PMCID: PMC4886207 DOI: 10.14802/jmd.16014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
Focal hand dystonia (FHD) is characterized by excessive and unwanted muscle activation in both the hand and arm resulting in impaired performance in particular tasks. Understanding the pathophysiology of FHD has progressed significantly for several decades and this has led to consideration of other potential therapies such as non-invasive brain stimulation (NIBS). A number of studies have been conducted to develop new therapy for FHD using transcranial magnetic stimulation and transcranial direct current stimulation. In this paper, we review previous studies and describe the potential therapeutic use of NIBS for FHD. We also discuss the future direction of NIBS to treat FHD.
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Affiliation(s)
- Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 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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35
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Frucht SJ. Evaluating the musician with dystonia of the upper limb: a practical approach with video demonstration. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:16. [PMID: 26788352 PMCID: PMC4711181 DOI: 10.1186/s40734-015-0026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/02/2015] [Indexed: 12/04/2022]
Abstract
Focal task-specific dystonia is an unusual movement disorder that may affect musicians specifically when they perform on their instruments. Muscles of the lower face, lower limb and upper limb may be involved depending on the nature of the instrument. We illustrate the rich phenomenology of focal task-specific dystonia affecting the upper limb in musicians, and present a practical approach for evaluating patients in the office.
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Affiliation(s)
- Steven J Frucht
- Mount Sinai Medical Center, Division of Movement Disorders, 5 East 98th Street, New York, NY 10029 USA
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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.
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Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, USA.
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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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Likhachev SА, Charnukha ТN, Charnenko NI. [Experience of botulinum toxin in treatment of writer's cramp]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:37-40. [PMID: 26120979 DOI: 10.17116/jnevro20151153137-40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of botulinum toxin type A (BTA) injections in patients with writer's cramp (WC). MATERIAL AND METHODS We treated 29 patients, in general, 49 BTA injections were performed. To determine points for the injections, we used ultrasound examination of the forearm including the time of writing. RESULTS Patients reported subjective improvement in 75.9% after the first injection. Positive results as assessed with the WCRS were seen in 82.7% of the patients. We observed muscle weakness in the hands of 17.2% of the patients. Most of the patients were satisfied with the result of the injection and agreed on the need to re-injection when clinical effect of BTA had decreased. CONCLUSION To determine the indications for BTA injections in PS, an individual approach to the development of schemes of injections and calculation of dose is needed. Treatment of BTA should be used in severe forms of WC with social significance to the patients.
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Affiliation(s)
- S А Likhachev
- Republican Scientific and Practical Centre of Neurology and Neurosurgery, Minsk, Belarus
| | - Т N Charnukha
- Republican Scientific and Practical Centre of Neurology and Neurosurgery, Minsk, Belarus
| | - N I Charnenko
- Republican Scientific and Practical Centre of Neurology and Neurosurgery, Minsk, Belarus
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Pandey S. A practical approach to management of focal hand dystonia. Ann Indian Acad Neurol 2015; 18:146-53. [PMID: 26019409 PMCID: PMC4445187 DOI: 10.4103/0972-2327.156563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 12/03/2022] Open
Abstract
Dystonia can be focal, segmental, multifocal, generalized, or hemidystonia. Focal dystonia is localized to a specific part of the body. Overall upper limb is more commonly involved in focal dystonia than lower limb and since it starts from hand, focal hand dystonia (FHD) is a more accepted terminology. Writer's cramp and musician dystonia are commonest types of FHD. Typically this dystonia is task specific, but in some patients this specificity may be lost over a period of time. Segmental or generalized dystonia may also start as FHD, so a detailed clinical assessment is required, which should be supplemented by relevant investigations. Treatment includes oral medications, injection botulinum toxin, neurosurgery including neurostimulation, and rehabilitation. Role of injection botulinum toxin has been extensively studied in writer's cramp patients and found to be effective; however, selection of muscles and techniques of injection are crucial in getting best results.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, Room No. 507, Academic Block, Govind Ballabh Pant Hospital, New Delhi, India
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40
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Jhunjhunwala K, Lenka A, Pal PK. A Clinical Profile of 125 Patients with Writer's Cramp. Eur Neurol 2015; 73:316-20. [PMID: 25997562 DOI: 10.1159/000381949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/29/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The characteristics of writer's cramp (WC) may vary according to native languages and scripts. We report the clinical profile of a large cohort of patients with WC from India. METHODS A chart review of 125 patients (F:M = 16:109) with WC seen over 10 years at the National Institute of Mental Health and Neurosciences (NIMHANS), India. RESULTS The mean age of patients was 36.8 ± 14.3, the mean age at onset (AAO) of symptoms was 31.5 ± 2.7 and the mean duration of difficulty in writing was 5.3 ± 6.3. The most common presenting complaint while writing was pain in the forearm (56%), followed by tremulousness of hand (28.8%) and abnormal posturing of hand (15.2%). Along with writing difficulty, 5.6% had difficulty in typing. The mean AAO of writing difficulty was significantly earlier in women than in men (22.8 ± 3.5 vs. 32.8 ± 4.2 years, p < 0.001). While writing, excessive extension (41.6%) of wrist was the most common abnormality, followed by excessive flexion (37.6%) and extension (19.2%) of index finger. CONCLUSIONS Women with WC have a significantly earlier age of onset than men. Excessive extension of wrist with flexion of thumb and index finger were the most common abnormalities noted in WC.
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Affiliation(s)
- Ketan Jhunjhunwala
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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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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Current uses of botulinum toxin A as an adjunct to hand therapy interventions of hand conditions. J Hand Ther 2014; 27:85-94; quiz 95. [PMID: 24524884 DOI: 10.1016/j.jht.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature review. DISCUSSION Botulinum toxin A, a neurotoxin causing temporary muscle paralysis at the neuromuscular junction, has been used to treat multiple acquired conditions of the hand and upper extremity. Initially approved for use in treating blepharospasm and strabismus in the 1980s, indications have expanded to include spasticity associated with cerebrovascular accidents, vasospastic disorders, focal dystonias, and pain conditions. This article reviews the current literature discussing the efficacy of botulinum toxin A in management of disorders of the hand and upper extremity relevant to hand therapists. LEVEL OF EVIDENCE NA.
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Ramos VFML, Karp BI, Lungu C, Alter K, Hallett M. Clinical Response to IncobotulinumtoxinA, after Demonstrated Loss of Clinical Response to OnabotulinumtoxinA and RimabotulininumtoxinB in a Patient with Musician's Dystonia. Mov Disord Clin Pract 2014; 1:383-385. [PMID: 27066521 DOI: 10.1002/mdc3.12094] [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: 11/07/2022] Open
Abstract
Botulinum toxin is a mainstay therapy for dystonia. Formulations available are three types of botulinumtoxinA and one type of botulinumtoxinB.1 Antibodies can develop against the toxin, leading to treatment failure. IncobotulinumtoxinA (Xeomin; Merz Pharmaceuticals GmbH, Frankfurt, Germany) is differentiated from other types of botulinumtoxinA preparations by being free from complexing proteins, speculated to make the product less antigenic.2.
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Affiliation(s)
| | - Barbara I Karp
- CNS, IRB, National Institutes of Health, Bethesda, Maryland, USA
| | - Codrin Lungu
- National Institutes of Health, Bethesda, Maryland, USA
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitaion Medicine Department, National Institutes of Health, Bethesda, Maryland, USA; Mount Washington Pediatric Hospital, Washington, District of Columbia, USA
| | - Mark Hallett
- Human Motor Control Section, National Institutes of Health, Bethesda, Maryland, USA
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Ramirez-Castaneda J, Jankovic J. Long-term efficacy, safety, and side effect profile of botulinum toxin in dystonia: a 20-year follow-up. Toxicon 2014; 90:344-8. [PMID: 25130293 DOI: 10.1016/j.toxicon.2014.07.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/18/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
Most long-term studies of the efficacy and safety profile of botulinum toxin (BoNT) in the treatment of dystonia are limited by lack of objective assessments, relatively small sample size, or short follow-up periods. We present one of the longest follow-up studies of BoNT treatment. This is a retrospective, longitudinal study that analyzes data on 89 patients treated with BoNT for dystonia at our Movement Disorders Clinic for up to 26 years (mean follow-up period of 18.5 years). The mean ages at the time of the first and last injections were 49 and 68 years old, respectively. The most common diagnoses were cervical dystonia (N = 51), blepharospasm (N = 34), and oromandibular dystonia (N = 26). The total number of onabotulinumtoxinA units received during the first injection was 140.3 as compared to 224.5 at the last injection (p < 0.0001). The global response effect was 3.18 after the first injection session and 3.57 after the last injection (p < 0.0001). The duration of response after the initial injection session and at the last injection was 16.33 weeks versus 19.42 weeks (p 0.0037), respectively. Adverse events, typically related to injection site, were reported in 19% of the visits. This series of dystonia patients with the longest reported treatment with BoNT provide evidence that in selected patients repeated chemodenervation is associated with sustained symptomatic benefit, decreased latency effect, and prolonged duration of therapeutic response. Despite the higher requirement of mean units per visit over time, only 19% of all treatment cycles are associated with adverse, but tolerable, side effects.
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Affiliation(s)
- Juan Ramirez-Castaneda
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Peña E. Treatment with botulinum toxin: An update. World J Neurol 2013; 3:29-41. [DOI: 10.5316/wjn.v3.i3.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/10/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is a potent toxin produced by the anaerobic bacterium clostridium botulinum. It causes flaccid, long-lasting, local and reversible paralysis. In addition, BoNT inhibits the secretion of the exocrine glands and could have properties in the control of pain. Thus, BoNT is useful in the treatment of many neuromuscular conditions where an increase of muscle tone is associated with the pathogenic mechanism. Furthermore, BoNT is recommended in the treatment of some hypersecretion disorders of the exocrine gland and could play a role in the treatment of migraine and other chronic pain conditions. In the BoNT therapy adverse effects are usually mild and reversible. However, repeated injections of BoNT can lead to the development of neutralizing antibodies that can subsequently inhibit the biological activity of the toxin. In this sense, many factors can influence the immunogenicity of the BoNT, such as product-related factors, the dose of BoNT used, the frequency of injection and the previous exposure to the toxin. In this review, we are going to discuss the current clinical applications of BoNT with a special focus on evidence, doses, injection technique and adverse effects for those applications more frequently used in neurology, namely spasticity, blepharospasm, hemifacial spasm, cervical dystonia and other focal dystonias, as well as chronic migraine, tremor, sialorrhea, facial palsy, neurogenic bladder and many other neurological condition.
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Musician's dystonia in pianists: long-term evaluation of retraining and other therapies. Parkinsonism Relat Disord 2013; 20:8-12. [PMID: 24055013 DOI: 10.1016/j.parkreldis.2013.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Musician's dystonia is characterized by loss of voluntary motor control in extensively trained movements on an instrument. The condition is difficult to treat. This retrospective study reports on the interventions received by a homogeneous cohort of pianists with musician's dystonia and the subjective and objective changes reported in task performance. METHODS This is a retrospective descriptive study. Fifty four pianists with musician's dystonia who had received care in a Movement Disorders Clinic completed a self report questionnaire regarding type and effectiveness of treatment received over the last 4 years. Pianists' fine motor control was assessed objectively by measuring the temporal regularity of their scale playing. RESULTS Nearly all patients (98.0%) reported deficits in motor tasks other than musical playing. Half of the patients were taking medications (Botulinum toxin (53%), Trihexyphenidyl (51%)). Subjects reported participating in multiple therapies: retraining (87%), hand therapy (42%), relaxation techniques (38%), physiotherapy (30%), psychotherapy (23%), acupuncture (21%) and body techniques (21%). Self-reported improvements in motor performance were reported by 81.5% of the subjects with 5.6% reporting a complete recovery. Objective gains in task-specific motor performance were documented in 42.9% of the subjects (with deterioration in 4.8%). Retraining therapy, relaxation techniques and change in teacher explained 52% of the variance in subjective outcomes. CONCLUSIONS Musician's dystonia not only interferes with musical performance but other fine motor tasks. Objectively, approximately 50% of patients improved task performance following participation in a variety of intervention strategies, but subjectively, 80% of subjects reported improvement.
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Jankovic J. Medical treatment of dystonia. Mov Disord 2013; 28:1001-12. [DOI: 10.1002/mds.25552] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/03/2013] [Accepted: 05/10/2013] [Indexed: 01/21/2023] Open
Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine; Houston Texas USA
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Peterson DA, Berque P, Jabusch HC, Altenmüller E, Frucht SJ. Rating scales for musician's dystonia: the state of the art. Neurology 2013; 81:589-98. [PMID: 23884039 DOI: 10.1212/wnl.0b013e31829e6f72] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Musician's dystonia (MD) is a focal adult-onset dystonia most commonly involving the hand. It has much greater relative prevalence than non-musician's focal hand dystonias, exhibits task specificity at the level of specific musical passages, and is a particularly difficult form of dystonia to treat. For most MD patients, the diagnosis confirms the end of their music performance careers. Research on treatments and pathophysiology is contingent upon measures of motor function abnormalities. In this review, we comprehensively survey the literature to identify the rating scales used in MD and the distribution of their use. We also summarize the extent to which the scales have been evaluated for their clinical utility, including reliability, validity, sensitivity, specificity to MD, and practicality for a clinical setting. Out of 135 publications, almost half (62) included no quantitative measures of motor function. The remaining 73 studies used a variety of choices from among 10 major rating scales. Most used subjective scales involving either patient or clinician ratings. Only 25% (18) of the studies used objective scales. None of the scales has been completely and rigorously evaluated for clinical utility. Whether studies involved treatments or pathophysiologic assays, there was a heterogeneous choice of rating scales used with no clear standard. As a result, the collective interpretive value of those studies is limited because the results are confounded by measurement effects. We suggest that the development and widespread adoption of a new clinically useful rating scale is critical for accelerating basic and clinical research in MD.
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Affiliation(s)
- David A Peterson
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA, USA.
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Ramirez-Castaneda J, Jankovic J, Comella C, Dashtipour K, Fernandez HH, Mari Z. Diffusion, spread, and migration of botulinum toxin. Mov Disord 2013; 28:1775-83. [PMID: 23868503 DOI: 10.1002/mds.25582] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/17/2013] [Accepted: 05/23/2013] [Indexed: 01/17/2023] Open
Abstract
Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the molecule from the injection site, passive diffusion, and migration to distal sites via axonal or hematogenous transport. The passive kinetic dispersion of the toxin away from the injection site in a gradient-dependent manner may also play a role in toxin spread. In addition to unique properties of the various BoNT products, volume and dilution may also influence local and systemic distribution of BoNT. Most of the local and remote complications of BoNT injections are thought to be due to unwanted spread or diffusion of the toxin's biologic activity into adjacent and distal muscles. Despite widespread therapeutic and cosmetic use of BoNT over more than three decades, there is a remarkable paucity of published data on the mechanisms of distribution and its effects on clinical outcomes. The primary aim of this article is to critically review the available experimental and clinical literature and place it in the practical context.
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Affiliation(s)
- Juan Ramirez-Castaneda
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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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: 157] [Impact Index Per Article: 14.3] [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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