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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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Fischer P, Piña-Fuentes D, Kassavetis P, Sadnicka A. Physiology of dystonia: Human studies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:137-162. [PMID: 37482391 DOI: 10.1016/bs.irn.2023.05.007] [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: 07/25/2023]
Abstract
In this chapter, we discuss neurophysiological techniques that have been used in the study of dystonia. We examine traditional disease models such as inhibition and excessive plasticity and review the evidence that these play a causal role in pathophysiology. We then review the evidence for sensory and peripheral influences within pathophysiology and look at an emergent literature that tries to probe how oscillatory brain activity may be linked to dystonia pathophysiology.
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Affiliation(s)
- Petra Fischer
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, United Kingdom
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, The Netherlands; Department of Neurology, OLVG, Amsterdam, The Netherlands
| | | | - Anna Sadnicka
- Motor Control and Movement Disorders Group, St George's University of London, London, United Kingdom; Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
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Frey J, Ramirez-Zamora A, Wagle Shukla A. Applications of Transcranial Magnetic Stimulation for Understanding and Treating Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:119-139. [PMID: 37338699 DOI: 10.1007/978-3-031-26220-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Transcranial magnetic stimulation (TMS)-based studies have led to an advanced understanding of the pathophysiology of dystonia. This narrative review summarizes the TMS data contributed to the literature so far. Many studies have shown that increased motor cortex excitability, excessive sensorimotor plasticity, and abnormal sensorimotor integration are the core pathophysiological substrates for dystonia. However, an increasing body of evidence supports a more widespread network dysfunction involving many other brain regions. Repetitive TMS pulses (rTMS) in dystonia have therapeutic potential as they can induce local and network-wide effects through modulation of excitability and plasticity. The bulk of rTMS studies has targeted the premotor cortex with some promising results in focal hand dystonia. Some studies have targeted the cerebellum for cervical dystonia and the anterior cingulate cortex for blepharospasm. We believe that therapeutic potential could be leveraged better when rTMS is implemented in conjunction with standard-of-care pharmacological treatments. However, due to several limitations in the studies conducted to date, including small samples, heterogeneous populations, variability in the target sites, and inconsistencies in the study design and control arm, it is hard to draw a definite conclusion. Further studies are warranted to determine optimal targets and protocols yielding the most beneficial outcomes that will translate into meaningful clinical changes.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A. Dystonia, chorea, hemiballismus and other dyskinesias. Clin Neurophysiol 2022; 140:110-125. [PMID: 35785630 DOI: 10.1016/j.clinph.2022.05.014] [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: 03/01/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Hyperkinesias are heterogeneous involuntary movements that significantly differ in terms of clinical and semeiological manifestations, including rhythm, regularity, speed, duration, and other factors that determine their appearance or suppression. Hyperkinesias are due to complex, variable, and largely undefined pathophysiological mechanisms that may involve different brain areas. In this chapter, we specifically focus on dystonia, chorea and hemiballismus, and other dyskinesias, specifically, levodopa-induced, tardive, and cranial dyskinesia. We address the role of neurophysiological studies aimed at explaining the pathophysiology of these conditions. We mainly refer to human studies using surface and invasive in-depth recordings, as well as spinal, brainstem, and transcortical reflexology and non-invasive brain stimulation techniques. We discuss the extent to which the neurophysiological abnormalities observed in hyperkinesias may be explained by pathophysiological models. We highlight the most relevant issues that deserve future research efforts. The potential role of neurophysiological assessment in the clinical context of hyperkinesia is also discussed.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Josep Valls-Solè
- Institut d'Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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Hao W, Wei T, Yang W, Yang Y, Cheng T, Li X, Dong W, Jiang H, Qian N, Wang H, Wang M. Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Dystonia in Patients With Wilson's Disease: A Randomized Controlled Trial. Front Neurol 2022; 12:783365. [PMID: 34970214 PMCID: PMC8712768 DOI: 10.3389/fneur.2021.783365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Upper limb dystonia is a frequent complication of Wilson's disease (WD). It can lead to poor quality of life and disability. Currently, no effective treatment for it exists. Therefore, we carried out a clinical trial to determine whether high frequency repetitive transcranial magnetic stimulation (rTMS) on the primary motor cortex alleviates upper limb dystonia in WD patients. Methods: This study was a single-center, double-blind, randomized clinical study, included 60 WD patients with upper limb dystonia from a research base of WD in Hefei, China. Participants were randomly divided into a treatment group (TG) and a control group (CG). The TG received rTMS at 10 Hz, while the CG received sham stimulation for 7 consecutive days. Participants were assessed at baseline, after the seventh treatment session, and at 2 and 4 weeks after the seventh treatment session. The primary outcomes included patients' objective muscle tension and stiffness as measured with the MyotonPRO device. The secondary results were scores on clinical scales assessing muscle spasm and motor symptoms, which included the Modified Ashworth Scale (MAS), Unified Wilson's Disease Rating Scale (UWDRS), Burke Fahn Marsden Scale (BFM), and the Activities of Daily Living (ADL) scale. Results: The analysis revealed that after 10 Hz rTMS, muscle tension (P < 0.01) and stiffness (P < 0.01) as measured by the MyotonPRO device decreased significantly in the TG compared to the CG. Moreover, clinically relevant scale scores, including the MAS (P < 0.01), UWDRS (P < 0.01), BFM (P < 0.01), and ADL (P < 0.01) were also significantly reduced. Conclusion: High-frequency rTMS over the primary motor cortex may be an effective complementary and alternative therapy to alleviating upper limb dystonia in WD patients. Clinical Trial Registration:http://www.chictr.org.cn/, identifier: ChiCTR2100046258.
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Affiliation(s)
- Wenjie Hao
- Department of Graduate, Anhui University of Chinese Medicine, Hefei, China
| | - Taohua Wei
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yue Yang
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Ting Cheng
- Department of Clinical Medicine, Clinical Medicine College of Anhui Medical University, Hefei, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Wei Dong
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Hailin Jiang
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Nannan Qian
- Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
| | - Han Wang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Meixia Wang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Precise Modulation Strategies for Transcranial Magnetic Stimulation: Advances and Future Directions. Neurosci Bull 2021; 37:1718-1734. [PMID: 34609737 DOI: 10.1007/s12264-021-00781-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a popular modulatory technique for the noninvasive diagnosis and therapy of neurological and psychiatric diseases. Unfortunately, current modulation strategies are only modestly effective. The literature provides strong evidence that the modulatory effects of TMS vary depending on device components and stimulation protocols. These differential effects are important when designing precise modulatory strategies for clinical or research applications. Developments in TMS have been accompanied by advances in combining TMS with neuroimaging techniques, including electroencephalography, functional near-infrared spectroscopy, functional magnetic resonance imaging, and positron emission tomography. Such studies appear particularly promising as they may not only allow us to probe affected brain areas during TMS but also seem to predict underlying research directions that may enable us to precisely target and remodel impaired cortices or circuits. However, few precise modulation strategies are available, and the long-term safety and efficacy of these strategies need to be confirmed. Here, we review the literature on possible technologies for precise modulation to highlight progress along with limitations with the goal of suggesting future directions for this field.
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Guidali G, Roncoroni C, Bolognini N. Paired associative stimulations: Novel tools for interacting with sensory and motor cortical plasticity. Behav Brain Res 2021; 414:113484. [PMID: 34302877 DOI: 10.1016/j.bbr.2021.113484] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022]
Abstract
In the early 2000s, a novel non-invasive brain stimulation protocol, the paired associative stimulation (PAS), was introduced, allowing to induce and investigate Hebbian associative plasticity within the humans' motor system, with patterns resembling spike-timing-dependent plasticity properties found in cellular models. Since this evidence, PAS efficacy has been proved in healthy, and to a lesser extent, in clinical populations. Recently, novel 'modified' protocols targeting sensorimotor and crossmodal networks appeared in the literature. In the present work, we have reviewed recent advances using these 'modified' PAS protocols targeting sensory and motor cortical networks. To better categorize them, we propose a novel classification according to the nature of the peripheral and cortical stimulations (i.e., within-system, cross-systems, and cortico-cortical PAS). For each protocol of the categories mentioned above, we describe and discuss their main features, how they have been used to study and promote brain plasticity, and their advantages and disadvantages. Overall, current evidence suggests that these novel non-invasive brain stimulation protocols represent very promising tools to study the plastic properties of humans' sensorimotor and crossmodal networks, both in the healthy and in the damaged central nervous system.
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Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.
| | - Camilla Roncoroni
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & NeuroMI - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Manzo N, Tocco P, Ginatempo F, Bertolasi L, Rocchi L. Brainstem Reflexes in Idiopathic Cervical Dystonia: Does Medullary Dysfunction Play a Role? Mov Disord Clin Pract 2021; 8:377-384. [PMID: 33816666 PMCID: PMC8015899 DOI: 10.1002/mdc3.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurophysiological markers in dystonia have so far not been sistematically applied in clinical practice due to limited reproducibility of results and low correlations with clinical findings. Exceptions might be represented by the blink reflex (BR), including its recovery cycle (BRRC) and the trigemino‐cervical reflex (TCR) which, compared to other neurophysiological methods, have shown more consistent alterations in cervical dystonia (CD). However, a comparison between the two techniques, and their possible correlation with disease symptoms, have not been thoroughly investigated. Objectives To assess the role of BR, BRCC and TCR in the pathophysiology of idiopathic cervical dystonia. Methods Fourteen patients and 14 age‐matched healthy controls (HC) were recruited. Neurophysiological outcome measures included latency of R1 and R2 components of the BR, R2 amplitude, BRRC, latency and amplitude of P19/N31 complex of TCR. Clinical and demographic features of patients were also collected, including age at disease onset, disease duration, presence of tremor, sensory trick and pain. The Toronto Western Spasmodic Torticollis Rating Scale was used to characterize dystonia. Results Compared to HC, CD patients showed increased latency of the BR R2 and decreased suppression of the BRRC. They also showed increased latency of the P19 and decreased amplitude of P19/N31 complex of TCR. The latency of P19 component of TCR was positively correlated with disease duration. Conclusions We propose that the increased latency of R2 and P19 observed here might be reflective of brainstem dysfunction, mediated either by local interneuronal excitability changes or by subtle structural damage.
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Affiliation(s)
| | - Pierluigi Tocco
- Department of Neuroscience, Biomedicine and Movement Sciences University of Verona Verona Italy
| | | | - Laura Bertolasi
- Department of Neuroscience, Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movements Neurosciences, UCL Queen Square Institute of Neurology University College London London United Kingdom
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Thomsen BLC, Teodoro T, Edwards MJ. Biomarkers in functional movement disorders: a systematic review. J Neurol Neurosurg Psychiatry 2020; 91:1261-1269. [PMID: 33087421 DOI: 10.1136/jnnp-2020-323141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 11/04/2022]
Abstract
Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural capacity for movement. In many cases, a positive diagnosis of FMD can be established on clinical grounds. However, the diagnosis remains challenging in certain scenarios, and there is a need for predictors of treatment response and long-term prognosis.In this context, we performed a systematic review of biomarkers in FMD. Eighty-six studies met our predefined criteria and were included.We found fairly reliable electroencephalography and electromyography-based diagnostic biomarkers for functional myoclonus and tremor. Promising biomarkers have also been described for functional paresis, gait and balance disorders. In contrast, there is still a lack of diagnostic biomarkers of functional dystonia and tics, where clinical diagnosis is often also more challenging. Importantly, many promising findings focus on pathophysiology and reflect group-level comparisons, but cannot differentiate on an individual basis. Some biomarkers also require access to time-consuming and resource-consuming techniques such as functional MRI.In conclusion, there are important gaps in diagnostic biomarkers in FMD in the areas of most clinical uncertainty. There is also is a lack of treatment response and prognostic biomarkers to aid in the selection of patients who would benefit from rehabilitation and other forms of treatment.
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Affiliation(s)
- Birgitte Liang Chen Thomsen
- Neurology, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tiago Teodoro
- Neurosciences Research Centre, St George's University of London, London, UK.,Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
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Latorre A, Rocchi L, Bhatia KP. Delineating the electrophysiological signature of dystonia. Exp Brain Res 2020; 238:1685-1692. [PMID: 32712678 DOI: 10.1007/s00221-020-05863-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
Over the last 30 years, the concept of dystonia has dramatically changed, from being considered a motor neurosis, to a pure basal ganglia disorder, to finally reach the definition of a network disorder involving the basal ganglia, cerebellum, thalamus and sensorimotor cortex. This progress has been possible due to the collaboration between clinicians and scientists, and the development of increasingly sophisticated electrophysiological techniques able to non-invasively investigate pathophysiological mechanisms in humans. This review is a chronological excursus of the electrophysiological studies that laid the foundation for the understanding of the pathophysiology of dystonia and delineated its electrophysiological signatures. Evidence for neurophysiological abnormalities is grouped according to the neural system involved, and a unifying theory, bringing together all the hypothesis and evidence provided to date, is proposed at the end.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
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11
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Strzalkowski NDJ, Sondergaard RE, Gan LS, Kiss ZHT. Case studies in neuroscience: deep brain stimulation changes upper limb cortical motor maps in dystonia. J Neurophysiol 2020; 124:268-273. [PMID: 32579422 DOI: 10.1152/jn.00159.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Deep brain stimulation of the globus pallidus pars interna (GPi-DBS) is an effective treatment for primary dystonia; however, its therapeutic mechanism is poorly understood. Because improvement is gradual, GPi-DBS treatment likely involves short- and long-term mechanisms. Abnormal plasticity resulting in somatotopic reorganization is involved in the development of dystonia and has been proposed as a possible mechanism for this gradual improvement, yet it has not been directly investigated. We hypothesized that GPi-DBS will lead to progressive changes in the cortical representations (motor maps) of upper limb muscles. Neuronavigated robotic transcranial magnetic stimulation was used to map the cortical representation of five upper limb muscles in six healthy controls and a 45-yr-old female cervical dystonia patient before (Pre) and at four time points (Post5 to Post314), 5 to 314 days after GPi-DBS. Motor map area and volume decreased in all muscles following GPi-DBS, while changes in overlap and center of gravity distance between muscles were variable. Despite these motor map changes, only dystonic tremor improved after a year of DBS; neck position worsened slightly. These preliminary findings suggest that GPi-DBS may reduce the cortical representation and excitability of upper limb muscles in dystonia and that these changes can occur without clinical improvement.NEW & NOTEWORTHY Neuronavigated robotic transcranial magnetic stimulation was used to investigate changes in upper limb muscle representation in a cervical dystonia patient before and at four time points up to 314 days after globus pallidus pars interna deep brain stimulation (GPi-DBS). GPi-DBS altered excitability and motor cortical representation of upper limb muscles; however, these changes were not associated with clinical improvement.
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Affiliation(s)
- Nicholas D J Strzalkowski
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Departments of Biology and General Education, Mount Royal University, Calgary, Alberta, Canada
| | - Rachel E Sondergaard
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Liu Shi Gan
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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12
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Plasticity and dystonia: a hypothesis shrouded in variability. Exp Brain Res 2020; 238:1611-1617. [PMID: 32206849 PMCID: PMC7413892 DOI: 10.1007/s00221-020-05773-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 12/19/2022]
Abstract
Studying plasticity mechanisms with Professor John Rothwell was a shared highlight of our careers. In this article, we discuss non-invasive brain stimulation techniques which aim to induce and quantify plasticity, the mechanisms and nature of their inherent variability and use such observations to review the idea that excessive and abnormal plasticity is a pathophysiological substrate of dystonia. We have tried to define the tone of our review by a couple of Professor John Rothwell's many inspiring characteristics; his endless curiosity to refine knowledge and disease models by scientific exploration and his wise yet humble readiness to revise scientific doctrines when the evidence is supportive. We conclude that high variability of response to non-invasive brain stimulation plasticity protocols significantly clouds the interpretation of historical findings in dystonia research. There is an opportunity to wipe the slate clean of assumptions and armed with an informative literature in health, re-evaluate whether excessive plasticity has a causal role in the pathophysiology of dystonia.
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13
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Gövert F, Becktepe J, Balint B, Rocchi L, Brugger F, Garrido A, Walter T, Hannah R, Rothwell J, Elble R, Deuschl G, Bhatia K. Temporal discrimination is altered in patients with isolated asymmetric and jerky upper limb tremor. Mov Disord 2019; 35:306-315. [PMID: 31724777 DOI: 10.1002/mds.27880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Unilateral or very asymmetric upper limb tremors with a jerky appearance are poorly investigated. Their clinical classification is an unsolved problem because their classification as essential tremor versus dystonic tremor is uncertain. To avoid misclassification as essential tremor or premature classification as dystonic tremor, the term indeterminate tremor was suggested. OBJECTIVES The aim of this study was to characterize this tremor subgroup electrophysiologically and evaluate whether diagnostically meaningful electrophysiological differences exist compared to patients with essential tremor and dystonic tremor. METHODS We enrolled 29 healthy subjects and 64 patients with tremor: 26 with dystonic tremor, 23 with essential tremor, and 15 patients with upper limb tremor resembling essential tremor but was unusually asymmetric and jerky (indeterminate tremor). We investigated the somatosensory temporal discrimination threshold, the short-interval intracortical inhibition, and the cortical plasticity by paired associative stimulation. RESULTS Somatosensory temporal discrimination threshold was significantly increased in patients with dystonic tremor and indeterminate tremor, but it was normal in the essential tremor patients and healthy controls. Significant differences in short-interval intracortical inhibition and paired associative stimulation were not found among the three patient groups and controls. CONCLUSION These results indicate that indeterminate tremor, as defined in this study, shares electrophysiological similarities with dystonic tremor rather than essential tremor. Therefore, we propose that indeterminate tremor should be considered as a separate clinical entity from essential tremor and that it might be dystonic in nature. Somatosensory temporal discrimination appears to be a useful tool in tremor classification. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Florian Brugger
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alicia Garrido
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom.,Movement Disorders Unit, Neurology Service, Hospital Clínic, Institut d'investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Tim Walter
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Ricci Hannah
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - John Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
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14
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Conte A, Rocchi L, Latorre A, Belvisi D, Rothwell JC, Berardelli A. Ten‐Year Reflections on the Neurophysiological Abnormalities of Focal Dystonias in Humans. Mov Disord 2019; 34:1616-1628. [DOI: 10.1002/mds.27859] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Anna Latorre
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | | | - John C. Rothwell
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza, University of Rome Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
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15
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Latorre A, Rocchi L, Berardelli A, Bhatia KP, Rothwell JC. The interindividual variability of transcranial magnetic stimulation effects: Implications for diagnostic use in movement disorders. Mov Disord 2019; 34:936-949. [DOI: 10.1002/mds.27736] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement NeurosciencesQueen Square Institute of Neurology University College London London United Kingdom
- Department of Neurology and Psychiatry, SapienzaUniversity of Rome Rome Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement NeurosciencesQueen Square Institute of Neurology University College London London United Kingdom
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, SapienzaUniversity of Rome Rome Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Neuromed Pozzilli Isernia Italy
| | - Kailash P. Bhatia
- Department of Clinical and Movement NeurosciencesQueen Square Institute of Neurology University College London London United Kingdom
| | - John C. Rothwell
- Department of Clinical and Movement NeurosciencesQueen Square Institute of Neurology University College London London United Kingdom
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16
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Abstract
We review the motor cortical and basal ganglia involvement in two important movement disorders: Parkinson's disease (PD) and dystonia. Single and paired pulse transcranial magnetic stimulation studies showed altered excitability and cortical circuits in PD with decreased silent period, short interval intracortical inhibition, intracortical facilitation, long afferent inhibition, interhemispheric inhibition, and cerebellar inhibition, and increased long interval intracortical inhibition and short interval intracortical facilitation. In dystonia, there is decreased silent period, short interval intracortical inhibition, long afferent inhibition, interhemispheric inhibition, and increased intracortical facilitation. Plasticity induction protocols revealed deficient plasticity in PD and normal and exaggerated plasticity in dystonia. In the basal ganglia, there is increased β (14-30Hz) rhythm in PD and characteristic 5-18Hz band synchronization in dystonia. These motor cortical circuits, cortical plasticity, and oscillation profiles of the basal ganglia are altered with medications and deep brain stimulation treatment. There is considerable variability in these measures related to interindividual variations, different disease characteristics, and methodological considerations. Nevertheless, these pathophysiologic studies have expanded our knowledge of cortical excitability, plasticity, and oscillations in PD and dystonia, improved our understanding of disease pathophysiology, and helped to develop new treatments for these conditions.
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Affiliation(s)
- Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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17
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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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18
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Spatial Integration of Somatosensory Inputs during Sensory-Motor Plasticity Phenomena Is Normal in Focal Hand Dystonia. Neural Plast 2018; 2018:4135708. [PMID: 30405710 PMCID: PMC6199881 DOI: 10.1155/2018/4135708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/18/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background Surround inhibition is a system that sharpens sensation by creating an inhibitory zone around the central core of activation. In the motor system, this mechanism probably contributes to the selection of voluntary movements, and it seems to be lost in dystonia. Objectives. To explore if sensory information is abnormally processed and integrated in focal hand dystonia (FHD) and if surround inhibition phenomena are operating during sensory-motor plasticity and somatosensory integration in normal humans and in patients with FHD. Methods. We looked at the MEP facilitation obtained after 5 Hz repetitive paired associative stimulation of median (PAS M), ulnar (PAS U), and median + ulnar nerve (PAS MU) stimulation in 8 normal subjects and 8 FHD. We evaluated the ratio MU/(M + U) ∗ 100 and the spatial and temporal somatosensory integration recording the somatosensory evoked potentials (SEPs) evoked by a dual nerve input. Results FHD had two main abnormalities: first, the amount of facilitation was larger than normal subjects; second, the spatial specificity was lost. The MU/(M + U) ∗ 100 ratio was similar in healthy subjects and in FHD patients, and the somatosensory integration was normal in this subset of patients. Conclusions. The inhibitory integration of somatosensory inputs and the somatosensory inhibition are normal in patients with focal dystonia as well as lateral surrounding inhibition phenomena during sensory-motor plasticity in FHD.
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19
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Abstract
Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions. Dystonia can be the manifesting neurological sign of many disorders, either in isolation (isolated dystonia) or with additional signs (combined dystonia). The main focus of this Primer is forms of isolated dystonia of idiopathic or genetic aetiology. These disorders differ in manifestations and severity but can affect all age groups and lead to substantial disability and impaired quality of life. The discovery of genes underlying the mendelian forms of isolated or combined dystonia has led to a better understanding of its pathophysiology. In some of the most common genetic dystonias, such as those caused by TOR1A, THAP1, GCH1 and KMT2B mutations, and idiopathic dystonia, these mechanisms include abnormalities in transcriptional regulation, striatal dopaminergic signalling and synaptic plasticity and a loss of inhibition at neuronal circuits. The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge. Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection and deep brain stimulation are available; however, future research will hopefully lead to reliable biomarkers, better treatments and cure of this disorder.
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20
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Fazl A, Fleisher J. Anatomy, Physiology, and Clinical Syndromes of the Basal Ganglia: A Brief Review. Semin Pediatr Neurol 2018; 25:2-9. [PMID: 29735113 PMCID: PMC6039104 DOI: 10.1016/j.spen.2017.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Movement disorders typically arise from dysfunction of the basal ganglia (BG), cerebellum, or both. The BG-a group of deep, subcortical structures-form complex circuits that shape motor control and motor learning, as well as limbic and associative functions. In this article, we summarize the anatomy and physiology of the BG and cerebellum, and briefly highlight the clinical syndromes that may arise in the context of their injury or dysfunction.
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Affiliation(s)
- Arash Fazl
- Department of Neurology, Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders at NYU Langone Health, New York University School of Medicine, New York, NY
| | - Jori Fleisher
- Department of Neurology, Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders at NYU Langone Health, New York University School of Medicine, New York, NY; Department of Neurological Sciences, Section of Movement Disorders, Rush Medical College, Rush Medical University, Chicago, IL.
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21
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Abstract
Dystonia can be seen in a number of different phenotypes that may arise from different etiologies. The pathophysiological substrate of dystonia is related to three lines of research. The first postulate a loss of inhibition which may account for the excess of movement and for the overflow phenomena. A second abnormality is sensory dysfunction which is related to the mild sensory complaints in patients with focal dystonias and may be responsible for some of the motor dysfunction. Finally, there are strong pieces of evidence from animal and human studies suggesting that alterations of synaptic plasticity characterized by a disruption of homeostatic plasticity, with a prevailing facilitation of synaptic potentiation may play a pivotal role in primary dystonia. These working hypotheses have been generalized in all form of dystonia. On the other hand, several pieces of evidence now suggest that the pathophysiology may be slightly different in the different types of dystonia. Therefore, in the present review, we would like to discuss the neural mechanisms underlying the different forms of dystonia to disentangle the different weight and role of environmental and predisposing factors.
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Affiliation(s)
- Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Diane Ruge
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
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22
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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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23
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Chen R, Szaflarski JP. Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Mov Disord 2018; 33:136-145. [PMID: 29124784 PMCID: PMC5767134 DOI: 10.1002/mds.27217] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/16/2017] [Accepted: 09/24/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to determine whether abnormalities in emotion processing underlie functional (psychogenic) dystonia, one of the most common functional movement disorders. METHODS Motor and emotion circuits were examined in 12 participants with functional dystonia, 12 with primary organic dystonia, and 25 healthy controls using functional magnetic resonance imaging at 4T and a finger-tapping task (motor task), a basic emotion-recognition task (emotional faces task), and an intense-emotion stimuli task. RESULTS There were no differences in motor task activation between groups. In the faces task, when compared with the other groups, functional dystonia patients showed areas of decreased activation in the right middle temporal gyrus and bilateral precuneus and increased activation in the right inferior frontal gyrus, bilateral occipital cortex and fusiform gyrus, and bilateral cerebellum. In the intense-emotion task, when compared with the other groups, functional dystonia patients showed decreased activation in the left insular and left motor cortices (compared to organic dystonia, they showed an additional decrease in activation in the right opercular cortex and right motor cortex) and increased activation in the left fusiform gyrus. CONCLUSIONS Functional dystonia patients exhibited stimulus-dependent altered activation in networks involved in motor preparation and execution, spatial cognition, and attentional control. These results support the presence of network dysfunction in functional dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alberto J. Espay
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Gardner Family Center for Parkinson’s disease and Movement Disorders, Cincinnati, Ohio
| | | | | | - Matthew M. Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - James C. Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - Erin Neefus
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Chen
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network and the, University of Toronto, Toronto, Canada
| | - Jerzy P. Szaflarski
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
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25
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Does the Somatosensory Temporal Discrimination Threshold Change over Time in Focal Dystonia? Neural Plast 2017; 2017:9848070. [PMID: 29062576 PMCID: PMC5618781 DOI: 10.1155/2017/9848070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022] Open
Abstract
Background The somatosensory temporal discrimination threshold (STDT) is defined as the shortest interval at which an individual recognizes two stimuli as asynchronous. Some evidence suggests that STDT depends on cortical inhibitory interneurons in the basal ganglia and in primary somatosensory cortex. Several studies have reported that the STDT in patients with dystonia is abnormal. No longitudinal studies have yet investigated whether STDT values in different forms of focal dystonia change during the course of the disease. Methods We designed a follow-up study on 25 patients with dystonia (15 with blepharospasm and 10 with cervical dystonia) who were tested twice: upon enrolment and 8 years later. STDT values from dystonic patients at the baseline were also compared with those from a group of 30 age-matched healthy subjects. Results Our findings show that the abnormally high STDT values observed in patients with focal dystonia remained unchanged at the 8-year follow-up assessment whereas disease severity worsened. Conclusions Our observation that STDT abnormalities in dystonia remain unmodified during the course of the disease suggests that the altered activity of inhibitory interneurons—either at cortical or at subcortical level—responsible for the increased STDT does not deteriorate as the disease progresses.
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26
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Kroneberg D, Plettig P, Schneider GH, Kühn AA. Motor Cortical Plasticity Relates to Symptom Severity and Clinical Benefit From Deep Brain Stimulation in Cervical Dystonia. Neuromodulation 2017; 21:735-740. [PMID: 28961350 DOI: 10.1111/ner.12690] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the relationship between motor cortical plasticity, intracortical inhibition, and clinical response to pallidal deep brain stimulation (DBS) in patients with cervical dystonia (CD). MATERIALS AND METHODS Response to paired associative stimulation (PAS) and short interval intracortical inhibition (SICI) were assessed in patients with CD before and after three months of DBS and correlated with severity of dystonic symptoms as assessed by Toronto-Western-Spasmodic Torticollis Rating Scale (TWSTRS) severity score. Relations of electrophysiological parameters with clinical improvement were explored with correlation analysis. RESULTS Patients with higher levels of plasticity before surgery showed higher symptom severity (R = 0.83, p = 0.008) but had also the larger clinical benefit following DBS (R = 0.88, p = 0.003). This correlation was independent from preoperative (preOP) TWSTRS motor score as revealed by partial correlation analysis. Intracortical inhibition was not altered in CD and not related to clinical outcome after DBS. CONCLUSIONS Our findings indicate that a high degree of preOP plasticity is associated with higher symptom severity, underlining the role of abnormal plasticity in the pathophysiology of dystonia. At the same time individual degree of plasticity may drive reestablishment of normal motor programs, leading to better clinical outcome with DBS. The latter suggests that individual PAS-response may indicate the susceptibility for neuromodulatory processes as an important factor for clinical DBS effects. It might therefore serve as a neurophysiological marker to predict outcome and guide patient selection.
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Affiliation(s)
- Daniel Kroneberg
- Department of Neurology, Charité Campus Mitte, Charité - University Medicine Berlin, Berlin, Germany
| | - Philip Plettig
- Department of Neurology, Charité Campus Mitte, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité Campus Mitte, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité Campus Mitte, Charité - University Medicine Berlin, Berlin, Germany.,NeuroCure, Charité - University Medicine Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Charité - University Medicine Berlin, Berlin, Germany
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27
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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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28
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Defazio G, Hallett M, Jinnah HA, Conte A, Berardelli A. Blepharospasm 40 years later. Mov Disord 2017; 32:498-509. [PMID: 28186662 DOI: 10.1002/mds.26934] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 01/04/2023] Open
Abstract
Forty years ago, C.D. Marsden proposed that blepharospasm should be considered a form of adult-onset focal dystonia. In the present paper, we provide a comprehensive overview of the findings regarding blepharospasm reported in the past 40 years. Although prolonged spasms of the orbicularis oculi muscles remain the clinical hallmark of blepharospasm, patients with blepharospasm may be characterized by various types of involuntary activation of periocular muscles. In addition to motor features, blepharospasm patients may also have nonmotor manifestations, including psychiatric, mild cognitive, and sensory disturbances. The various motor and nonmotor symptoms are not present in all patients, suggesting that blepharospasm is phenomenologically a heterogeneous condition. This emphasizes the need for tools for severity assessment that take into account both motor and nonmotor manifestations. The cause of blepharospasm remains elusive, but several lines of evidence indicate that blepharospasm is a multifactorial condition in which one, or several, as yet unknown genes together with epigenetic and environmental factors combine to reach the threshold of the disease. Although blepharospasm was originally believed to be solely a basal ganglia disorder, neurophysiological and neuroimaging evidence point to anatomical and functional involvement of several brain regions. The contribution of multiple areas has led to the hypothesis that blepharospasm should be considered as a network disorder, and this might reflect the varying occurrence of motor and nonmotor manifestations in blepharospasm patients. Despite advances in the aetiology and pathophysiology, treatment remains symptomatic. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Giovanni Defazio
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro", University of Bari, Bari, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Hyder A Jinnah
- Departments of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Antonella Conte
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
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Morgante F, Naro A, Terranova C, Russo M, Rizzo V, Risitano G, Girlanda P, Quartarone A. Normal sensorimotor plasticity in complex regional pain syndrome with fixed posture of the hand. Mov Disord 2016; 32:149-157. [DOI: 10.1002/mds.26836] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/30/2016] [Accepted: 09/15/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Francesca Morgante
- Dipartimento di Medicina Clinica e Sperimentale; Università di Messina; Messina Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo”; Messina Italy
| | - Carmen Terranova
- Dipartimento di Medicina Clinica e Sperimentale; Università di Messina; Messina Italy
| | | | - Vincenzo Rizzo
- Dipartimento di Medicina Clinica e Sperimentale; Università di Messina; Messina Italy
| | - Giovanni Risitano
- Unità Funzionale di Ortopedia e Traumatologia; Casa di Cura “Cappellani-GIOMI”; Messina Italy
| | - Paolo Girlanda
- Dipartimento di Medicina Clinica e Sperimentale; Università di Messina; Messina Italy
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences, and Morphological and Functional Images; University of Messina; Messina Italy
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30
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Sadnicka A, Kassavetis P, Pareés I, Meppelink AM, Butler K, Edwards M. Task-specific dystonia: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87:968-74. [PMID: 26818730 DOI: 10.1136/jnnp-2015-311298] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/22/2015] [Indexed: 12/23/2022]
Abstract
Task-specific dystonia is a form of isolated focal dystonia with the peculiarity of being displayed only during performance of a specific skilled motor task. This distinctive feature makes task-specific dystonia a particularly mysterious and fascinating neurological condition. In this review, we cover phenomenology and its increasingly broad-spectrum risk factors for the disease, critically review pathophysiological theories and evaluate current therapeutic options. We conclude by highlighting the unique features of task-specific dystonia within the wider concept of dystonia. We emphasise the central contribution of environmental risk factors, and propose a model by which these triggers may impact on the motor control of skilled movement. By viewing task-specific dystonia through this new lens which considers the disorder a modifiable disorder of motor control, we are optimistic that research will yield novel therapeutic avenues for this highly motivated group of patients.
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Affiliation(s)
- Anna Sadnicka
- Sobell Department for Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | | | - Isabel Pareés
- Department of Neurology, San Carlos Health Research Institute (IdISSC) Universidad Complutense de Madrid, Madrid, Spain
| | - Anne Marthe Meppelink
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Katherine Butler
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Mark Edwards
- Institute of Cardiovascular and Cell Sciences, St George's University, London, UK
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31
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Calabresi P, Pisani A, Rothwell J, Ghiglieri V, Obeso JA, Picconi B. Hyperkinetic disorders and loss of synaptic downscaling. Nat Neurosci 2016; 19:868-75. [DOI: 10.1038/nn.4306] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/18/2016] [Indexed: 12/14/2022]
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32
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Karabanov A, Ziemann U, Hamada M, George MS, Quartarone A, Classen J, Massimini M, Rothwell J, Siebner HR. Consensus Paper: Probing Homeostatic Plasticity of Human Cortex With Non-invasive Transcranial Brain Stimulation. Brain Stimul 2016; 8:993-1006. [PMID: 26598772 DOI: 10.1016/j.brs.2015.06.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Homeostatic plasticity is thought to stabilize neural activity around a set point within a physiologically reasonable dynamic range. Over the last ten years, a wide range of non-invasive transcranial brain stimulation (NTBS) techniques have been used to probe homeostatic control of cortical plasticity in the intact human brain. Here, we review different NTBS approaches to study homeostatic plasticity on a systems level and relate the findings to both, physiological evidence from in vitro studies and to a theoretical framework of homeostatic function. We highlight differences between homeostatic and other non-homeostatic forms of plasticity and we examine the contribution of sleep in restoring synaptic homeostasis. Finally, we discuss the growing number of studies showing that abnormal homeostatic plasticity may be associated to a range of neuropsychiatric diseases.
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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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34
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Suppa A, Marsili L, Giovannelli F, Di Stasio F, Rocchi L, Upadhyay N, Ruoppolo G, Cincotta M, Berardelli A. Abnormal motor cortex excitability during linguistic tasks in adductor-type spasmodic dysphonia. Eur J Neurosci 2015; 42:2051-60. [PMID: 26061279 DOI: 10.1111/ejn.12977] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/16/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
In healthy subjects (HS), transcranial magnetic stimulation (TMS) applied during 'linguistic' tasks discloses excitability changes in the dominant hemisphere primary motor cortex (M1). We investigated 'linguistic' task-related cortical excitability modulation in patients with adductor-type spasmodic dysphonia (ASD), a speech-related focal dystonia. We studied 10 ASD patients and 10 HS. Speech examination included voice cepstral analysis. We investigated the dominant/non-dominant M1 excitability at baseline, during 'linguistic' (reading aloud/silent reading/producing simple phonation) and 'non-linguistic' tasks (looking at non-letter strings/producing oral movements). Motor evoked potentials (MEPs) were recorded from the contralateral hand muscles. We measured the cortical silent period (CSP) length and tested MEPs in HS and patients performing the 'linguistic' tasks with different voice intensities. We also examined MEPs in HS and ASD during hand-related 'action-verb' observation. Patients were studied under and not-under botulinum neurotoxin-type A (BoNT-A). In HS, TMS over the dominant M1 elicited larger MEPs during 'reading aloud' than during the other 'linguistic'/'non-linguistic' tasks. Conversely, in ASD, TMS over the dominant M1 elicited increased-amplitude MEPs during 'reading aloud' and 'syllabic phonation' tasks. CSP length was shorter in ASD than in HS and remained unchanged in both groups performing 'linguistic'/'non-linguistic' tasks. In HS and ASD, 'linguistic' task-related excitability changes were present regardless of the different voice intensities. During hand-related 'action-verb' observation, MEPs decreased in HS, whereas in ASD they increased. In ASD, BoNT-A improved speech, as demonstrated by cepstral analysis and restored the TMS abnormalities. ASD reflects dominant hemisphere excitability changes related to 'linguistic' tasks; BoNT-A returns these excitability changes to normal.
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Affiliation(s)
- A Suppa
- Neuromed Institute, Pozzilli, IS, Italy
| | - L Marsili
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - F Giovannelli
- Unit of Neurology, Florence Health Authority, Florence, Italy
| | - F Di Stasio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - L Rocchi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - N Upadhyay
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - G Ruoppolo
- Otorhinolaryngology Section, Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - M Cincotta
- Unit of Neurology, Florence Health Authority, Florence, Italy
| | - A Berardelli
- Neuromed Institute, Pozzilli, IS, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy
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