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Vogelnik Žakelj K, Trošt M, Tomše P, Petrović IN, Tomić Pešić A, Radovanović S, Kojović M. Zolpidem improves task-specific dystonia: A randomized clinical trial integrating exploratory transcranial magnetic stimulation and [18F] FDG-PET imaging. Parkinsonism Relat Disord 2024; 124:107014. [PMID: 38823169 DOI: 10.1016/j.parkreldis.2024.107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Task-specific dystonia (TSFD) is a disabling movement disorder. Effective treatment options are currently limited. Zolpidem was reported to improve primary focal and generalized dystonia in a proportion of patients. The mechanisms underlying its therapeutic effects have not yet been investigated. METHODS We conducted a randomized, double-blind, placebo-controlled, crossover trial of single-dose zolpidem in 24 patients with TSFD. Patients were clinically assessed using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Writers' Cramp Rating Scale (WCRS), and Visual Analogue Scale (VAS), before and after receiving placebo and zolpidem. Transcranial magnetic stimulation was conducted on placebo and zolpidem to compare corticospinal excitability - active and resting motor thresholds (AMT and RMT), resting and active input/output curves and intracortical excitability - cortical silent period (CSP), short-interval intracortical inhibition curve (SICI), long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF). Eight patients underwent brain FDG-PET imaging on zolpidem and placebo. RESULTS Zolpidem treatment improved TSFD. Zolpidem compared to placebo flattened rest and active input/output curves, reduced ICF and was associated with hypometabolism in the right cerebellum and hypermetabolism in the left inferior parietal lobule and left cingulum. Correlations were found between changes in dystonia severity on WCRS and changes in active input/output curve and in brain metabolism, respectively. Patients with lower RMT, and higher rest and active input/output curves exhibited better response to zolpidem compared to placebo. CONCLUSIONS Zolpidem improved TSFD by reducing corticomotor output and influencing crucial nodes in higher-order sensory and motor networks.
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Affiliation(s)
- Katarina Vogelnik Žakelj
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia
| | - Petra Tomše
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Igor N Petrović
- Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Saša Radovanović
- Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia.
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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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Vysakha KV, Radhakrishnan V, James P, Kumar BS, Susvirkar AA, Sarma G, Cherian A, Divya KP, Nair SK, Kishore A. Quantifying abnormal writing kinematics in writer's cramp using a novel software platform. Acta Neurol Belg 2024:10.1007/s13760-024-02532-x. [PMID: 38575842 DOI: 10.1007/s13760-024-02532-x] [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: 05/01/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Writer's cramp is a task-specific focal hand dystonia, which is diagnosed clinically. Quantification of defect in WC is done using clinical scales, while digitized platforms are lacking. OBJECTIVE To design and test a platform that can differentiate and quantify the abnormal kinematics of writing using a software interface and to validate it in adult-onset isolated writer's cramp (WC). METHODS A native platform was designed using Java and Wacom Intuos pro tablet and the data analyzed using a MATLAB-based platform called Large Data-Based Evaluation of Kinematics in Handwriting (LEKH). We standardized this new platform by comparing the handwriting between patients with WC and age, and gender and education-matched healthy controls, using standard tasks to assess the kinematics. RESULTS Comparison of the writing of right-handed WC patients (N = 21) and 39 healthy controls (N = 39) showed that patients differed from controls in the frequency of strokes (P < 0.001), number of inversions of velocity (P < 0.001), number of breaks (P = 0.02), air time and paper time (P < 0.001). CONCLUSIONS Using the LEKH platform, the kinematic profile of patients with WC could be differentiated from healthy controls. Studies in larger samples will be needed to derive statistical models that can differentiate the flexion and extension types of WC which can help in muscle selection and to quantify the effects of treatment.
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Affiliation(s)
| | - Vineeth Radhakrishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Praveen James
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - B Suresh Kumar
- Department Computer Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ashish Anand Susvirkar
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Gangadhara Sarma
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Ajith Cherian
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - K P Divya
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
| | - Syam Krishnan Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Asha Kishore
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
- Parkinson and Movement Disorders, Centre of Excellence in Neurosciences, Aster Medcity, Kochi, Kerala, India
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4
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Maamary J, Peters J, Kyle K, Ruge D, Jonker B, Barnett Y, Tisch S. Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial. BMJ Neurol Open 2023; 5:e000522. [PMID: 37900622 PMCID: PMC10603452 DOI: 10.1136/bmjno-2023-000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/23/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit. Methods and analysis A total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present. Ethics and dissemination This trial was reviewed and approved by the St Vincent's Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences. Trial registration number CTRN12622000775718.
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Affiliation(s)
- Joel Maamary
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James Peters
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kain Kyle
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Diane Ruge
- Laboratoire de Recherche en Neurosciences Cliniques, Montpellier, France
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Yael Barnett
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
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Correa-Vela M, Carvalho J, Ferrero-Turrion J, Cazurro-Gutiérrez A, Vanegas M, Gonzalez V, Alvárez R, Marcé-Grau A, Moreno A, Macaya-Ruiz A, Pérez-Dueñas B. Early recognition of SGCE-myoclonus-dystonia in children. Dev Med Child Neurol 2023; 65:207-214. [PMID: 35723607 DOI: 10.1111/dmcn.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/20/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023]
Abstract
AIM To evaluate early dystonic features in children and adolescents with SGCE-myoclonus-dystonia. METHOD In this cross-sectional study, 49 patients (26 females and 23 males) with SGCE-myoclonus-dystonia (aged 15y 2mo, SD 12y) with childhood-onset (2y 10mo, SD 1y 10mo) dystonia were examined using a standardized video recorded protocol. Dystonia was rated using the Writer's Cramp and Gait Dystonia Rating Scales. Disability and impairment for handwriting and walking were also rated. RESULTS Dystonia was present at rest (n=1), posture (n=12), and during specific motor tasks (n=45) such as writing (n=35), walking (n=23), and running (n=20). Most children reported disability while performing these tasks. Early dystonic patterns were identified for writer's cramp and gait dystonia, the latter named the 'circular shaking leg', 'dragging leg', and 'hobby-horse gait' patterns. Sensory tricks were used by five and eight children to improve dystonia and myoclonus during writing and walking respectively. The rating scales accurately measured the severity of action dystonia and correlated with self-reported disability. INTERPRETATION Children with SGCE-myoclonus-dystonia show recognizable dystonic patterns and sensory tricks that may lead to an early diagnosis and timely therapeutic approach. Isolated writer's cramp is a key feature in childhood and should prompt SCGE analysis. The proposed action dystonia scales could be used to monitor disease course and response to treatment. WHAT THIS PAPER ADDS Most children with SGCE-myoclonus-dystonia got writer's cramp and had walking and running dystonia. Writer's cramp was a key feature and should prompt SGCE genetic investigation. 'Circular shaking leg', 'dragging leg', and 'hobby-horse gait' were recognized as early gait patterns. Children used sensory tricks to improve myoclonus and dystonia, suggesting common pathophysiological mechanisms. Action dystonia rating scales are valid tools to assess severity in children.
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Affiliation(s)
- Marta Correa-Vela
- Department of Pediatric Neurology, Vall d'Hebron Hospital Universitari, Pediatric.,Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joao Carvalho
- Pediatric Neurology, Centro de Desenvolvimento da Criança Torrado da Silva, Hospital Garcia de Orta. Almada, Portugal
| | | | | | - Maria Vanegas
- Department of Pediatric Neurology, Vall d'Hebron Hospital Universitari, Pediatric.,Paediatric Department, Evelina Children's Hospital, London, UK
| | | | - Ramiro Alvárez
- Department of Neurology, Hospital Germans Trias, Barcelona, Spain
| | - Anna Marcé-Grau
- Department of Pediatric Neurology, Vall d'Hebron Hospital Universitari, Pediatric
| | - Antonio Moreno
- Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Pediatrics, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Alfons Macaya-Ruiz
- Department of Pediatric Neurology, Vall d'Hebron Hospital Universitari, Pediatric.,Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain.,Neurology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Belén Pérez-Dueñas
- Department of Pediatric Neurology, Vall d'Hebron Hospital Universitari, Pediatric.,Departament de Pediatria, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Neurology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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6
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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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7
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Patil A, Shaikh SZ, Karajgi A, Ali MU. Efficacy and safety of botulinum toxin-A in writer’s cramp: a systematic review, meta-analysis, and meta-regression. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00566-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Botulinum toxin-A (BoNT) reduce over-firing of dystonic muscles, spasmodic contractions by enhancing function. We conducted a systematic review and random-effects meta-regression to investigate the efficacy and safety of BoNT in writer’s cramp (WC). Published electronic articles from inception till January 2022 were screened from four databases (Medline, Science Direct, Scopus, ProQuest). Effect sizes in the form of standardized mean differences were calculated for estimation of efficacy.
Results
Nineteen studies [six randomized control trials (RCTs) and 13 observational studies] involved 587 (514 experimental; 73 Controls) participants with mean age of 43.46 ± 8.84 years with mean duration of WC of 8.31 ± 5.35 years. Injection did not result in significant improvement in writing speed [standard mean difference (95% CI) 0.06 (− 0.35, 0.46)]. There was no significant difference in writing speed as compared to controls [standard mean difference (95% CI) − 0.51 (− 2.55, 1.52)]. The meta-analysis of observational studies showed a significant difference in the mean WC rating score [standard mean difference (95% CI) 0.54 (0.20, 0.88)]. Pooled analysis (observational studies and RCTs) demonstrated a significant difference in the mean Writer’s cramp rating score (WCRS) after BoNT [standard mean difference (95% CI) 0.75 (0.06, 1.44)]. No major safety concerns were reported in the included studies.
Conclusions
According to the meta-analysis of observational studies, BoNT injections are effective in WC for improving WCRS without major safety concerns. However, according to the meta-analysis of RCTs, there was no significant effect in efficacy with BoNT.
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8
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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: 3] [Impact Index Per Article: 1.5] [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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9
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Botulinum toxin for the treatment of tremor. J Neurol Sci 2022; 435:120203. [DOI: 10.1016/j.jns.2022.120203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
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10
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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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11
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Schill J, Zeuner KE, Knutzen A, Tödt I, Simonyan K, Witt K. Functional Neural Networks in Writer's Cramp as Determined by Graph-Theoretical Analysis. Front Neurol 2021; 12:744503. [PMID: 34887826 PMCID: PMC8650489 DOI: 10.3389/fneur.2021.744503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023] Open
Abstract
Dystonia, a debilitating neurological movement disorder, is characterized by involuntary muscle contractions and develops from a complex pathophysiology. Graph theoretical analysis approaches have been employed to investigate functional network changes in patients with different forms of dystonia. In this study, we aimed to characterize the abnormal brain connectivity underlying writer's cramp, a focal hand dystonia. To this end, we examined functional magnetic resonance scans of 20 writer's cramp patients (11 females/nine males) and 26 healthy controls (10 females/16 males) performing a sequential finger tapping task with their non-dominant (and for patients non-dystonic) hand. Functional connectivity matrices were used to determine group averaged brain networks. Our data suggest that in their neuronal network writer's cramp patients recruited fewer regions that were functionally more segregated. However, this did not impair the network's efficiency for information transfer. A hub analysis revealed alterations in communication patterns of the primary motor cortex, the thalamus and the cerebellum. As we did not observe any differences in motor outcome between groups, we assume that these network changes constitute compensatory rerouting within the patient network. In a secondary analysis, we compared patients with simple writer's cramp (only affecting the hand while writing) and those with complex writer's cramp (affecting the hand also during other fine motor tasks). We found abnormal cerebellar connectivity in the simple writer's cramp group, which was less prominent in complex writer's cramp. Our preliminary findings suggest that longitudinal research concerning cerebellar connectivity during WC progression could provide insight on early compensatory mechanisms in WC.
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Affiliation(s)
- Jana Schill
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Kirsten E Zeuner
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Arne Knutzen
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Inken Tödt
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Kristina Simonyan
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
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12
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Hirt L, Grassia F, Feuerstein J, Thompson JA, Ojemann S, Kern DS. Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Writer's Cramp: A Case Report. Tremor Other Hyperkinet Mov (N Y) 2021; 11:46. [PMID: 34824889 PMCID: PMC8588894 DOI: 10.5334/tohm.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Globus pallidus internus (GPi) deep brain stimulation (DBS) and thalamotomy are interventions for writer's cramp (WC). Ventralis intermedius nucleus (VIM) DBS is targeted for tremor, however, many aspects of VIM DBS remained underexplored in WC. Case Report A 62-year-old man with WC underwent DBS. Dystonic tremor improved intraoperatively with ventralis oralis anterior (VoA)/ventral oralis posterior (VoP) and with subthalamic nucleus stimulation; although greatest benefit was obtained with VIM stimulation. Sustained benefit with VIM DBS at ten months post-operative was obtained. Discussion This case demonstrates an intraoperative approach in target selection and supports benefits of VIM DBS for WC. Highlights This case highlights the intraoperative approach and clinical effects of VIM DBS in the treatment of medically refractory writer's cramp (WC). We contextualize our results from this case with previous reports of VoA/VoP stimulation for WC.
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Affiliation(s)
- Lisa Hirt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
| | - Fabio Grassia
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
| | - Jeanne Feuerstein
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, Rocky Mountain Regional VA Medical Center, Aurora, CO, US
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
| | - Drew S. Kern
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
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Zeuner KE, Knutzen A, Granert O, Trampenau L, Baumann A, Wolff S, Jansen O, van Eimeren T, Kuhtz-Buschbeck JP. Never too little: Grip and lift forces following probabilistic weight cues in patients with writer's cramp. Clin Neurophysiol 2021; 132:2937-2947. [PMID: 34715418 DOI: 10.1016/j.clinph.2021.09.010] [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: 04/16/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Planning of voluntary object-related movements requires the estimation of the most probable object properties. We investigated how 14 writer's cramp (WC) patients compared to 14 controls use probabilistic weight cues in a serial grip-lift task. METHODS In every grip-lift trial, an object of either light, medium or heavy weight had to be grasped and lifted after a visual cue gave a probabilistic prediction of the object weights (e.g. 32.5% light, 67.5% medium, 0 % heavy). We determined peak (1) grip force GF, (2) load force LF, (3) grip force rate GFR, (4) load force rate LFR, while we registered brain activity with functional magnetic resonance imaging. RESULTS In both groups, GFR, LFR and GF increased when a higher probability of heavy weights was announced. When a higher probability of light weights was indicated, controls reduced GFR, LFR and GF, while WC patients did not downscale their forces. There were no inter-group differences in blood oxygenation level dependent activation. CONCLUSIONS WC patients could not utilize the decision range in motor planning and adjust their force in a probabilistic cued fine motor task. SIGNIFICANCE The results support the pathophysiological model of a hyperfunctional dopamine dependent direct basal ganglia pathway in WC.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University, Germany
| | | | | | | | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University Hospital Cologne, Germany
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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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Doshi PK. Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases. Front Hum Neurosci 2021; 15:673848. [PMID: 34194307 PMCID: PMC8236715 DOI: 10.3389/fnhum.2021.673848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background Radiofrequency lesioning (RFL) though used since the 1950s, had been replaced by DBS in the 1990s. The availability of magnetic resonance-guided focused ultrasound for lesioning has renewed the interest in RFL. Objective This paper analysis RFL in contemporary Functional Neurosurgery for various indications and its outcome. Complication rates of RFL are compared with the same author’s experience of DBS. Methods One hundred and seven patients underwent RFL between 1998 and 2019. Indications included Parkinson’s Disease (PD), tremors, dystonia, and obsessive-compulsive disorders (OCD). The surgeries performed include thalamotomy (29), pallidotomy (49), subthalamotomy (23), and anterior capsulotomy/nucleus accumbens lesioning (6). Appropriate rating scales were used for preoperative and postoperative evaluations. Results There was a 25% recurrence rate of tremors for PD after thalamotomy. Writer’s cramp rating scale improved from a mean of 10.54–1.6 in task specific dystonia (TSD) patients, after thalamotomy. In PD patients, after pallidotomy, contralateral motor Unified Parkinson’s Disease Rating Scale (UPDRS) and dyskinesia scores, improved by 41 and 57%, respectively, at 1-year. Burke-Fahn-Marsden Dystonia Rating Scale in hemidystonia patients improved from 18.04 to 6.91, at 1-year. There was 32 and 31% improvement in total and motor UPDRS, respectively, in the subthalamotomy patients, at 2-year. All patients of OCD were in remission. There were three deaths in the pallidotomy group. Postoperative, dysarthria, confusion, hemiparesis, dyskinesia, and paraesthesia occurred in 12 patients, of which, 7 were transient. Conclusion RFL is a useful option in a select group of patients with tremors and dystonia. It is our preferred treatment option for TSD and OCD.
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Rajan R, Srivastava AK, Anandapadmanabhan R, Saini A, Upadhyay A, Gupta A, Vishnu VY, Pandit AK, Vibha D, Singh MB, Bhatia R, Goyal V, Dwivedi SN, Srivastava P, Prasad K. Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor: A Randomized Clinical Trial. JAMA Neurol 2021; 78:302-311. [PMID: 33346814 DOI: 10.1001/jamaneurol.2020.4766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is an unmet need for safe and efficacious treatments for upper-extremity dystonic tremor (DT). To date, only uncontrolled retrospective case series have reported the effect of botulinum neurotoxin (BoNT) injections on upper-extremity DT. Objective To assess the effect of BoNT injections on tremor in patients with upper-extremity DT. Design, Setting, and Participants In this placebo-controlled, parallel-group randomized clinical trial, 30 adult patients with upper-extremity DT treated at a movement disorder clinic in a tertiary care university hospital were randomized in a 1:1 ratio to BoNT or saline injection, 0.9%, using a computer-generated randomization sequence. Randomization was masked using opaque envelopes. The participant, injector, outcome assessor, and statistician were blinded to the randomization. Participants were recruited between November 20, 2018, and December 12, 2019, and the last follow-up was completed in March 2020. Interventions Participants received electromyographically guided intramuscular injections of BoNT or placebo into the tremulous muscles of the upper extremity. Injection patterns and doses were individualized according to tremor phenomenologic findings. Main Outcomes and Measures The primary outcome was the total score on the Fahn-Tolosa-Marin Tremor Rating Scale 6 weeks after the intervention. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. All patients were offered open-label BoNT injections after 12 weeks and reassessed 6 weeks later. Results A total of 48 adult patients with a diagnosis of brachial dystonia with DT were screened. Fifteen were ineligible and 3 refused consent; therefore, 30 patients (mean [SD] age, 46.0 [18.6] years; 26 [86.7%] male) were recruited, with 15 randomized to receive BoNT and 15 to receive placebo. In the intention-to-treat group, the Fahn-Tolosa-Marin Tremor Rating Scale total score was significantly lower in the BoNT group at 6 weeks (adjusted mean difference, -10.9; 95% CI, -15.4 to -6.5; P < .001) and 12 weeks (adjusted mean difference, -5.7; 95% CI, -11.0 to -0.5; P = .03). More participants in the BoNT group reported global improvement on the Global Impression of Change (PGIC) assessment (PGIC 1, 2, and 3: BoNT: 4 [26.7%], 6 [40.0%], and 5 [33.3%]; placebo: 5 [33.3%], 10 [66.7%], and 0, respectively; P = .047). Subjective hand weakness (BoNT: 6 [40.0%]; placebo: 4 [28.6%], P = .52) and dynamometer-assessed grip strength (mean difference, -0.2 log10[kgf/m2]2/Hz-Hz; 95% CI, -0.9 to 0.4 log10[kgf/m2]2/Hz-Hz; P = .45) were similar in both groups. Conclusions and Relevance In this randomized clinical trial, botulinum neurotoxin injections were superior to placebo in reducing tremor severity in upper-extremity DT. An individualized approach to muscle selection and dosing was beneficial without unacceptable adverse effects. Trial Registration Clinical Trials Registry of India (http://ctri.nic.in) Identifier: CTRI/2018/02/011721.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Arti Saini
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Todisco M, Gana S, Cosentino G, Errichiello E, Arceri S, Avenali M, Valente EM, Alfonsi E. KCTD17-related myoclonus-dystonia syndrome: clinical and electrophysiological findings of a patient with atypical late onset. Parkinsonism Relat Disord 2020; 78:129-133. [DOI: 10.1016/j.parkreldis.2020.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
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Slowed Movement Stopping in Parkinson's Disease and Focal Dystonia is Improved by Standard Treatment. Sci Rep 2019; 9:19504. [PMID: 31862983 PMCID: PMC6925208 DOI: 10.1038/s41598-019-55321-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Patients with Parkinson’s disease and focal dystonia have difficulty in generating and preventing movement. Reaction time (RT) and stop signal reaction time (SSRT) measure the speed to initiate and stop a movement respectively. We developed a portable device to assess RT and SSRT. This incorporated a novel analysis to measure SSRT more efficiently (optimal combination SSRT, ocSSRT). After validation ocSSRT was measured in Parkinson’s disease patients without dyskinesia (PD), cervical dystonia (CD) and writer’s cramp. We also assessed how ocSSRT responded to L-dopa in PD patients and botulinum toxin injections in CD patients. Participants were instructed to release a button following a green LED flash on the device. On 25% of trials, a red LED flashed 5–195 ms after the green LED; participations were instructed to abort the button release on these trials. ocSSRT and RT were significantly prolonged in patients with Parkinson’s disease and focal dystonia (one-way ANOVA p < 0.001). Administration of L-dopa significantly improved ocSSRT and RT in PD patients (p < 0.001). Administration of botulinum toxin significantly improved ocSSRT, but not RT, in CD patients (p < 0.05). ocSSRT is an easily-administered bedside neuro-physiological tool; significantly prolonged ocSSRT is associated with PD and focal dystonia.
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19
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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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Desrochers P, Brunfeldt A, Sidiropoulos C, Kagerer F. Sensorimotor Control in Dystonia. Brain Sci 2019; 9:brainsci9040079. [PMID: 30979073 PMCID: PMC6523253 DOI: 10.3390/brainsci9040079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 12/24/2022] Open
Abstract
This is an overview of the sensorimotor impairments in dystonia, a syndrome characterized by sustained or intermittent aberrant movement patterns leading to abnormal movements and/or postures with or without a tremulous component. Dystonia can affect the entire body or specific body regions and results from a plethora of etiologies, including subtle changes in gray and white matter in several brain regions. Research over the last 25 years addressing topics of sensorimotor control has shown functional sensorimotor impairments related to sensorimotor integration, timing, oculomotor and head control, as well as upper and lower limb control. In the context of efforts to update the classification of dystonia, sensorimotor research is highly relevant for a better understanding of the underlying pathology, and potential mechanisms contributing to global and regional dysfunction within the central nervous system. This overview of relevant research regarding sensorimotor control in humans with idiopathic dystonia attempts to frame the dysfunction with respect to what is known regarding motor control in patients and healthy individuals. We also highlight promising avenues for the future study of neuromotor control that may help to further elucidate dystonia etiology, pathology, and functional characteristics.
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Affiliation(s)
- Phillip Desrochers
- Dept. of Kinesiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Alexander Brunfeldt
- Dept. of Kinesiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Christos Sidiropoulos
- Dept. of Neurology and Ophthalmology, Michigan State University, East Lansing, MI 48824, USA.
| | - Florian Kagerer
- Dept. of Kinesiology, Michigan State University, East Lansing, MI 48824, USA.
- Neuroscience Program, Michigan State University, East Lansing, MI 48824, USA.
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21
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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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22
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Novaretti N, Cunha ALN, Bezerra TC, Pena Pereira MA, de Oliveira DS, Macruz Brito MMC, Pimentel AV, Brozinga TR, Foss MP, Tumas V. The Prevalence and Correlation of Non-motor Symptoms in Adult Patients with Idiopathic Focal or Segmental Dystonia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:596. [PMID: 30783550 PMCID: PMC6377805 DOI: 10.7916/fhnv-v355] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/14/2018] [Indexed: 12/28/2022]
Abstract
Background Idiopathic focal dystonia is a motor syndrome associated with dysfunction of basal ganglia circuits. Observations have suggested that many other non-motor symptoms may also be part of the clinical picture. The aim was to assess the prevalence and correlation of non-motor symptoms in patients with common idiopathic focal or segmental dystonia. Methods In a single-center cross-sectional case–control study, we evaluated the presence of pain, neuropsychiatric symptoms, and sleep alterations in 28 patients with blepharospasm, 28 patients with cervical dystonia, 24 patients with writer’s cramp, and 80 control subjects matched for sex, age, and schooling. We obtained clinical and demographic data, and evaluated patients using the Fahn–Marsden Dystonia Rating Scale and other specific scales for dystonia. All subjects completed the following questionnaires: Beck Depression Inventory, Beck Anxiety Inventory, Social Phobia Inventory, Apathy Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Brief Pain Scale, and the World Health Organization Quality of Life brief scale. Results The patients presented more symptoms of depression, anxiety, and apathy than the control subjects. They also reported worse quality of sleep and more pain complaints. Patients with blepharospasm were the most symptomatic subgroup. The patients had worse quality of life, and the presence of pain and symptoms of apathy and depression were the main influences for these findings, but not the severity of motor symptoms. Discussion Patients with dystonia, especially those with blepharospasm, showed higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep, and pain. These symptoms had a negative impact on their quality of life.
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Affiliation(s)
- Nathália Novaretti
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | - Ana Luiza N Cunha
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | - Torben C Bezerra
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | | | | | | | - Angela V Pimentel
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | - Tamara R Brozinga
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | - Maria Paula Foss
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
| | - Vitor Tumas
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, BR
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23
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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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Berndt M, Li Y, Gora-Stahlberg G, Jochim A, Haslinger B. Impaired white matter integrity between premotor cortex and basal ganglia in writer's cramp. Brain Behav 2018; 8:e01111. [PMID: 30239158 PMCID: PMC6192408 DOI: 10.1002/brb3.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Writer's cramp (WC) as a focal hand dystonia is characterized by abnormal postures of the hand during writing. Impaired inhibition and maladaptive plasticity in circuits linking the basal ganglia and sensorimotor cortices have been described. In particular, a dysfunction of lateral premotor cortices has been associated with impaired motor control in WC. We applied diffusion tensor imaging to identify changes in white matter connectivity between premotor regions and important cortical and subcortical structures. METHODS Whole brain white matter tracts were reconstructed in 18 right-handed WC patients and 18 matched controls, using probabilistic fiber tracking. We restricted our analyses to left-hemispheric fibers between the middle frontal gyrus (MFG) and basal ganglia, thalamus, primary motor, and sensory cortex. Diffusion parameters (fractional anisotropy and linear anisotropy) were compared between both groups. RESULTS A significant reduction in fractional anisotropy values was shown for patients (mean ± SD: 0.37 ± 0.02) vs. controls (0.39 ± 0.03) regarding fibers between the left-sided MFG and the putamen (p < 0.05). The same applied for linear anisotropy values in this connection (p < 0.05). CONCLUSIONS Our results suggest an impaired structural connectivity between the left-hemispheric MFG and putamen with a loss of equally aligned fibers in WC patients. This could reflect a structural basis for functional findings interpreted as altered inhibition and plasticity, both within the premotor cortex and the basal ganglia, that at last lead to the clinical symptoms of WC.
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Affiliation(s)
- Maria Berndt
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Gina Gora-Stahlberg
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität Muenchen, Muenchen, Germany
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25
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Choudhury S, Singh R, Chatterjee P, Trivedi S, Shubham S, Baker MR, Kumar H, Baker SN. Abnormal Blink Reflex and Intermuscular Coherence in Writer's Cramp. Front Neurol 2018; 9:517. [PMID: 30013510 PMCID: PMC6037196 DOI: 10.3389/fneur.2018.00517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Writer's cramp (WC) is a task-specific focal hand dystonia presenting with pain, stiffness and/or tremor while writing. We explored the involvement of cortical and brainstem circuits by measuring intermuscular coherence (IMC) and pre-pulse inhibition (PPI) of the blink reflex. Methods: IMC was measured in 10 healthy controls and 20 WC patients (10 with associated tremor) while they performed a precision grip task at different force levels. Blink responses were evaluated in 9 healthy controls and 10 WC patients by stimulating the right supraorbital nerve and recording surface EMG from the orbicularis oculi muscles bilaterally. PPI involved conditioning this stimulation with a prior shock to the right median nerve (100 ms interval), and measuring the reduction in the R2 component of the blink reflex. Results: Significant IMC at 3-7 Hz was present in WC patients, but not in healthy controls. Compared to healthy controls, in WC patients the R2 component of the blink reflex showed significantly less PPI. IMC at 3-7 Hz could reliably discriminate WC patients from healthy controls. Conclusion: Cortical or sub-cortical circuits generating theta (3-7 Hz) oscillations might play an important role in the pathogenesis of WC. Moreover, the lack of PPI implicates abnormalities in brainstem inhibition in the emergence of WC. IMC may merit further development as an electrodiagnostic test for focal dystonia.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Ravi Singh
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Payel Chatterjee
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Santosh Trivedi
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Shantanu Shubham
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Mark R. Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hrishikesh Kumar
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Stuart N. Baker
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
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Okada Y, Shibamoto C, Osumi Y, Asano C, Takeuchi R, Nabeshima S, Morioka S, Shomoto K. Transcranial Direct Current Stimulation Combined with Action Observation and Electromyographic Biofeedback Training in a Patient with Writer's Cramp. J Mov Disord 2018; 11:82-86. [PMID: 29860789 PMCID: PMC5990908 DOI: 10.14802/jmd.18007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 04/18/2018] [Indexed: 12/26/2022] Open
Abstract
We present a 47-year-old right-handed woman with a 15-year history of writer’s cramp who was provided with six sessions of cathodal transcranial direct current stimulation (tDCS) combined with observation of writing actions performed by a healthy subject and electromyographic (EMG) biofeedback training to decrease EMG activities in her right forehand muscles while writing for 30 min for 4 weeks. She showed improvement in dystonic posture and writing speed after the intervention. The writing movement and writing speed scores on a writer’s cramp rating scale decreased, along with writing time. Our findings demonstrated that cathodal tDCS combined with action observation and EMG biofeedback training might improve dystonic writing movements in a patient with writer’s cramp.
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Affiliation(s)
- Yohei Okada
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Chiharu Shibamoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | - Yukari Osumi
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | - Chihiro Asano
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | - Riho Takeuchi
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | | | - Shu Morioka
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Koji Shomoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
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27
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Dynamic causal modeling revealed dysfunctional effective connectivity in both, the cortico-basal-ganglia and the cerebello-cortical motor network in writers' cramp. NEUROIMAGE-CLINICAL 2018; 18:149-159. [PMID: 29868443 PMCID: PMC5984595 DOI: 10.1016/j.nicl.2018.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 12/25/2022]
Abstract
Writer's cramp (WC) is a focal task-specific dystonia characterized by sustained or intermittent muscle contractions while writing, particularly with the dominant hand. Since structural lesions rarely cause WC, it has been assumed that the disease might be caused by a functional maladaptation within the sensory-motor system. Therefore, our objective was to examine the differences between patients suffering from WC and a healthy control (HC) group with regard to the effective connectivity that describes causal influences one brain region exerts over another within the motor network. The effective connectivity within a network including contralateral motor cortex (M1), supplementary motor area (SMA), globus pallidus (GP), putamen (PU) and ipsilateral cerebellum (CB) was investigated using dynamic causal modeling (DCM) for fMRI. Eight connectivity models of functional motor systems were compared. Fifteen WC patients and 18 age-matched HC performed a sequential, five-element finger-tapping task with the non-dominant and non-affected left hand within a 3 T MRI-scanner as quickly and accurately as possible. The task was conducted in a fixed block design repeated 15 times and included 30 s of tapping followed by 30 s of rest. DCM identified the same model in WC and HC as superior for reflecting basal ganglia and cerebellar motor circuits of healthy subjects. The M1-PU, as well as M1-CB connectivity, was more strongly influenced by tapping in WC, but the intracortical M1-SMA connection was more facilitating in controls. Inhibiting influences originating from GP to M1 were stronger in controls compared to WC patients whereby facilitating influences the PU exerts over CB and CB exerts over M1 were not as strong. Although the same model structure explains the given data best, DCM confirms previous research demonstrating a malfunction in effective connectivity intracortically (M1-SMA) and in the cortico-basal ganglia circuitry in WC. In addition, DCM analysis demonstrates abnormal reciprocal excitatory connectivity in the cortico-cerebellar circuitry. These results highlight the dysfunctional cerebello-cortical as well as basalganglio-cortical interaction in WC. Effective connectivity in writer`s cramp differs under sequential finger movements. We found a deficient inhibitory pallido-cortical connectivity in writer`s cramp. We found a diverging effective connectivity in the cortico-cerebellar loop. We found a diverging effective connectivity in the cortico-basal ganglia pathway. Pathophysiological interaction between the cerebellum and the basal ganglia.
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Kandaswamy D, M M, Alexander M, Prabhu K, S MG, Krothapalli SB. Quantitative Assessment of Hand Dysfunction in Patients with Early Parkinson's Disease and Focal Hand Dystonia. J Mov Disord 2018; 11:35-44. [PMID: 29316781 PMCID: PMC5790625 DOI: 10.14802/jmd.17046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/23/2017] [Accepted: 10/19/2017] [Indexed: 12/04/2022] Open
Abstract
Objective
Motor impairments related to hand function are common symptoms in patients with movement disorders, such as Parkinson’s disease (PD) and focal hand dystonia (FHD). However, hand dysfunction has not been quantitatively assessed as a clinical tool for screening patient groups from healthy controls (HCs). The aim of our study was 1) to quantitatively assess hand dysfunction in patients with PD and FHD and its usefulness as a screening tool 2) to grade disease severity in PD and FHD based on hand dysfunction. Methods
The current case-control study included HCs (n = 50) and patients with known history of PD (n = 25) or FHD (n = 16). Hand function was assessed by a precision grip task while participants lifted objects of 1.3 N and 1.7 N under dry skin conditions, followed by very wet skin conditions (VWSCs). Receiver operating characteristic and summative scoring analyses were performed. Results
In PD, the combination of loading phase duration and lifting phase duration at quantitative cutoffs of 0.36 and 0.74 seconds identified 21/25 patients as diseased and 49/50 subjects as HCs with 1.7 N under VWSCs. In PD, 5/21 was graded as “mild” and 16/21 as “moderate cases.” In FHD, slip force at a cutoff of 1.2 N identified 13/16 patients as diseased and 41/50 subjects as HC with 1.7 N under VWSCs, but disease severity could not be graded. Conclusion
Our results demonstrate the use of precision grip task as an important clinical tool in assessment of hand dysfunction in movement disorder patients. Use of quantitative cutoffs may improve diagnostic accuracy and serve as a valuable adjunct to existing clinical assessment methods.
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Affiliation(s)
- Deepa Kandaswamy
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - MuthuKumar M
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Mathew Alexander
- Neurology Division, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Neurosurgery Division, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - Srinivasa Babu Krothapalli
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, India
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Simonyan K, Cho H, Hamzehei Sichani A, Rubien-Thomas E, Hallett M. The direct basal ganglia pathway is hyperfunctional in focal dystonia. Brain 2017; 140:3179-3190. [PMID: 29087445 PMCID: PMC5841143 DOI: 10.1093/brain/awx263] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 12/22/2022] Open
Abstract
See Fujita and Eidelberg (doi:10.1093/brain/awx305) for a scientific commentary on this article. Focal dystonias are the most common type of isolated dystonia. Although their causative pathophysiology remains unclear, it is thought to involve abnormal functioning of the basal ganglia-thalamo-cortical circuitry. We used high-resolution research tomography with the radioligand 11C-NNC-112 to examine striatal dopamine D1 receptor function in two independent groups of patients, writer’s cramp and laryngeal dystonia, compared to healthy controls. We found that availability of dopamine D1 receptors was significantly increased in bilateral putamen by 19.6–22.5% in writer’s cramp and in right putamen and caudate nucleus by 24.6–26.8% in laryngeal dystonia (all P ≤ 0.009). This suggests hyperactivity of the direct basal ganglia pathway in focal dystonia. Our findings paralleled abnormally decreased dopaminergic function via the indirect basal ganglia pathway and decreased symptom-induced phasic striatal dopamine release in writer’s cramp and laryngeal dystonia. When examining topological distribution of dopamine D1 and D2 receptor abnormalities in these forms of dystonia, we found abnormal separation of direct and indirect pathways within the striatum, with negligible, if any, overlap between the two pathways and with the regions of phasic dopamine release. However, despite topological disorganization of dopaminergic function, alterations of dopamine D1 and D2 receptors were somatotopically localized within the striatal hand and larynx representations in writer’s cramp and laryngeal dystonia, respectively. This finding points to their direct relevance to disorder-characteristic clinical features. Increased D1 receptor availability showed significant negative correlations with dystonia duration but not its severity, likely representing a developmental endophenotype of this disorder. In conclusion, a comprehensive pathophysiological mechanism of abnormal basal ganglia function in focal dystonia is built upon upregulated dopamine D1 receptors that abnormally increase excitation of the direct pathway, downregulated dopamine D2 receptors that abnormally decrease inhibition within the indirect pathway, and weakened nigro-striatal phasic dopamine release during symptomatic task performance. Collectively, these aberrations of striatal dopaminergic function underlie imbalance between direct and indirect basal ganglia pathways and lead to abnormal thalamo-motor-cortical hyperexcitability in dystonia.
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Affiliation(s)
- Kristina Simonyan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hyun Cho
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Azadeh Hamzehei Sichani
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Estee Rubien-Thomas
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Lozeron P, Poujois A, Meppiel E, Masmoudi S, Magnan TP, Vicaut E, Houdart E, Guichard JP, Trocello JM, Woimant F, Kubis N. Inhibitory rTMS applied on somatosensory cortex in Wilson's disease patients with hand dystonia. J Neural Transm (Vienna) 2017; 124:1161-1170. [PMID: 28689295 DOI: 10.1007/s00702-017-1756-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022]
Abstract
Hand dystonia is a common complication of Wilson's disease (WD), responsible for handwriting difficulties and disability. Alteration of sensorimotor integration and overactivity of the somatosensory cortex have been demonstrated in dystonia. This study investigated the immediate after effect of an inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the somatosensory cortex on the writing function in WD patients with hand dystonia. We performed a pilot prospective randomized double-blind sham-controlled crossover rTMS study. A 20-min 1-Hz rTMS session, stereotaxically guided, was applied over the left somatosensory cortex in 13 WD patients with right dystonic writer's cramp. After 3 days, each patient was crossed-over to the alternative treatment. Patients were clinically evaluated before and immediately after each rTMS session with the Unified Wilson's Disease rating scale (UWDRS), the Writers' Cramp Rating Scale (WCRS), a specifically designed scale for handwriting difficulties in Wilson's disease patients (FAR, flow, accuracy, and rhythmicity evaluation), and a visual analog scale (VAS) for handwriting discomfort. No significant change in UWDRS, WCRS, VAS, or FAR scores was observed in patients treated with somatosensory inhibitory rTMS compared to the sham protocol. The FAR negatively correlated with UWDRS (r = -0.6; P = 0.02), but not with the WCRS score, disease duration, MRI diffusion lesions, or with atrophy scores. In our experimental conditions, a single inhibitory rTMS session applied over somatosensory cortex did not improve dystonic writer cramp in WD patients.
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Affiliation(s)
- Pierre Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, 75475, Paris, France.,INSERM UMR965, 75475, Paris, France
| | - Aurélia Poujois
- Service de Neurologie, AP-HP, Hôpital Lariboisière, Paris, France.,Centre de référence national de la maladie de Wilson, Hôpital Lariboisière, Paris, France
| | - Elodie Meppiel
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
| | - Sana Masmoudi
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
| | - Thierry Peron Magnan
- Centre de référence national de la maladie de Wilson, Hôpital Lariboisière, Paris, France
| | - Eric Vicaut
- Université Paris Diderot, Sorbonne Paris Cité, 75475, Paris, France.,Unité de Recherche Clinique, AP-HP, Hôpital Lariboisière, Paris, France
| | - Emmanuel Houdart
- Université Paris Diderot, Sorbonne Paris Cité, 75475, Paris, France.,Service de Neuroradiologie, AP-HP, Hôpital Lariboisière, Paris, France
| | | | - Jean-Marc Trocello
- Service de Neurologie, AP-HP, Hôpital Lariboisière, Paris, France.,Centre de référence national de la maladie de Wilson, Hôpital Lariboisière, Paris, France
| | - France Woimant
- Service de Neurologie, AP-HP, Hôpital Lariboisière, Paris, France.,Centre de référence national de la maladie de Wilson, Hôpital Lariboisière, Paris, France
| | - Nathalie Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, 75475, Paris, France. .,INSERM UMR965, 75475, Paris, France.
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Jackman M, Delrobaei M, Rahimi F, Atashzar SF, Shahbazi M, Patel R, Jog M. Predicting Improvement in Writer's Cramp Symptoms following Botulinum Neurotoxin Injection Therapy. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:410. [PMID: 27625900 PMCID: PMC5013165 DOI: 10.7916/d82z15q5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/10/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Writer's cramp is a specific focal hand dystonia causing abnormal posturing and tremor in the upper limb. The most popular medical intervention, botulinum neurotoxin type A (BoNT-A) therapy, is variably effective for 50-70% of patients. BoNT-A non-responders undergo ineffective treatment and may experience significant side effects. Various assessments have been used to determine response prediction to BoNT-A, but not in the same population of patients. METHODS A comprehensive assessment was employed to measure various symptom aspects. Clinical scales, full upper-limb kinematic measures, self-report, and task performance measures were assessed for nine writer's cramp patients at baseline. Patients received two BoNT-A injections then were classified as responders or non-responders based on a quantified self-report measure. Baseline scores were compared between groups, across all measures, to determine which scores predicted a positive BoNT-A response. RESULTS Five of nine patients were responders. No kinematic measures were predictably different between groups. Analyses revealed three features that predicted a favorable response and separated the two groups: higher than average cramp severity and cramp frequency, and below average cramp latency. DISCUSSION Non-kinematic measures appear to be superior in making such predictions. Specifically, measures of cramp severity, frequency, and latency during performance of a specific set of writing and drawing tasks were predictive factors. Since kinematic was not used to determine the injection pattern and the injections were visually guided, it may still be possible to use individual patient kinematics for better outcomes.
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Affiliation(s)
| | - Mehdi Delrobaei
- Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Fariborz Rahimi
- Department of Electrical and Computer Engineering, Bonab University, Bonab, East Azerbaijan, Iran
| | - S Farokh Atashzar
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Mahya Shahbazi
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Rajni Patel
- Lawson Health Research Institute, London, ON, Canada; Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Mandar Jog
- Lawson Health Research Institute, London, ON, Canada; Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Bologna M, Paparella G, Fabbrini A, Leodori G, Rocchi L, Hallett M, Berardelli A. Effects of cerebellar theta-burst stimulation on arm and neck movement kinematics in patients with focal dystonia. Clin Neurophysiol 2016; 127:3472-3479. [PMID: 27721106 DOI: 10.1016/j.clinph.2016.09.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/11/2016] [Accepted: 09/04/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the cerebellar inhibitory influence on the primary motor cortex in patients with focal dystonia using a cerebellar continuous theta-burst stimulation protocol (cTBS) and to evaluate any relationship with movement abnormalities. METHODS Thirteen patients with focal hand dystonia, 13 patients with cervical dystonia and 13 healthy subjects underwent two sessions: (i) cTBS over the cerebellar hemisphere (real cTBS) and (ii) cTBS over the neck muscles (sham cTBS). The effects of cerebellar cTBS were quantified as excitability changes in the contralateral primary motor cortex, as well as possible changes in arm and neck movements in patients. RESULTS Real cerebellar cTBS reduced the excitability in the contralateral primary motor cortex in healthy subjects and in patients with cervical dystonia, though not in patients with focal hand dystonia. There was no correlation between changes in primary motor cortex excitability and arm and neck movement kinematics in patients. There were no changes in clinical scores or in kinematic measures, after either real or sham cerebellar cTBS in patients. CONCLUSIONS The reduced cerebellar inhibitory modulation of primary motor cortex excitability in focal dystonia may be related to the body areas affected by dystonia as opposed to being a widespread pathophysiological abnormality. SIGNIFICANCE The present study yields information on the differential role played by the cerebellum in the pathophysiology of different focal dystonias.
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Affiliation(s)
- Matteo Bologna
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli (IS), Italy
| | - Giulia Paparella
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Andrea Fabbrini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Giorgio Leodori
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Rocchi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke - NINDS, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Neuromed Institute IRCCS, Pozzilli (IS), Italy.
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Differences in active range of motion measurements in the upper extremity of patients with writer's cramp compared with healthy controls. J Hand Ther 2016; 29:489-495. [PMID: 27773588 PMCID: PMC5118176 DOI: 10.1016/j.jht.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 12/07/2015] [Accepted: 02/08/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Exploratory case-control study. INTRODUCTION Writer's cramp (WC) is a type of focal hand dystonia. The central nervous system plays a role in its pathophysiology, but abnormalities in the affected musculoskeletal components may also be relevant. PURPOSE OF THE STUDY We compared the active range of motion (ROM) in patients with WC and healthy volunteers (HVs) and correlated the findings with disease duration and severity. METHODS Affected limb joints were measured with goniometers. Patients were assessed at least 3 months after their last botulinum toxin (botulinum neurotoxin) injection, and strength was clinically normal. t tests were used to compare the ROMs of WC with matched HVs. The Spearman correlation coefficient assessed the relationship of active ROMs to the disease duration and handwriting subscore of the Dystonia Disability Scale. RESULTS ROMs of D1 metacarpophalangeal (MCP) joint extension as well as D2 and D5 MCP flexion were significantly smaller in WC, and distal interphalangeal joint extension in D3 and D5 was significantly greater compared with HVs. There were negative correlations between D2 MCP flexion and disease duration and with Dystonia Disability Scale. DISCUSSION Abnormalities in ROMs in WC were found. Severity and disease duration correlated with reduced D2 MCP flexion. This may be related to intrinsic biomechanical abnormalities, co-contraction of muscles, or a combination of subclinical weakness and atrophy from repeated botulinum neurotoxin injections. CONCLUSIONS Hand biomechanical properties should not be ignored in the pathophysiology of WC. LEVEL OF EVIDENCE 2c.
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Zeuner KE, Knutzen A, Granert O, Sablowsky S, Götz J, Wolff S, Jansen O, Dressler D, Schneider SA, Klein C, Deuschl G, van Eimeren T, Witt K. Altered brain activation in a reversal learning task unmasks adaptive changes in cognitive control in writer's cramp. NEUROIMAGE-CLINICAL 2015; 10:63-70. [PMID: 26702397 PMCID: PMC4669532 DOI: 10.1016/j.nicl.2015.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
Abstract
Previous receptor binding studies suggest dopamine function is altered in the basal ganglia circuitry in task-specific dystonia, a condition characterized by contraction of agonist and antagonist muscles while performing specific tasks. Dopamine plays a role in reward-based learning. Using fMRI, this study compared 31 right-handed writer's cramp patients to 35 controls in reward-based learning of a probabilistic reversal-learning task. All subjects chose between two stimuli and indicated their response with their left or right index finger. One stimulus response was rewarded 80%, the other 20%. After contingencies reversal, the second stimulus response was rewarded in 80%. We further linked the DRD2/ANKK1-TaqIa polymorphism, which is associated with 30% reduction of the striatal dopamine receptor density with reward-based learning and assumed impaired reversal learning in A + subjects. Feedback learning in patients was normal. Blood-oxygen level dependent (BOLD) signal in controls increased with negative feedback in the insula, rostral cingulate cortex, middle frontal gyrus and parietal cortex (pFWE < 0.05). In comparison to controls, patients showed greater increase in BOLD activity following negative feedback in the dorsal anterior cingulate cortex (BA32). The genetic status was not correlated with the BOLD activity. The Brodmann area 32 (BA32) is part of the dorsal anterior cingulate cortex (dACC) that plays an important role in coordinating and integrating information to guide behavior and in reward-based learning. The dACC is connected with the basal ganglia-thalamo-loop modulated by dopaminergic signaling. This finding suggests disturbed integration of reinforcement history in decision making and implicate that the reward system might contribute to the pathogenesis in writer's cramp.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University, Germany
| | | | | | - Julia Götz
- Department of Neurology, Kiel University, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Germany
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Germany
| | | | | | | | | | - Karsten Witt
- Department of Neurology, Kiel University, Germany
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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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Del Sorbo F, Albanese A. Botulinum neurotoxins for the treatment of focal dystonias: Review of rating tools used in clinical trials. Toxicon 2015; 107:89-97. [PMID: 26365917 DOI: 10.1016/j.toxicon.2015.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 12/14/2022]
Abstract
Botulinum neurotoxins (BoNTs) are used to achieve therapeutic benefit in focal dystonia. An expert panel recently reviewed published evidence on the efficacy of BoNTs for the treatment of focal dystonias and produced recommendations for clinical practice. Another panel reviewed the clinimetric properties of rating scales for dystonia and produced recommendations for current usage and future directions. Considering that the strength of evidence derives not only from the quality of the study design, but also from usage of validated outcome measures, we combined the information provided by these two recent reviews and assessed the appropriateness of the rating instruments used in clinical trials on BoNT treatment in focal dystonia. Data sources included all the publications on BoNT treatment for focal dystonias reviewed by the recent evidence-based analysis. We reviewed all rating instruments used to assess primary and secondary outcome following BoNT treatment. The publications were allocated into five topics according to the focal dystonia type reviewed in the meta-analysis: blepharospasm, oromandibular dystonia, cervical dystonia, upper limb dystonia, and laryngeal dystonia. For each topic, papers were divided, according to the terminology used in the meta-analysis, into placebo-controlled, active comparator and methodological or uncontrolled. For each topic we identified the rating tools used in each study class and annotated which were the mostly used in each focal dystonia type. Outcome measures included tools related to motor and non-motor features, such as pain and depression, and functional as well as health-related quality of life features. Patient- and investigator-reported outcomes were also included. Rating instruments were classified as recommended, suggested, listed or not included, based on recommendations produced by the rating scale task force. Both primary and secondary outcome measures were assessed. As a final step we compared current practice, as summarized by the meta-analysis, with the recommendations of the rating scales panel. For blepharospasm, three placebo-controlled trials used suggested scales, one active-comparator study used a recommended scale and three active-comparator studies used suggested scales. For oromandibular dystonia, one placebo-controlled study used a suggested scale. For cervical dystonia, six placebo-controlled trials used a recommended scale, four active-comparator trials used a recommended scale and one active-comparator study used a suggested scale. For upper limb and laryngeal dystonia, no trial used validated instruments. Appropriately designed studies should be based on recommended rating instruments. Therapeutic trials not using clinimetrically tested rating measures do not provide sufficient information on efficacy of BoNT treatment, even if the study design is robust. Further research is needed to develop and validate new tools to assess all types of focal dystonia and to apply them in prospective placebo-controlled clinical trials.
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Affiliation(s)
| | - Alberto Albanese
- Istituto di Neurologia, Istituto Clinico Humanitas, Rozzano, Milano, Italy; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milano, Italy.
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Valdes K, Naughton N, Algar L. Sensorimotor interventions and assessments for the hand and wrist: a scoping review. J Hand Ther 2015; 27:272-85; quiz 286. [PMID: 25193532 DOI: 10.1016/j.jht.2014.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/28/2014] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Scoping review. INTRODUCTION Sensorimotor deficits can impair function and may be present in individuals with common upper extremity conditions. PURPOSE OF THE STUDY To provide clinicians with an understanding of the usefulness of the assessments to evaluate sensorimotor function and the interventions reported in the literature to effect positive change in our patients with sensorimotor deficits affecting the hand and wrist. METHODS A systematic search produced seventeen studies involving sensorimotor retraining and assessment of sensorimotor performance for the upper extremity. RESULTS Sensorimotor interventions and assessments found in the literature vary in regards to their effectiveness in restoring sensorimotor function in subjects with a number of conditions that affect hand and wrist function. CONCLUSIONS There is a potential value of sensorimotor interventions for individuals with specific upper extremity conditions. There is a need for further studies to improve treatment of sensorimotor deficits and understanding of sensorimotor interventions.
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Affiliation(s)
- Kristin Valdes
- Drexel University, Philadelphia, PA, USA; Hand Works Therapy, 744 the Rialto, Venice, FL 34285, USA.
| | | | - Lori Algar
- Northeast Orthopaedic and Hand Surgery, Waterbury, CT, USA
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Kimberley TJ, Schmidt RLS, Chen M, Dykstra DD, Buetefisch CM. Mixed effectiveness of rTMS and retraining in the treatment of focal hand dystonia. Front Hum Neurosci 2015. [PMID: 26217209 PMCID: PMC4496570 DOI: 10.3389/fnhum.2015.00385] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Though the pathophysiology of dystonia remains uncertain, two primary factors implicated in the development of dystonic symptoms are excessive cortical excitability and impaired sensorimotor processing. The aim of this study was to determine the functional efficacy of an intervention combining repetitive transcranial magnetic stimulation (rTMS) and sensorimotor retraining. A randomized, single-subject, multiple baseline design with crossover was used to examine participants with focal hand dystonia (FHD) (n = 9). Intervention: 5 days rTMS + sensorimotor retraining (SMR) vs. Five days rTMS + control therapy (CTL) (which included stretching and massage). The rTMS was applied to the premotor cortex at 1 Hz at 80% resting motor threshold for 1200 pulses. For sensorimotor retraining, a subset of the Learning-based Sensorimotor Training program was followed. Each session in both groups consisted of rTMS followed immediately by 30 min of the therapy intervention (SMR or CTL). Contrary to our hypothesis, group analyses revealed no additional benefit from the SMR training vs. CTL. When analyzed across group however, there was significant improvement from the first baseline assessment in several measures, including tests of sensory ability and self-rated changes. The patient rated improvements were accompanied by a moderate effect size suggesting clinical meaningfulness. These results provide encouragement for further investigation of rTMS in FHD with a need to optimize a secondary intervention and determine likely responders vs. non-responders.
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Affiliation(s)
- Teresa J Kimberley
- Program in Physical Therapy, Brain Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA
| | - Rebekah L S Schmidt
- Program in Physical Therapy, Brain Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA
| | - Mo Chen
- Program in Physical Therapy, Brain Plasticity Laboratory, Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA
| | - Dennis D Dykstra
- Department of Physical Medicine and Rehabilitation, University of Minnesota Minneapolis, MN, USA
| | - Cathrin M Buetefisch
- Department of Neurology and Rehabilitation Medicine, Emory University Atlanta, GA, 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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Bradnam LV, Graetz LJ, McDonnell MN, Ridding MC. Anodal transcranial direct current stimulation to the cerebellum improves handwriting and cyclic drawing kinematics in focal hand dystonia. Front Hum Neurosci 2015; 9:286. [PMID: 26042019 PMCID: PMC4435234 DOI: 10.3389/fnhum.2015.00286] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022] Open
Abstract
There is increasing evidence that the cerebellum has a role in the pathophysiology of primary focal hand dystonia and might provide an intervention target for non-invasive brain stimulation to improve function of the affected hand. The primary objective of this study was to determine if cerebellar transcranial direct current stimulation (tDCS) improves handwriting and cyclic drawing kinematics in people with hand dystonia, by reducing cerebellar-brain inhibition (CBI) evoked by transcranial magnetic stimulation (TMS). Eight people with dystonia (5 writer’s dystonia, 3 musician’s dystonia) and eight age-matched controls completed the study and underwent cerebellar anodal, cathodal and sham tDCS in separate sessions. Dystonia severity was assessed using the Writer’s Cramp Rating Scale (WRCS) and the Arm Dystonia Disability Scale (ADDS). The kinematic measures that differentiated the groups were; mean stroke frequency during handwriting and fast cyclic drawing and average pen pressure during light cyclic drawing. TMS measures of cortical excitability were no different between people with FHD and controls. There was a moderate, negative relationship between TMS-evoked CBI at baseline and the WRCS in dystonia. Anodal cerebellar tDCS reduced handwriting mean stroke frequency and average pen pressure, and increased speed and reduced pen pressure during fast cyclic drawing. Kinematic measures were not associated with a decrease in CBI within an individual. In conclusion, cerebellar anodal tDCS appeared to improve kinematics of handwriting and circle drawing tasks; but the underlying neurophysiological mechanism remains uncertain. A study in a larger homogeneous population is needed to further investigate the possible therapeutic benefit of cerebellar tDCS in dystonia.
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Affiliation(s)
- Lynley V Bradnam
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW, Australia ; Discipline of Physiotherapy, School of Health Sciences, Flinders University Adelaide, SA, Australia
| | - Lynton J Graetz
- Discipline of Physiotherapy, School of Health Sciences, Flinders University Adelaide, SA, Australia
| | - Michelle N McDonnell
- Sansom Institute for Health Research, School of Health Sciences, University of South Australia Adelaide, SA, Australia
| | - Michael C Ridding
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide Adelaide, SA, Australia
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Zeuner KE, Knutzen A, Granert O, Götz J, Wolff S, Jansen O, Dressler D, Hefter H, Hallett M, Deuschl G, van Eimeren T, Witt K. Increased volume and impaired function: the role of the basal ganglia in writer's cramp. Brain Behav 2015; 5:e00301. [PMID: 25642386 PMCID: PMC4309880 DOI: 10.1002/brb3.301] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The pathophysiology of writer's cramp, a task-specific dystonia, remains unclear. The objective of this study was to investigate the basal ganglia circuit and the cerebellum during a complex motor sequence learning task carried out with the nonaffected hand in writer's cramp patients. METHODS We applied structural and functional imaging in 22 writer's cramp patients and 28 matched controls using 3T MRI. With the asymptomatic left hand all participants learned a complex, sequential, five-element sequence-tapping task as accurately and quickly as possible. Functional imaging was measured during a repeated (15 times), fixed block design with tapping (30 sec) and rest (30 sec). Additionally, gray matter volume of the basal ganglia was analyzed using voxel-based morphometry (VBM). RESULTS While behavior was comparable between groups, after small volume correction the anterior part of the right putamen and the left globus pallidus exhibited reduced blood oxygen level-dependent (BOLD) activity in patients during the sequential finger-tapping task. VBM analysis showed larger gray matter volume bilateral in the posterior part of the putamen and globus pallidus. There were no group differences in the cerebellum. CONCLUSION The results indicate an impairment of anterior basal ganglia loops involved in producing complex sequential movements of the unaffected hand. These findings are in line with previous reports of reduced neuronal activity in the globus pallidus internus. Higher gray matter volume of the putamen and globus pallidus may stem from elevated activity of the direct pathway, which could reflect a compensatory phenomenon or a primary predisposition, that is, endophenotypic trait.
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Affiliation(s)
| | - Arne Knutzen
- Department of Neurology, Kiel University Kiel, Germany
| | | | - Julia Götz
- Department of Neurology, Kiel University Kiel, Germany
| | - Stephan Wolff
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Olav Jansen
- Department of Neuroradiology, Kiel University Kiel, Germany
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School Hannover, Germany
| | - Harald Hefter
- Department of Neurology, University of Düsseldorf Düsseldorf, Germany
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland
| | | | | | - Karsten Witt
- Department of Neurology, Kiel University Kiel, Germany
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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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Dresel C, Li Y, Wilzeck V, Castrop F, Zimmer C, Haslinger B. Multiple changes of functional connectivity between sensorimotor areas in focal hand dystonia. J Neurol Neurosurg Psychiatry 2014; 85:1245-52. [PMID: 24706945 DOI: 10.1136/jnnp-2013-307127] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Task-specific focal hand dystonia impairs the control of arm muscles during fine motor skills such as writing (writer's cramp (WC)). Functional imaging found abnormal task-related activation of sensorimotor areas in this disorder, but little is known on their functional connectivity (FC). METHODS Resting-state fMRI and regions of interest (ROI)-voxel cross-correlation analyses were used for systematically analysing the FC between multiple ROIs within the cerebello-basal ganglia-thalamocortical network in 15 patients with right-sided WC and 15 healthy volunteers. RESULTS Patients with WC showed a lower positive FC of several seed ROIs (left lateral premotor cortex, left thalamus, left/right pallidum) to the symptomatic left primary sensorimotor cortex compared with controls. The FC of the left primary motor cortex to prefrontal areas, pre- supplementary motor area and right somatosensory cortex was reduced and correlated with disease severity. Several cerebellar seed ROIs (right dentate nucleus, right crus I and bilateral crus II) revealed a stronger negative FC to primary and secondary sensorimotor areas. CONCLUSIONS An increase of negative cerebello-cortical FC at rest is in line with the hypothesis of a pathogenetic role of the cerebellum in dystonia. The deficit of positive subcortico-cortical FC indicates more generalised changes within the basal ganglia-thalamocortical motor loops beyond primary sensorimotor areas in WC. As patients with WC are asymptomatic during rest, these functional network changes could reflect an underlying abnormality or compensatory neuroplastic changes of network architecture in this disorder.
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Affiliation(s)
- Christian Dresel
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Verena Wilzeck
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Florian Castrop
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
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Hashimoto Y, Ota T, Mukaino M, Liu M, Ushiba J. Functional recovery from chronic writer's cramp by brain-computer interface rehabilitation: a case report. BMC Neurosci 2014; 15:103. [PMID: 25179667 PMCID: PMC4158043 DOI: 10.1186/1471-2202-15-103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dystonia is often currently treated with botulinum toxin injections to spastic muscles, or deep brain stimulation to the basal ganglia. In addition to these pharmacological or neurosurgical measures, a new noninvasive treatment concept, functional modulation using a brain-computer interface, was tested for feasibility. We recorded electroencephalograms (EEGs) over the bilateral sensorimotor cortex from a patient suffering from chronic writer's cramp. The patient was asked to suppress an exaggerated beta frequency component in the EEG during hand extension. RESULTS The patient completed biweekly one-hour training for 5 months without any adverse effects. Significant decrease of the beta frequency component during handwriting was confirmed, and was associated with clear functional improvement. CONCLUSION The current pilot study suggests that a brain-computer Interface can give explicit feedback of ongoing cortical excitability to patients with dystonia and allow them to suppress exaggerated neural activity, resulting in functional recovery.
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Affiliation(s)
- Yasunari Hashimoto
- Department of Electrical and Electronic Engineering, Kitami Institute of Technology, Hokkaido, Japan.
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Sadnicka A, Hamada M, Bhatia KP, Rothwell JC, Edwards MJ. Cerebellar stimulation fails to modulate motor cortex plasticity in writing dystonia. Mov Disord 2014; 29:1304-7. [DOI: 10.1002/mds.25881] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/04/2014] [Accepted: 02/17/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anna Sadnicka
- Shared first authorshipLondon United Kingdom
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College LondonLondon United Kingdom
| | - Masashi Hamada
- Shared first authorshipLondon United Kingdom
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College LondonLondon United Kingdom
- Department of NeurologyGraduate School of Medicine, The University of TokyoTokyo Japan
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College LondonLondon United Kingdom
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College LondonLondon United Kingdom
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College LondonLondon United Kingdom
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Sattler V, Dickler M, Michaud M, Meunier S, Simonetta-Moreau M. Does abnormal interhemispheric inhibition play a role in mirror dystonia? Mov Disord 2013; 29:787-96. [PMID: 24352854 DOI: 10.1002/mds.25768] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 11/07/2022] Open
Abstract
The presence of mirror dystonia (dystonic movement induced by a specific task performed by the unaffected hand) in the dominant hand of writer's cramp patients when the nondominant hand is moved suggests an abnormal interaction between the 2 hemispheres. In this study we compare the level of interhemispheric inhibition (IHI) in 2 groups of patients with writer's cramp, one with the presence of a mirror dystonia and the other without as well as a control group. The level of bidirectional IHI was measured in wrist muscles with dual-site transcranial magnetic stimulation with a 10-millisecond (short IHI) and a 40-millisecond (long IHI) interstimulus interval during rest and while holding a pen in 9 patients with mirror dystonia 7 without mirror dystonia, and 13 controls. The group of patients without mirror dystonia did not differ from the controls in their IHI level. In contrast, IHI was significantly decreased in the group of patients with mirror dystonia in comparison with the group without mirror dystonia and the controls in both wrist muscles of both the dystonic and unaffected hand whatever the resting or active condition (P = 0.001). The decrease of IHI level in the group of patients with mirror dystonia was negatively correlated with the severity and the duration of the disease: the weaker the level of IHI, the more severe was the disease and the longer its duration. Interhemispheric inhibition disturbances are most likely involved in the occurrence of mirror dystonia. This bilateral deficient inhibition further suggests the involvement of the unaffected hemisphere in the pathophysiology of unilateral dystonia.
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Affiliation(s)
- Virginie Sattler
- Centre Hospitalier Universitaire de Toulouse, Pôle Neurosciences, CHU Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France; Inserm; Imagerie cérébrale et handicaps neurologiques, UMR 825, CHU Purpan, Pavillon Baudot, Toulouse, France
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Berman BD, Hallett M, Herscovitch P, Simonyan K. Striatal dopaminergic dysfunction at rest and during task performance in writer's cramp. ACTA ACUST UNITED AC 2013; 136:3645-58. [PMID: 24148273 DOI: 10.1093/brain/awt282] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Writer's cramp is a task-specific focal hand dystonia characterized by involuntary excessive muscle contractions during writing. Although abnormal striatal dopamine receptor binding has been implicated in the pathophysiology of writer's cramp and other primary dystonias, endogenous dopamine release during task performance has not been previously investigated in writer's cramp. Using positron emission tomography imaging with the D2/D3 antagonist 11C-raclopride, we analysed striatal D2/D3 availability at rest and endogenous dopamine release during sequential finger tapping and speech production tasks in 15 patients with writer's cramp and 15 matched healthy control subjects. Compared with control subjects, patients had reduced 11C-raclopride binding to D2/D3 receptors at rest in the bilateral striatum, consistent with findings in previous studies. During the tapping task, patients had decreased dopamine release in the left striatum as assessed by reduced change in 11C-raclopride binding compared with control subjects. One cluster of reduced dopamine release in the left putamen during tapping overlapped with a region of reduced 11C-raclopride binding to D2/D3 receptors at rest. During the sentence production task, patients showed increased dopamine release in the left striatum. No overlap between altered dopamine release during speech production and reduced 11C-raclopride binding to D2/D3 receptors at rest was seen. Striatal regions where D2/D3 availability at rest positively correlated with disease duration were lateral and non-overlapping with striatal regions showing reduced D2/D3 receptor availability, except for a cluster in the left nucleus accumbens, which showed a negative correlation with disease duration and overlapped with striatal regions showing reduced D2/D3 availability. Our findings suggest that patients with writer's cramp may have divergent responses in striatal dopamine release during an asymptomatic motor task involving the dystonic hand and an unrelated asymptomatic task, sentence production. Our voxel-based results also suggest that writer's cramp may be associated with reduced striatal dopamine release occuring in the setting of reduced D2/D3 receptor availability and raise the possibility that basal ganglia circuits associated with premotor cortices and those associated with primary motor cortex are differentially affected in primary focal dystonias.
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Affiliation(s)
- Brian D Berman
- 1 Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, CO USA
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Pelosin E, Avanzino L, Marchese R, Stramesi P, Bilanci M, Trompetto C, Abbruzzese G. kinesiotaping reduces pain and modulates sensory function in patients with focal dystonia: a randomized crossover pilot study. Neurorehabil Neural Repair 2013; 27:722-31. [PMID: 23764884 DOI: 10.1177/1545968313491010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is one of the most common and disabling "nonmotor" symptoms in patients with dystonia. No recent study evaluated the pharmacological or physical therapy approaches to specifically treat dystonic pain symptoms. OBJECTIVE To evaluate the effectiveness of KinesioTaping in patients with cervical dystonia (CD) and focal hand dystonia (FHD) on self-reported pain (primary objective) and on sensory functions (secondary objective). METHODS Twenty-five dystonic patients (14 with CD and 11 FHD) entered a randomized crossover pilot study. The patients were randomized to 14-day treatment with KinesioTaping or ShamTaping over neck (in CD) or forearm muscles (in FHD), and after a 30-day washout period, they received the other treatment. The MAIN OUTCOME MEASURES were 3 visual analog scales (VASs) for usual pain, worst pain, and pain relief. Disease severity changes were evaluated by means of the Toronto Western Spasmodic Torticollis Rating Scale (CD) and the Writer's Cramp Rating Scale (FHD). Furthermore, to investigate possible KinesioTaping-induced effects on sensory functions, we evaluated the somatosensory temporal discrimination threshold. RESULTS Treatment with KinesioTape induced a decrease in the subjective sensation of pain and a modification in the ability of sensory discrimination, whereas ShamTaping had no effect. A significant, positive correlation was found in both groups of patients between the improvement in the subjective sensation of pain and the reduction of somatosensory temporal discrimination threshold values induced by KinesioTaping. CONCLUSIONS These preliminary results suggest that KinesioTaping may be useful in treating pain in patients with dystonia.
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Botulinum neurotoxin treatment improves force regulation in writer's cramp. Parkinsonism Relat Disord 2013; 19:611-6. [PMID: 23507416 DOI: 10.1016/j.parkreldis.2013.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/05/2013] [Accepted: 02/22/2013] [Indexed: 11/23/2022]
Abstract
Writer's cramp patients show poor force regulation during handwriting, but also in other experimental tasks requiring fine motor control. Botulinum neurotoxin (BoNT) treatment is clinically effective in a substantial portion of writer's cramp patients, but the full mechanism of action remains enigmatic. BoNT possibly influences α- and γ-motoneurons through chemodenervation not only of extra-, but also intrafusal muscle fibres and might thus influence muscle spindle afferents. Hence, BoNT weakens injected muscles, but may also modulate sensory aspects of force control. Ten patients and 18 controls pressed their index finger on a force sensor tracking two visual targets: The first target consisted of five plateaus with successively higher force levels and alternated with ascending ramps. In the second target condition the same successive plateaus were to be reached by abrupt jumps. The generated force displayed as a time dependant curve. Root mean square of the difference between target and produced force level was calculated for each plateau/ramp/jump. Patients were treated with BoNT at week 4 and measured at baseline, weeks 2, 4, 6 and 8. Disturbed force regulation in patients for the plateaus and the second jump at baseline resolved after BoNT treatment, and the root mean square of force deviation decreased for the ramps. Fine force control was within the 95% confidence interval of the control group after treatment. In conclusion, force regulation was disturbed in patients and improved after BoNT treatment. This is not compatible with a simple muscle weakening and might thus reflect improved sensorimotor integration.
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