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Teraoka Y, Hanada K, Iki S, Kawaguchi T, Yokoi K, Fujii H, Inoue K, Hirayama K. Dystonia-like Movement Disorders Ameliorated by Shear Force and Pressure Stimulation after Small Infarction in the Left Posterolateral Thalamus. Intern Med 2023; 62:893-902. [PMID: 35989278 PMCID: PMC10076139 DOI: 10.2169/internalmedicine.9543-22] [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] [Indexed: 11/06/2022] Open
Abstract
Focal dystonia (FD) can develop after thalamic lesions. Abnormal somatic sensations were argued to be responsible for FD. Our patient experienced FD-like movement disorders, agraphesthesia, and a reduced sense of shear force on the skin and pressure to deep tissues of the right upper limb following a small infarction in the left posterolateral thalamus. FD-like symptoms improved while the skin was being pulled or the deep tissue was being pushed in a manner proportional to the strength of muscle contractions. Therefore, the lack of these sensations was suggested to be related to FD-like symptoms.
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Affiliation(s)
- Youki Teraoka
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Keisuke Hanada
- Department of Rehabilitation, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | - Shinya Iki
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
| | - Takuya Kawaguchi
- Department of Occupational Therapy, Kawaguchi Neurosurgery Rehabilitation Clinic, Japan
| | - Kayoko Yokoi
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Hiromi Fujii
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Kaori Inoue
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
| | - Kazumi Hirayama
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Japan
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Menon V, Varadharajan N, Bascarane S, Andrade C. Efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in focal hand dystonia: Systematic review of intervention trials. Asian J Psychiatr 2023; 80:103437. [PMID: 36603324 DOI: 10.1016/j.ajp.2022.103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
We reviewed trials examining the efficacy of repetitive transcranial magnetic stimulation (rTMS) (seven trials) and transcranial direct current stimulation (tDCS) (seven trials) in focal and dystonia (FHD). Among tDCS trials, one randomized controlled trial and three quasi-experimental studies showed evidence of efficacy; these trials combined different types of stimulations or used tDCS along with neurorehabilitation. Four rTMS trials showed evidence of efficacy but differed in stimulation parameters. Risk of bias was noted in nearly all the trials. There is weak and inconsistent evidence for the efficacy of rTMS and tDCS administered alone or with other interventions in FHD.
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Affiliation(s)
- Vikas Menon
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India.
| | - Natarajan Varadharajan
- Dept of Psychiatry, Employees State Insurance Corporation (ESIC) Medical College and Postgraduate Institute of Medical Sciences and Research (PGIMSR), KK Nagar, Chennai 600078, India
| | - Sharmi Bascarane
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
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Pateraki G, Anargyros K, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Ziogka P, Sgantzos M, Folia V, Peristeri E, Dardiotis E. Therapeutic application of rTMS in neurodegenerative and movement disorders: A review. J Electromyogr Kinesiol 2021; 62:102622. [PMID: 34890834 DOI: 10.1016/j.jelekin.2021.102622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive form of brain stimulation that makes use of the magnetic field generated when an electric current passes through a magnetic coil placed over the scalp. It can be applied as a single stimulus at a time, in pairs of stimuli, or repetitively in trains of stimuli (repetitive TMS, rTMS). RTMS can induce changes in brain activity, whose after-effects reflect the processes of long-term potentiation and long-term depression, as certain protocols, namely those using low frequencies (≤1 Hz) seem to suppress cortical excitability, while those using high frequencies (>1 Hz) seem to enhance it. It is a technique with very few and mostly mild side-effects, whose effects can persist for long time periods, and as such, it has been studied as a potential treatment option in a multitude of neurodegenerative diseases, including those affecting movement. Although rTMS has received approval as a treatment strategy of only a few aspects in movement disorders in the latest guidelines, its further use seems to also be promising in their context. In this review, we gathered the available literature on the therapeutic application of rTMS in movement disorders, namely Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Dystonia, Tic disorders and Essential Tremor.
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Affiliation(s)
- Georgia Pateraki
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Anargyros
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Pinelopi Ziogka
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
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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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Hyperactive sensorimotor cortex during voice perception in spasmodic dysphonia. Sci Rep 2020; 10:17298. [PMID: 33057071 PMCID: PMC7566443 DOI: 10.1038/s41598-020-73450-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Spasmodic dysphonia (SD) is characterized by an involuntary laryngeal muscle spasm during vocalization. Previous studies measured brain activation during voice production and suggested that SD arises from abnormal sensorimotor integration involving the sensorimotor cortex. However, it remains unclear whether this abnormal sensorimotor activation merely reflects neural activation produced by abnormal vocalization. To identify the specific neural correlates of SD, we used a sound discrimination task without overt vocalization to compare neural activation between 11 patients with SD and healthy participants. Participants underwent functional MRI during a two-alternative judgment task for auditory stimuli, which could be modal or falsetto voice. Since vocalization in falsetto is intact in SD, we predicted that neural activation during speech perception would differ between the two groups only for modal voice and not for falsetto voice. Group-by-stimulus interaction was observed in the left sensorimotor cortex and thalamus, suggesting that voice perception activates different neural systems between the two groups. Moreover, the sensorimotor signals positively correlated with disease severity of SD, and classified the two groups with 73% accuracy in linear discriminant analysis. Thus, the sensorimotor cortex and thalamus play a central role in SD pathophysiology and sensorimotor signals can be a new biomarker for SD diagnosis.
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Spatial Integration of Somatosensory Inputs during Sensory-Motor Plasticity Phenomena Is Normal in Focal Hand Dystonia. Neural Plast 2018; 2018:4135708. [PMID: 30405710 PMCID: PMC6199881 DOI: 10.1155/2018/4135708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/18/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background Surround inhibition is a system that sharpens sensation by creating an inhibitory zone around the central core of activation. In the motor system, this mechanism probably contributes to the selection of voluntary movements, and it seems to be lost in dystonia. Objectives. To explore if sensory information is abnormally processed and integrated in focal hand dystonia (FHD) and if surround inhibition phenomena are operating during sensory-motor plasticity and somatosensory integration in normal humans and in patients with FHD. Methods. We looked at the MEP facilitation obtained after 5 Hz repetitive paired associative stimulation of median (PAS M), ulnar (PAS U), and median + ulnar nerve (PAS MU) stimulation in 8 normal subjects and 8 FHD. We evaluated the ratio MU/(M + U) ∗ 100 and the spatial and temporal somatosensory integration recording the somatosensory evoked potentials (SEPs) evoked by a dual nerve input. Results FHD had two main abnormalities: first, the amount of facilitation was larger than normal subjects; second, the spatial specificity was lost. The MU/(M + U) ∗ 100 ratio was similar in healthy subjects and in FHD patients, and the somatosensory integration was normal in this subset of patients. Conclusions. The inhibitory integration of somatosensory inputs and the somatosensory inhibition are normal in patients with focal dystonia as well as lateral surrounding inhibition phenomena during sensory-motor plasticity in FHD.
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Abstract
OBJECTIVES There is increasing evidence of non-motor, sensory symptoms, mainly involving the spatial domain, in cervical dystonia (CD). These manifestations are likely driven by dysfunctional overactivity of the parietal cortex during the execution of a sensory task. Few studies also suggest the possibility that visuospatial attention might be specifically affected in patients with CD. Therefore, we asked whether non-motor manifestations in CD might also comprise impairment of higher level visuospatial processing. METHODS To this end, we investigated visuospatial attention in 23 CD patients and 12 matched healthy controls (for age, gender, education, and ocular dominance). The patients were identified according to the dystonia pattern type (laterocollis vs. torticollis). Overall, participants were right-handers, and the majority of them was right-eye dominant. Visuospatial attention was assessed using a line bisection task. Participants were asked to bisect horizontal lines, using their right or left hand. RESULTS Participants bisected more to the left of true center when using their left hand to perform the task than when using their right hand. However, overall, torticollis patients produced a significantly greater leftward deviation than controls. CONCLUSIONS These data are consistent with preliminary findings suggesting the presence of biased spatial attention in patients with idiopathic cervical dystonia. The presence of an attentional bias in patients with torticollis seem to indicate that alterations of attentional circuits might be implicated in the pathophysiology of this type of CD. (JINS, 2018, 24, 23-32).
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Erro R, Tinazzi M, Morgante F, Bhatia KP. Non-invasive brain stimulation for dystonia: therapeutic implications. Eur J Neurol 2017; 24:1228-e64. [PMID: 28782903 DOI: 10.1111/ene.13363] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
Dystonia is characterized by excessive muscle contractions giving rise to abnormal posture and involuntary twisting movements. Although dystonia syndromes are a heterogeneous group of disorders, certain pathophysiological mechanisms have been consistently identified across different forms. These pathophysiological mechanisms have subsequently been exploited for the development of non-invasive brain stimulation (NIBS) techniques able to modulate neural activity in one or more nodes of the putative network that is altered in dystonia, and the therapeutic role of NIBS has hence been suggested. Here all studies that applied such techniques as a therapeutic intervention in any forms of dystonia, including the few works performed in children, are reviewed and emerging concepts and pitfalls of NIBS are discussed.
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Affiliation(s)
- R Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Neuroscience Section, University of Salerno, Salerno, Italy.,Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - M Tinazzi
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - F Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
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Chillemi G, Calamuneri A, Morgante F, Terranova C, Rizzo V, Girlanda P, Ghilardi MF, Quartarone A. Spatial and Temporal High Processing of Visual and Auditory Stimuli in Cervical Dystonia. Front Neurol 2017; 8:66. [PMID: 28316586 PMCID: PMC5334342 DOI: 10.3389/fneur.2017.00066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/15/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Investigation of spatial and temporal cognitive processing in idiopathic cervical dystonia (CD) by means of specific tasks based on perception in time and space domains of visual and auditory stimuli. BACKGROUND Previous psychophysiological studies have investigated temporal and spatial characteristics of neural processing of sensory stimuli (mainly somatosensorial and visual), whereas the definition of such processing at higher cognitive level has not been sufficiently addressed. The impairment of time and space processing is likely driven by basal ganglia dysfunction. However, other cortical and subcortical areas, including cerebellum, may also be involved. METHODS We tested 21 subjects with CD and 22 age-matched healthy controls with 4 recognition tasks exploring visuo-spatial, audio-spatial, visuo-temporal, and audio-temporal processing. Dystonic subjects were subdivided in three groups according to the head movement pattern type (lateral: Laterocollis, rotation: Torticollis) as well as the presence of tremor (Tremor). RESULTS We found significant alteration of spatial processing in Laterocollis subgroup compared to controls, whereas impairment of temporal processing was observed in Torticollis subgroup compared to controls. CONCLUSION Our results suggest that dystonia is associated with a dysfunction of temporal and spatial processing for visual and auditory stimuli that could underlie the well-known abnormalities in sequence learning. Moreover, we suggest that different movement pattern type might lead to different dysfunctions at cognitive level within dystonic population.
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Affiliation(s)
- Gaetana Chillemi
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Alessandro Calamuneri
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Maria Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, City University of New York Medical School , New York, NY , USA
| | - Angelo Quartarone
- Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro "Bonino Pulejo", Messina, Italy; Department of Biomedical Science and Morphological and Functional Images, University of Messina, Messina, Italy
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10
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Furuya S, Hanakawa T. The curse of motor expertise: Use-dependent focal dystonia as a manifestation of maladaptive changes in body representation. Neurosci Res 2015; 104:112-9. [PMID: 26689332 DOI: 10.1016/j.neures.2015.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 01/20/2023]
Abstract
Focal task-specific dystonia (FTSD) impairs not only motor dexterity, but also somatosensory perception involved in well-trained behavioral tasks. Occupations that carry a risk of developing FTSD include musician, writer, painter, surgeon, and golfer, which are characterized by repetitive and precise motor actions over a prolonged period. Behavioral studies have uncovered various undesirable effects of FTSD on sensorimotor functions, such as a loss of independent movement control, unintended muscular co-activation, awkward limb posture, and impairment of fine discrimination of tactile and proprioceptive sensations. Studies using neuroimaging and noninvasive brain stimulation techniques have related such sensorimotor malfunctions to maladaptive neuroplastic changes in the sensorimotor system, including the primary motor and somatosensory areas, premotor area, cerebellum, and basal ganglia. In this review, we summarize recent empirical findings regarding phenomenological and pathophysiological abnormalities associated with the development of FTSD. We particularly focused on maladaptive alterations of body representations underlying the degradation of fine motor control and somatosensory perception in FTSD patients.
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Affiliation(s)
- Shinichi Furuya
- Musical Skill and Injury Center (MuSIC), Sophia University, Japan; Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Japan.
| | - Takashi Hanakawa
- Musical Skill and Injury Center (MuSIC), Sophia University, Japan; Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Japan.
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11
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Furuya S, Tominaga K, Miyazaki F, Altenmüller E. Losing dexterity: patterns of impaired coordination of finger movements in musician's dystonia. Sci Rep 2015; 5:13360. [PMID: 26289433 PMCID: PMC4542337 DOI: 10.1038/srep13360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/24/2015] [Indexed: 11/23/2022] Open
Abstract
Extensive training can bring about highly-skilled action, but may also impair motor dexterity by producing involuntary movements and muscular cramping, as seen in focal dystonia (FD) and tremor. To elucidate the underlying neuroplastic mechanisms of FD, the present study addressed the organization of finger movements during piano performance in pianists suffering from the condition. Principal component (PC) analysis identified three patterns of fundamental joint coordination constituting finger movements in both patients and controls. The first two coordination patterns described less individuated movements between the “dystonic” finger and key-striking fingers for patients compared to controls. The third coordination pattern, representing the individuation of movements between the middle and ring fingers, was evident during a sequence of strikes with these fingers in controls, which was absent in the patients. Consequently, rhythmic variability of keystrokes was more pronounced during this sequence of strikes for the patients. A stepwise multiple-regression analysis further identified greater variability of keystrokes for individuals displaying less individuated movements between the affected and striking fingers. The findings suggest that FD alters dexterous joint coordination so as to lower independent control of finger movements, and thereby degrades fine motor control.
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Affiliation(s)
- Shinichi Furuya
- Institute for Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Emmichplatz 1, Hanover, Germany 30175.,Department of Information and Communication Sciences, Sophia University, Tokyo, Japan, 1020081
| | - Kenta Tominaga
- Department of Engineering Science, Osaka University, Osaka, Japan, 5608531
| | - Fumio Miyazaki
- Department of Engineering Science, Osaka University, Osaka, Japan, 5608531
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Emmichplatz 1, Hanover, Germany 30175
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12
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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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