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Nijenhuis B, van Wensen E, Smit M, van Zutphen T, Zwerver J, Tijssen M. Treatment of task-specific dystonia in sports: A systematic review. Clin Park Relat Disord 2024; 10:100245. [PMID: 38456155 PMCID: PMC10918566 DOI: 10.1016/j.prdoa.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/30/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Task specific dystonia is a movement disorder only affecting a highly practiced skill and is found in a broad set of expert movements including in sports. Despite affecting many sports, there is no comprehensive review of treatment options, which is in contrast to better studied forms of task specific dystonia in musicians and writers. For this reason, studies involving an intervention to treat task specific dystonia in sports were systematically reviewed, with special attention for the quality of outcome measures. Methods The PICO systematic search strategy was employed on task-specific dystonia, and all synonyms. Inclusion criteria were peer reviewed published studies pertaining to sports, studies with a measurement and/or intervention in TSD, all in English. We excluded abstracts, expert opinions, narrative review articles, unpublished studies, dissertations and studies exclusively relating to choking. We included case reports, case studies and case-control studies. Results In April 2022 Pubmed, Embase, Web of Science, and Psychinfo were searched. Of the 7000 articles identified, 31 were included that described psychological and invasive and/or pharmacological interventions. There was a lack of formal standardized outcome measures in studies resulting in low quality evidence for the effectiveness of treatment options. A descriptive synthesis showed emotional regulation was effective, but was exclusively tried in golfers. Interventions like botulinum toxin or pharmacology had a similar effectiveness compared to studies in musicians dystonia, however there was almost no formal evidence for these treatments. Conclusion The quality of studies was low with a lack of standardized outcome measures. Future studies with larger cohorts and quantitative outcome measures are needed to improve understanding of treatments for task specific dystonia in athletes.
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Affiliation(s)
- B. Nijenhuis
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - E. van Wensen
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn and Sports Dystonia Centre, Apeldoorn, The Netherlands
| | - M. Smit
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T. van Zutphen
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - J. Zwerver
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Abstract
Background Task-specific dystonia (TSD) is a form of focal dystonia that occurs in the context of the performance of selective, highly skilled, often repetitive, motor activity. TSD may be apparent during certain tasks such as writing, playing musical instruments, or other activities requiring fine motor control, but may also occur during certain sports, and maybe detrimental to professional athletes' careers. Therefore, sports physicians and movement disorder neurologists need to be aware of the presentation and phenomenology of sports-related dystonia (SRD), the topic of this review. Methods A broad PubMed search using a wide range of keywords and combinations was done in October 2021 to identify suitable articles for this review. Results Most of the publications are on yips in golfers and on runners' dystonia. Other sports in which SRD has been reported are ice skating, tennis, table tennis, pistol shooting, petanque, baseball, and billiards. Discussion Yips, which may affect up to half of the golfers and rarely athletes in other sports (e.g., baseball, cricket, basketball, speed skating, gymnastics) seems to be a multi-factorial form of TSD that is particularly troublesome in highly skilled professional golfers. Runners' dystonia, affecting the foot, leg, and hip (in decreasing order), may evolve into more generalized and less specific dystonia. The pathophysiologic mechanisms of SRD are not well understood. Botulinum toxin has been reported to alleviate dystonia in golfers', runners', and other forms of SRD. Future studies should utilize neurophysiologic, imaging, and other techniques to elucidate mechanisms of this underrecognized group of movement disorders.
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Ogasawara I, Hattori N, Revankar GS, Konda S, Uno Y, Nakano T, Kajiyama Y, Mochizuki H, Nakata K. Symptom Locus and Symptom Origin Incongruity in Runner's Dystonia - Case Study of an Elite Female Runner. Front Hum Neurosci 2022; 15:809544. [PMID: 34975442 PMCID: PMC8716826 DOI: 10.3389/fnhum.2021.809544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Runner's dystonia is a task-specific dystonia that occurs in the lower limbs and trunk, with diverse symptomatology. We aimed to identify the origin of a dystonic movement abnormality using combined three-dimensional kinematic analysis and electromyographic (EMG) assessment during treadmill running. Participant: A 20-year-old female runner who complained of right-foot collision with the left-leg during right-leg swing-phase, which mimicked right-ankle focal dystonia. Results: Kinematic and EMG assessment of her running motion was performed, which showed a significant drop of the left pelvis during right-leg stance-phase, and a simultaneous increase of right hip adductor muscle activity. This resulted in a pronounced adduction of the entire right lower limb with respect to the pelvis segment. Trajectories of right foot were seen to encroach upon left-leg area. Discussion: These findings suggested that the symptom of this runner was most likely a form of segmental dystonia originating from an impaired control of hip and pelvis, rather than a distal focal ankle dystonia. Conclusion: We conclude that, for individualized symptom assessment, deconstructing the symptom origin from its secondary compensatory movement is crucial for characterizing dystonia. Kinematic and EMG evaluation will therefore be a prerequisite to distinguish symptom origin from secondary compensatory movement.
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Affiliation(s)
- Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriaki Hattori
- Department of Rehabilitation, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Gajanan S Revankar
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.,Institute for Transdisciplinary Graduate Degree Programs, Osaka University, Osaka, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Uno
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomohito Nakano
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuta Kajiyama
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Neurology, Sakai City Medical Center, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
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4
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Barad N. Weaver's Dystonia: A Novel form of Focal Task-Specific Dystonia. Mov Disord Clin Pract 2020; 7:847-848. [PMID: 33043081 PMCID: PMC7533999 DOI: 10.1002/mdc3.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 08/02/2023] Open
Affiliation(s)
- Narendrakumar Barad
- Consultant Neurologist & Movement Disorders SpecialistSterling HospitalAhmedabadIndia
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5
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Yoo SW, Lee M, Kim JS. “Stepping on the brakes” dystonic tremor: a new type of task-specific dystonic tremor of the lower extremity. Neurol Sci 2020; 41:477-479. [DOI: 10.1007/s10072-019-04060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
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Baik JS, Ma HI, Lee PH, Taira T. Focal Task-Specific Lower Limb Dystonia Only When Walking Stairs: Is It a New Disease Entity? Front Neurol 2019; 10:1081. [PMID: 31749753 PMCID: PMC6842934 DOI: 10.3389/fneur.2019.01081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Focal task-specific dystonia in the lower limb or foot often occurs only during walking, running, hiking, or cycling. Several medications and botulinum toxin injection are effective in patients with this disorder. The objective of this study was to understand the spectrum of focal task-specific dystonia in the lower limb only when walking stairs and to compare other types of task-specific dystonia. Methods: All original articles and case reports were collected and reviewed using PubMed. In addition, all video clips of published cases were evaluated, and patients' clinical findings analyzed. The present study included 12 patients described in previous studies and five new Asian patients found in the medical records. Results: Most of the patients were women, and the onset age was 42 years. Ten patients were classified as the Kicking type, including three patients with the rKicking type, and six patients were considered as the Lifting type; however, only one patient was not included in any of the types. Symptoms in most of the patients did not improve with any medications or botulinum toxin injection. The symptoms of most patients did not change over a long time. Conclusion: Most patients showed the dystonic symptom when walking downstairs rather than upstairs. Psychogenic dystonia is a disease differentially diagnosed with this dystonia. Unlike other types of focal task-specific dystonia, the response to treatment was disappointing because most of the medications and botulinum toxin injection were not effective. The prognosis is completely different from that of other types of focal task-specific dystonia.
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Affiliation(s)
- Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Hospital, Anyang, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Wu KH, Chien CF, Wu MN, Hsu CY, Lai CL, Liou LM. Posterior spinal artery infarction initially presenting as acute bilateral lower limb dystonia. Neurol Sci 2019; 40:2197-2199. [PMID: 31168690 DOI: 10.1007/s10072-019-03955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Kun-Han Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiou-Lian Lai
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Min Liou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan. .,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Arceri T, Ratliff J. A Case of Ascending and Descending Stair-Specific Dystonia. J Mov Disord 2019; 12:130-131. [PMID: 30944285 PMCID: PMC6547041 DOI: 10.14802/jmd.18057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Talia Arceri
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey Ratliff
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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9
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Portaro S, Naro A, Cacciola A, Marra A, Quartarone A, Milardi D, Calabrò RS. Adult-Onset Walking-Upstairs Dystonia. J Clin Neurol 2019; 15:122-124. [PMID: 30375761 PMCID: PMC6325365 DOI: 10.3988/jcn.2019.15.1.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Angela Marra
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Demetrio Milardi
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Department of Anatomy, University of Messina, Messina, Italy
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10
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Electromyographic and Joint Kinematic Patterns in Runner's Dystonia. Toxins (Basel) 2018; 10:toxins10040166. [PMID: 29677101 PMCID: PMC5923332 DOI: 10.3390/toxins10040166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 01/21/2023] Open
Abstract
Runner’s dystonia (RD) is a task-specific focal dystonia of the lower limbs that occurs when running. In this retrospective case series, we present surface electromyography (EMG) and joint kinematic data from thirteen patients with RD who underwent instrumented gait analysis (IGA) at the Functional and Biomechanics Laboratory at the National Institutes of Health. Four cases of RD are described in greater detail to demonstrate the potential utility of EMG with kinematic studies to identify dystonic muscle groups in RD. In these cases, the methodology for muscle selection for botulinum toxin therapy and the therapeutic response is discussed. Lateral heel whip, a proposed novel presentation of lower-limb dystonia, is also described.
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11
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Asahi T, Taira T, Ikeda K, Yamamoto J, Sato S. Full recovery from drummer's dystonia with foot and arm symptoms after stereotactic ventro-oral thalamotomy: a case report. Acta Neurochir (Wien) 2018; 160:835-838. [PMID: 29423776 DOI: 10.1007/s00701-018-3480-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
Ventro-oral (Vo) thalamotomy is effective in patients with focal task-specific dystonias (FTSDs), but only in those with upper-limb symptoms. We describe a patient with drummer's dystonia who completely recovered after Vo thalamotomy. A 37-year-old man who started playing drums at 14 began having difficulty performing fine movements with his right foot when drumming at 22. He experienced right hand cramps while drumming 3 months before visiting our hospital. He was diagnosed with FTSD. Left Vo thalamotomy was performed, which led to complete improvement of symptoms. Vo thalamotomy may be effective for FTSD patients with upper- and lower-extremity symptoms.
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Menon S, Muglan JA, Shimon L, Stewart D, Snow B, Hayes M, Fung VSC, Jog MS. Down the Stairs Dystonia-A Novel Task-Specific Focal Isolated Syndrome. Mov Disord Clin Pract 2016; 4:121-124. [PMID: 30713957 DOI: 10.1002/mdc3.12371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/06/2022] Open
Abstract
Adult-onset, task-specific dystonia of the lower limb is a rare occurrence. In this report, the authors present 6 cases of task-specific dystonia manifested only when going down the stairs. These patients were seen by 6 different neurologists from across Canada, Australia, and New Zealand, and all videos were reviewed by 1 movement disorders specialist who made the final diagnosis. Video description of each case is also presented. All 6 patients demonstrated dystonia of 1 of their lower limbs specifically only when going down the stairs. The remainder of the neurological examination was normal, and distractibility, inconsistency, fixed dystonia, or a premonitory urge were absent, making functional movement disorder and tic disorder unlikely. These 6 patients display a distinct, adult-onset, focal isolated dystonia manifested only on going down the stairs that is recognizable as a new task-specific dystonia of the lower extremity.
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Affiliation(s)
- Suresh Menon
- Department of Medicine Division of Neurology McMaster University Hamilton Ontario Canada
| | - Jihad A Muglan
- Department of Clinical Neurological Sciences Western University London Ontario Canada
| | - Laith Shimon
- Division of Neurology Department of Medicine Dalhousie University Halifax Nova Scotia Canada
| | | | - Barry Snow
- Department of Neurology Auckland Hospital Auckland New Zealand
| | - Michael Hayes
- Department of Neurology Concord Repatriation General Hospital Concord New South Wales Australia
| | - Victor S C Fung
- Movement Disorders Unit Department of Neurology Westmead Hospital and Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Mandar S Jog
- National Parkinson Foundation Center of Excellence and Movement Disorder Program London Health Sciences Center London Ontario Canada
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13
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Logan L, Resseque B, Dontamsetti MS. Adult onset primary focal dystonia of the foot: an orthopaedic intervention. BMJ Case Rep 2016; 2016:bcr-2015-212072. [PMID: 27030449 DOI: 10.1136/bcr-2015-212072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old woman presented to a foot centre with a chief symptom of cramping in her toes, which, she believed, was of a secondary cause originating from a bunion. She was treated conservatively; however, she returned a month later as the symptoms had progressed to painful cramping of toes, toe-curling and instability while walking, due to involuntary movement of her toes. It was believed that the patient presented with a rare case of primary adult onset focal foot dystonia. This case report explains dystonia further in detail and delves into the different treatment and management options available today, including the unique orthopaedic intervention provided for this patient.
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Affiliation(s)
- Loretta Logan
- Department of Orthopedics & Pediatrics, New York College of Podiatric Medicine, New York, New York, USA
| | - Barbara Resseque
- Department of Orthopedics & Pediatrics, New York College of Podiatric Medicine, New York, New York, USA
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