Abstract
Narrative Review
Advances in structural and functional imaging have provided both scientists and clinicians
with information about the neural mechanisms underlying focal hand dystonia (FHd),
a motor disorder associated with aberrant posturing and patterns of muscle contraction
specific to movements of the hand. Consistent with the hypothesis that FHd is the
result of reorganization in cortical fields, studies in neuroimaging have confirmed
alterations in the topography and response properties of somatosensory and motor areas
of the brain. Noninvasive stimulation of these regions also demonstrates that FHd
may be due to reductions in inhibition between competing sensory and motor representations.
Compromises in neuroanatomical structure, such as white matter density and gray matter
volume, have also been identified through neuroimaging methods. These advances in
neuroimaging have provided clinicians with an expanded understanding of the changes
in the brain that contribute to FHd. These findings should provide a foundation for
the development of retraining paradigms focused on reversing overlapping sensory representations
and interactions between brain regions in patients with FHd. Continued collaborations
between health professionals who treat FHd and research scientists who examine the
brain using neuroimaging tools are imperative for answering difficult questions about
patients with specific movement disorders.
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References
- Writer's cramp—a focal dystonia.Brain. 1982; 105: 461-480
- Writer's cramp.Trends Neurosci. 1990; 13: 148-153
- Focal hand dystonia.Pract Neurol. 2006; 6: 278-287
- Botulinum toxin therapy of writer's cramp.Eur J Neurol. 2006; 13: 55-59
- Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization.PNAS. 2003; 100: 7942-7946
- Limb immobilization for the treatment of focal occupational dystonia.Neurology. 2001; 57: 405-409
- Motor training as treatment in focal hand dystonia.Mov Disord. 2005; 20: 335-341
- Sensory representation abnormalities that parallel focal hand dystonia in a primate model.Somatosens Mot Res. 2002; 19: 347-357
- A primate genesis model of focal hand dystonia and repetitive strain injury: 1. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.Neurology. 1996; 47: 508-520
- Magnification, receptive-field area, and “hypercolumn” size in areas 3b and 1 of somatosensory cortex in owl monkeys.J Neurophysiol. 1980; 44: 295-311
- Abnormal cortical sensory activation in dystonia: an fMRI study.Mov Disord. 2003; 186: 673-682
- Human brain mapping in dystonia reveals both endophenotypic traits and adaptive reorganization.Ann Neurol. 2001; 50: 521-527
- Somatosensory representation of the digits in clinical performance in patients with focal hand dystonia.Am J Phys Med Rehabil. 2003; 82: 737-749
- Computational model of the role of sensory disorganization in focal task-specific dystonia.J Neurophysiol. 2000; 84: 2458-2464
- Abnormalities of spatial and temporal sensory discrimination in writer's cramp.Mov Disord. 2001; 16: 94-99
- Abnormalities of spatial discrimination in focal and generalized dystonia.Brain. 2003; 126: 2175-2182
- The basal ganglia are hyperactive during the discrimination of tactile stimuli in writer's cramp.Brain. 2006; 129: 2697-2708
- Sensory dysfunction associated with repetitive strain injuries of tendonitis and focal hand dystonia: a comparative study.J Ortho Sports Phys Ther. 1996; 23: 234-244
- Sensory discrimination capabilities in patients with focal hand dystonia.Ann Neurol. 2000; 47: 377-380
- Dynamic organization of the somatosensory cortex induced by motor activity.Brain. 2001; 124: 2259-2267
- Task-specific plasticity of somatosensory cortex in patients with writer's cramp.Neuroimage. 2003; 20: 1329-1338
- Movement preparation and motor intention.Neuroimage. 2001; 14: S110-S117
- Activation of cortical and cerebellar motor areas during executed and imagined hand movements: an fMRI study.J Cogn Neurosci. 1999; 11: 491-501
- Cerebral activation patterns in patients with writer's cramp: a functional magnetic resonance imaging study.J Neurol. 2001; 248: 10-17
- Basal ganglia activity remains elevated after movement in focal hand dystonia.Ann Neurol. 2004; 55: 744-748
- Increased basal-ganglia activation performing a non-dystonia-related task in focal dystonia.Eur J Neurol. 2008; 8: 831-838
- Regional cerebral blood flow correlates of the severity of writer's cramp symptoms.Neuroimage. 2004; 21: 904-913
- Deficient activation of the motor cortical network in patients with writer's cramp.Neurology. 1999; 53: 96-105
- Abnormal cortical mechanisms of voluntary muscle relaxation in patients with writer's cramp: an fMRI study.Brain. 2002; 125: 895-903
- The pathophysiological basis of dystonias.Nat Rev Neurosci. 2008; 9: 222-234
- Do primary adult-onset focal dystonias share aetiological factors?.Brain. 2007; 130: 1183-1193
- Abnormal cortical motor excitability in dystonia.Neurology. 1996; 46: 1371-1376
- Direct demonstration of the effect of lorazepam on the excitability of the human motor cortex.Clin Neurophysiol. 2000; 111: 794-799
- Changes in the balance between motor cortical excitation and inhibition in focal, task specific dystonia.J Neurol Neurosurg Psychiatry. 1995; 59: 493-498
- Abnormalities of sensorimotor integration in focal dystonia: a transcranial magnetic stimulation study.Brain. 2001; 124: 537-545
- Impaired modulation of corticospinal excitability following subthreshold rTMS in focal hand dystonia.Hum Mov Sci. 2004; 23: 527-538
- Elevated threshold for intracortical inhibition in focal hand dystonia.Mov Disord. 2004; 19: 1312-1317
- Disturbed surround inhibition in focal hand dystonia.Ann Neurol. 2004; 56: 595-599
- Selective impairment of hand mental rotation in patients with focal hand dystonia.Brain. 2006; 129: 47-54
- Corticospinal excitability during motor imagery of a simple tonic finger movement in patients with writer's cramp.Mov Disord. 2005; 22: 1488-1495
- The learned nonuse phenomenon: implications for rehabilitation.Eura Medicophys. 2006; 42: 241-255
- Treatment effectiveness of patients with a history of repetitive strain injury and focal hand dystonia: a planned, prospective follow-up study.J Hand Ther. 2000; 13: 289-301
- Neuromagnetic fields reveal cortical plasticity when learning an auditory discrimination task.Brain Res. 1997; 764: 53-66
- Distributed auditory cortical representations are modified when non-musicians are trained at pitch discrimination with 40 Hz amplitude modulated tones.Cereb Cortex. 2004; 14: 1088-1099
- Auditory cortical plasticity in learning to discriminate modulation rate.J Neurosci. 2007; 27: 2663-2672
- Practice-related improvements in somatosensory interval discrimination are temporally specific but generalize across skin location, hemisphere, and modality.J Neurosci. 1998; 18: 1559-1570
- Precentral glioma location determines the displacement of cortical hand representation.Neurosurgery. 1998; 42: 18-26
- Pilot study of functional MRI to assess cerebral activation of motor function after poststroke hemiparesis.Stroke. 1998; 29: 112-122
- A functional MRI study of three motor tasks in the evaluation of stroke recovery.Neurorehabil Neural Repair. 2001; 15: 1-8
- Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series.Arch Phys Med Rehabil. 2003; 84: 1505-1514
- Phenotypic expression of the DYT1 mutation: a family with writer's cramp of juvenile onset.Ann Neurol. 1998; 44: 126-128
- Clinical and genetic evaluation in a French population presenting with primary focal dystonia.Mov Disord. 2005; 20: 822-825
- Three brothers with a very-late-onset writer's cramp.Mov Disord. 2005; 20: 1375-1377
- Putamen volume in idiopathic focal dystonia.Neurology. 1998; 51: 819-824
- Low striatal D2 receptor binding as assessed by [123I]IBZM SPECT in patients with writer's cramp.J Neurol Neurosurg Psychiatry. 1997; 62: 672-673
- “Motor circuit” gray matter changes in idiopathic cervical dystonia.Neurology. 2003; 61: 1228-1231
- Changes in brain anatomy in focal hand dystonia.Ann Neurol. 2004; 55: 736-739
- Bilateral gray-matter increase in the putamen in primary blepherospasm.J Neurol Neurosurg Psychiatry. 2006; 77: 1017-1020
- Impaired sequence learning in carriers of the DYT1 dystonia mutation.Ann Neurol. 2003; 54: 102-109
- Increased cerebellar activation during sequence learning in DYT1 carriers: an equiperformance study.Brain. 2008; 131: 146-154
- Microstructural white matter changes in carriers of the DYT1 gene mutation.Ann Neurol. 2004; 56: 283-286
- White matter abnormalities in dystonia normalize after botulinum toxin treatment.Neuroreport. 2006; 17: 1251-1255
- Functional magnetic resonance imaging study of writer's cramp.Chin Med J. 2006; 119: 1263-1271
- Brain cortical activation during guitar-induced hand dystonia studied by functional MRI.Neuroimage. 2000; 12: 257-267
- Combining structural and functional neuroimaging data for studying brain connectivity: a review.Psychophysiology. 2008; 45: 173-187
- Imaging structural and functional connectivity: towards a unified definition of human brain organization?.Curr Opin Neurol. 2008; 21: 393-403
JHT Read for Credit
Quiz: Article # 122
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.The article suggests that
- a.emotional disturbances are the root cause of focal hand dystonia
- b.sub clinical closed head trauma is the most common root cause of focal hand dystonia
- c.the brain is at the center of the disturbances that play into the clinical manifestation of focal hand dystonia
- d.the peripheral nervous system is the primary locus of the disturbances that play into the clinical manifestation of focal hand dystonia
- a.
- #2.A significant factor in the cause of focal hand dystonia often is overlapping sensory representations in the
- a.cortex
- b.peripheral nervous system
- c.dorsal root ganglia
- d.anterior horn cells
- a.
- #3.The information presented in this paper is derived primarily from
- a.CAT scans
- b.X-ray techniques
- c.neuroimaging techniques that will soon be able to be performed in most hand therapy clinical settings
- d.neuroimaging techniques that cannot be performed in the traditional hand therapy clinical setting
- a.
- #4.The most common drug intervention is injection of
- a.norepinephrine to weaken forearm and hand muscles
- b.epinephrine to strengthen forearm and hand muscles
- c.botulinum toxin to weaken forearm and hand muscles
- d.botulinium toxin to strengthen forearm and hand muscles
- a.
- #5.The following technique is used to indirectly measure neural activity
- a.CAT scan
- b.fMRI
- c.flouroscopy
- d.enhanced X-ray
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: February 13, 2009
Identification
Copyright
© 2009 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
