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Mark Hallett - One of the best experts on this subject based on the ideXlab platform.
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Loss of inhibition in sensorimotor networks in Focal Hand Dystonia
Neuroimage-Clinical, 2018Co-Authors: Cecile Gallea, Silvina G. Horovitz, Valerie Voon, Priyantha Herath, Alicja Lerner, John Ostuni, Ziad Saad, Shantalaxmi Thada, Solomon Jeffrey, Mark HallettAbstract:Objective: To investigate GABA-ergic receptor density and associated brain functional and grey matter changes in Focal Hand Dystonia (FHD). Methods: 18 patients with FHD of the right Hand and 18 age and gender matched healthy volunteers (HV) participated in this study. We measured the density of GABA-A receptors using [11C] Flumazenil and perfusion using [15O] H2O. Anatomical images were also used to measure grey matter volume with voxel-based morphometry (VBM). Results: In FHD patients compared to HV, the vermis VI of the right cerebellum and the left sensorimotor cortex had a decrease of Flumazenil binding potential (FMZ-BP), whereas the striatum and the lateral cerebellum did not show significant change. Bilateral inferior prefrontal cortex had increased FMZ-BP and an increase of perfusion, which correlated negatively with disease duration. Only the left sensorimotor cortex showed a decrease of grey matter volume. Interpretation: Impairments of GABAergic neurotransmission in the cerebellum and the sensorimotor cortical areas could explain different aspects of loss of inhibitory control in FHD, the former being involved in maladaptive plasticity, the latter in surround inhibition. Reorganization of the inferior prefrontal cortices, part of the associative network, might be compensatory for the loss of inhibitory control in sensorimotor circuits. These findings suggest that cerebellar and cerebral GABAergic abnormalities could play a role in the functional imbalance of striato-cerebello-cortical loops in Dystonia.
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A JOURNAL OF NEUROLOGY Disordered plasticity in the primary somatosensory cortex in Focal Hand Dystonia
2016Co-Authors: Ryusuke Kakigi, Mark Hallett, Human Motor, Control Section, Medical Neurology BranchAbstract:Interventional paired associative stimulation (PAS) can induce plasticity in the cortex, and this plasticity was previously shown to be disordered in the primary motor cortex in Focal Hand Dystonia (FHD). This study aimed to test whether associative plasticity is abnormal in the primary somatosensory cortex (S1) in FHD and whether PAS modulates excitatory or inhibitory interneurons within the cortex. Ten FHD patients and 10 healthy volunteers were studied. We investigated the changes in single- and double-pulse somatosensory-evoked potentials before and after PAS, which consisted of peripheral electrical nerve stimulation and subsequent transcranial magnetic stimulation over S1. Four sessions of somatosensory-evoked potentials recordings were performed: before PAS, and immediately, 15 and 30min after PAS. We compared the time course of the somatosensory-evoked potentials between the FHD and healthy groups. In the single-pulse condition, the P27 amplitudes were significantly higher in FHD immediately after PAS than before PAS, while no changes were observed in healthy subjects. In the double-pulse condition, significant differences in the suppression ratio of P27 were found immediately after and 15min after PAS, while there were no significant differences in healthy subjects. The P27 suppression tended to normalize toward the level of the healthy volunteer group. In FHD, PAS transiently induced an abnormal increase in excitability in S1
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Non-Invasive Brain Stimulation for Treatment of Focal Hand Dystonia: Update and Future Direction.
Journal of movement disorders, 2016Co-Authors: Hyun Joo Cho, Mark HallettAbstract:Focal Hand Dystonia (FHD) is characterized by excessive and unwanted muscle activation in both the Hand and arm resulting in impaired performance in particular tasks. Understanding the pathophysiology of FHD has progressed significantly for several decades and this has led to consideration of other potential therapies such as non-invasive brain stimulation (NIBS). A number of studies have been conducted to develop new therapy for FHD using transcranial magnetic stimulation and transcranial direct current stimulation. In this paper, we review previous studies and describe the potential therapeutic use of NIBS for FHD. We also discuss the future direction of NIBS to treat FHD.
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Individuated finger control in Focal Hand Dystonia: An fMRI study
NeuroImage, 2012Co-Authors: Ryan D. Moore, Cecile Gallea, Silvina G. Horovitz, Mark HallettAbstract:Objectives To better understand deficient selective motor control in Focal Hand Dystonia by determining changes in striatal activation and connectivity in patients performing individuated finger control.
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Abnormal reorganization of functional cortical small-world networks in Focal Hand Dystonia.
PloS one, 2011Co-Authors: Seung-hyun Jin, Peter Lin, Mark HallettAbstract:We investigated the large-scale functional cortical connectivity network in Focal Hand Dystonia (FHD) patients using graph theoretic measures to assess efficiency. High-resolution EEGs were recorded in 15 FHD patients and 15 healthy volunteers at rest and during a simple sequential finger tapping task. Mutual information (MI) values of wavelet coefficients were estimated to create an association matrix between EEG electrodes, and to produce a series of adjacency matrices or graphs, G, by thresholding with network cost. Efficiency measures of small-world networks were assessed. As a result, we found that FHD patients have economical small-world properties in their brain functional networks in the alpha and beta bands. During a motor task, in the beta band network, FHD patients have decreased efficiency of small-world networks, whereas healthy volunteers increase efficiency. Reduced efficient beta band network in FHD patients during the task was consistently observed in global efficiency, cost-efficiency, and maximum cost-efficiency. This suggests that the beta band functional cortical network of FHD patients is reorganized even during a task that does not induce dystonic symptoms, representing a loss of long-range communication and abnormal functional integration in large-scale brain functional cortical networks. Moreover, negative correlations between efficiency measures and duration of disease were found, indicating that the longer duration of disease, the less efficient the beta band network in FHD patients. In regional efficiency analysis, FHD patients at rest have high regional efficiency at supplementary motor cortex (SMA) compared with healthy volunteers; however, it is diminished during the motor task, possibly reflecting abnormal inhibition in FHD patients. The present study provides the first evidence with graph theory for abnormal reconfiguration of brain functional networks in FHD during motor task.
Nancy N. Byl - One of the best experts on this subject based on the ideXlab platform.
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aberrant oscillatory activity during simple movement in task specific Focal Hand Dystonia
Frontiers in Neurology, 2012Co-Authors: Leighton B Hinkley, Nancy N. Byl, Rebecca Dolberg, Susanne M Honma, Anne M Findlay, Srikantan S NagarajanAbstract:In task-specific Focal Hand Dystonia (tspFHD), the temporal dynamics of cortical activity in the motor system and how these processes are related to impairments in sensory and motor function are poorly understood. Here, we use time-frequency reconstructions of magnetoencephalographic (MEG) data to elaborate the temporal and spatial characteristics of cortical activity during movement. A self-paced finger tapping task during MEG recording was performed by 11 patients with tspFHD and 11 matched healthy controls. In both groups robust changes in beta (12-30Hz) and high-gamma (65-90Hz) oscillatory activity were identified over sensory and motor cortices during button press. A significant decrease (p<0.05, 1% False Discovery Rate (FDR) corrected) in high-gamma power during movements of the affected Hand was identified over ipsilateral sensorimotor cortex in the period prior to (-575ms) and following (725ms) button press. Furthermore, an increase (p<0.05, 1% FDR corrected) in beta power suppression following movement of the affected Hand was identified over visual cortex in patients with tspFHD. For movements of the unaffected Hand, a significant (p<0.05, 1% FDR corrected) increase in beta power suppression was identified over secondary somatosensory cortex (S2) in the period following button press in patients with tspFHD. Oscillatory activity within in the tspFHD group was however not correlated with clinical measures. Understanding these aberrant oscillatory dynamics can provide the groundwork for interventions that focus on modulating the timing of this activity.
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Aberrant Oscillatory Activity during Simple Movement in Task-Specific Focal Hand Dystonia.
Frontiers in neurology, 2012Co-Authors: Leighton B Hinkley, Nancy N. Byl, Rebecca Dolberg, Susanne M Honma, Anne M Findlay, Srikantan S NagarajanAbstract:In task-specific Focal Hand Dystonia (tspFHD), the temporal dynamics of cortical activity in the motor system and how these processes are related to impairments in sensory and motor function are poorly understood. Here, we use time-frequency reconstructions of magnetoencephalographic (MEG) data to elaborate the temporal and spatial characteristics of cortical activity during movement. A self-paced finger tapping task during MEG recording was performed by 11 patients with tspFHD and 11 matched healthy controls. In both groups robust changes in beta (12-30Hz) and high-gamma (65-90Hz) oscillatory activity were identified over sensory and motor cortices during button press. A significant decrease (p
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Diagnosis and management of Focal Hand Dystonia in a rheumatology practice.
Current opinion in rheumatology, 2012Co-Authors: Nancy N. BylAbstract:PURPOSE OF REVIEW This article reviews current evidence on etiology, diagnosis and clinical management of patients with a challenging movement disorder referred to as Focal Hand Dystonia (FHd). RECENT FINDINGS Patients who present to a rhematologist with a history of repetitive overuse, weakness, pain and involuntary, end-range posturing of the digits when performing a target task may have FHd. The etiology is considered idiopathic and multifactorial. There are no specific laboratory or clinical tests to 'rule in' or 'rule out' the diagnosis. Comparative neuroimaging studies report inadequate inhibition and aberrant sensory and motor processing in patients with FHd. This movement disorder can be recalcitrant to recovery. Current research evidence supports the benefit of quieting muscle contractions with botulinum toxin injections, modifying ergonomics, performance biomechanics, lifestyle, stress, health, personality and practice behaviors and simultaneously beginning a progressive brain-retraining program. SUMMARY Rheumatologist can facilitate effective management of patients with FHd by making an early, accurate diagnosis, providing patient education about the etiology and risk factors associated with the disorder, managing medications and identifying a team to oversee learning-based sensory and motor retraining.
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amplitude and timing of somatosensory cortex activity in task specific Focal Hand Dystonia
Clinical Neurophysiology, 2011Co-Authors: Rebecca Dolberg, Nancy N. Byl, Leighton B Hinkley, Susanne M Honma, Zhao Zhu, Anne M Findlay, Srikantan S NagarajanAbstract:Objective Task-specific Focal Hand Dystonia (tspFHD) is a movement disorder diagnosed in individuals performing repetitive Hand behaviors. The extent to which processing anomalies in primary sensory cortex extend to other regions or across the two hemispheres is presently unclear.
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Focal Hand Dystonia: effectiveness of a home program of fitness and learning-based sensorimotor and memory training.
Journal of hand therapy : official journal of the American Society of Hand Therapists, 2009Co-Authors: Nancy N. Byl, Eve Serena Archer, Alison MckenzieAbstract:Abstract Study Design This was a pre post test design. Introduction Retraining the brain is one approach to remediate movement dysfunction resulting from task specific Focal Hand Dystonia (FHD TSP ). Purpose Document change in task specific performance (TSP) for patients with FHD TSP after 8 weeks of comprehensive home training (fitness activities, task practice, learning based memory and sensorimotor training). Methods Thirteen subjects were admitted and evaluated at baseline, immediately and 6 months post treatment for task specific performance, functional independence, sensory discrimination, fine motor speed and strength. In Phase I, 10 subjects were randomly assigned to home training alone or supervised practice prior to initiating the home training. In phase II, 2 subjects crossed over and 3 new subjects were added (18 Hands). The intent to treat model was followed. Outcomes were summarized by median, effect size, and proportion improving with nonparametric analysis for significance. Results Immediately post-intervention, TSP, sensory discrimination, and fine motor speed improved 60-80% (p Conclusions Progressive task practice plus learning based memory and sensorimotor training can improve TSP in patients with FHD TSP . Compliance with home training is enhanced when initiated with supervised practice. Level of Evidence 4.
Srikantan S Nagarajan - One of the best experts on this subject based on the ideXlab platform.
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aberrant oscillatory activity during simple movement in task specific Focal Hand Dystonia
Frontiers in Neurology, 2012Co-Authors: Leighton B Hinkley, Nancy N. Byl, Rebecca Dolberg, Susanne M Honma, Anne M Findlay, Srikantan S NagarajanAbstract:In task-specific Focal Hand Dystonia (tspFHD), the temporal dynamics of cortical activity in the motor system and how these processes are related to impairments in sensory and motor function are poorly understood. Here, we use time-frequency reconstructions of magnetoencephalographic (MEG) data to elaborate the temporal and spatial characteristics of cortical activity during movement. A self-paced finger tapping task during MEG recording was performed by 11 patients with tspFHD and 11 matched healthy controls. In both groups robust changes in beta (12-30Hz) and high-gamma (65-90Hz) oscillatory activity were identified over sensory and motor cortices during button press. A significant decrease (p<0.05, 1% False Discovery Rate (FDR) corrected) in high-gamma power during movements of the affected Hand was identified over ipsilateral sensorimotor cortex in the period prior to (-575ms) and following (725ms) button press. Furthermore, an increase (p<0.05, 1% FDR corrected) in beta power suppression following movement of the affected Hand was identified over visual cortex in patients with tspFHD. For movements of the unaffected Hand, a significant (p<0.05, 1% FDR corrected) increase in beta power suppression was identified over secondary somatosensory cortex (S2) in the period following button press in patients with tspFHD. Oscillatory activity within in the tspFHD group was however not correlated with clinical measures. Understanding these aberrant oscillatory dynamics can provide the groundwork for interventions that focus on modulating the timing of this activity.
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Aberrant Oscillatory Activity during Simple Movement in Task-Specific Focal Hand Dystonia.
Frontiers in neurology, 2012Co-Authors: Leighton B Hinkley, Nancy N. Byl, Rebecca Dolberg, Susanne M Honma, Anne M Findlay, Srikantan S NagarajanAbstract:In task-specific Focal Hand Dystonia (tspFHD), the temporal dynamics of cortical activity in the motor system and how these processes are related to impairments in sensory and motor function are poorly understood. Here, we use time-frequency reconstructions of magnetoencephalographic (MEG) data to elaborate the temporal and spatial characteristics of cortical activity during movement. A self-paced finger tapping task during MEG recording was performed by 11 patients with tspFHD and 11 matched healthy controls. In both groups robust changes in beta (12-30Hz) and high-gamma (65-90Hz) oscillatory activity were identified over sensory and motor cortices during button press. A significant decrease (p
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amplitude and timing of somatosensory cortex activity in task specific Focal Hand Dystonia
Clinical Neurophysiology, 2011Co-Authors: Rebecca Dolberg, Nancy N. Byl, Leighton B Hinkley, Susanne M Honma, Zhao Zhu, Anne M Findlay, Srikantan S NagarajanAbstract:Objective Task-specific Focal Hand Dystonia (tspFHD) is a movement disorder diagnosed in individuals performing repetitive Hand behaviors. The extent to which processing anomalies in primary sensory cortex extend to other regions or across the two hemispheres is presently unclear.
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Neuroimaging characteristics of patients with Focal Hand Dystonia.
Journal of hand therapy : official journal of the American Society of Hand Therapists, 2009Co-Authors: Leighton B Hinkley, Nancy N. Byl, Rebecca L. Webster, Srikantan S NagarajanAbstract: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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Somatosensory representation of the digits and clinical performance in patients with Focal Hand Dystonia.
American journal of physical medicine & rehabilitation, 2003Co-Authors: Alison Mckenzie, Srikantan S Nagarajan, Timothy P.l. Roberts, Michael M. Merzenich, Nancy N. BylAbstract:ABSTRACTMcKenzie AL, Nagarajan SS, Roberts TPL, Merzenich MM, Byl NN: Somatosensory representation of the digits and clinical performance in patients with Focal Hand Dystonia. Am J Phys Med Rehabil 2003;82:737–749.ObjectiveThe purpose of this study was to incorporate magnetoencephalography and clini
Teresa Jacobson Kimberley - One of the best experts on this subject based on the ideXlab platform.
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Mixed effectiveness of rTMS and retraining in the treatment of Focal Hand Dystonia
Frontiers in human neuroscience, 2015Co-Authors: Teresa Jacobson Kimberley, Rebekah Schmidt, Dennis D. Dykstra, Mo Chen, Cathrin M. BuetefischAbstract: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 a sensorimotor intervention combining 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. 5 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 consisted of rTMS followed immediately by 30 minutes of the therapy intervention (SMR or CTL). Group analyses revealed no additional benefit from the SMR training vs CTL, which was contrary to our hypothesis. When analyzed across group however, there was significant improvement from first baseline 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 optimized a secondary intervention and determine likely responders vs. non-responders.
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Focal Hand Dystonia individualized intervention with repeated application of repetitive transcranial magnetic stimulation
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Teresa Jacobson Kimberley, Rebekah Schmidt, Michael R. Borich, James R Carey, Bernadette T GillickAbstract:Abstract Objectives To examine for individual factors that may predict response to inhibitory repetitive transcranial magnetic stimulation (rTMS) in Focal Hand Dystonia (FHD); to present the method for determining optimal stimulation to increase inhibition in a given patient; and to examine individual responses to prolonged intervention. Design Single-subject design to determine optimal parameters to increase inhibition for a given subject and to use the selected parameters once per week for 6 weeks, with 1-week follow-up, to determine response. Setting Clinical research laboratory. Participants A volunteer sample of subjects with FHD (N=2). One participant had transcranial magnetic stimulation responses indicating impaired inhibition, and the other had responses within normative limits. Interventions There were 1200 pulses of 1-Hz rTMS delivered using 4 different stimulation sites/intensity combinations: primary motor cortex at 90% or 110% of resting motor threshold (RMT) and dorsal premotor cortex (PMd) at 90% or 110% of RMT. The parameters producing the greatest within-session increase in cortical silent period (CSP) duration were then used as the intervention. Main Outcome Measures Response variables included Handwriting pressure and velocity, subjective symptom rating, CSP, and short latency intracortical inhibition and facilitation. Results The individual with baseline transcranial magnetic stimulation responses indicating impaired inhibition responded favorably to the repeated intervention, with reduced Handwriting force, an increase in the CSP, and subjective report of moderate symptom improvement at 1-week follow-up. The individual with normative baseline responses failed to respond to the intervention. In both subjects, 90% of RMT to the PMd produced the greatest lengthening of the CSP and was used as the intervention. Conclusions An individualized understanding of neurophysiological measures can be an indicator of responsiveness to inhibitory rTMS in Focal Dystonia, with further work needed to determine likely responders versus nonresponders.
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establishing the definition and inter rater reliability of cortical silent period calculation in subjects with Focal Hand Dystonia and healthy controls
Neuroscience Letters, 2009Co-Authors: Teresa Jacobson Kimberley, Michael R. Borich, Kristina D Prochaska, Shannon L Mundfrom, Ariel E Perkins, Joseph M PoeppingAbstract:Abstract The purpose of this paper is to describe a clearly defined manual method for calculating cortical silent period (CSP) length that can be employed successfully and reliably by raters after minimal training in subjects with Focal Hand Dystonia (FHD) and healthy subjects. A secondary purpose was to explore intra-subject variability of the CSP in subjects with FHD vs. healthy subjects. Two raters previously naive to CSP identification and one experienced rater independently analyzed 170 CSP measurements collected in 6 subjects with Focal Hand Dystonia (FHD) and 9 healthy subjects. Intraclass correlation coefficient (ICC) was calculated to quantify inter-rater reliability within the two groups of subjects. The relative variability of CSP in each group was calculated by the coefficient of variation (CV). Relative variation between raters within repeated measures of individual subjects was also quantified by CV. Reliability measures were as follows—mean of three raters: all subjects: ICC = 0.976; within healthy subjects: ICC = 0.965; in subjects with FHD: ICC = 0.956. The median within-subject variability for the healthy group was CV = 7.33% and in subjects with FHD:CV = 11.78%. The median variability of calculating individual subject CSP duration between raters was CV = 10.23% in subjects with Dystonia and CV = 10.46% in healthy subjects. Manual calculation of CSP results in excellent reliability between raters of varied levels of experience. Healthy subjects display less variability in CSP. Despite greater variability, the CSP in impaired subjects can be reliably calculated across raters.
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Lasting effects of repeated rTMS application in Focal Hand Dystonia.
Restorative neurology and neuroscience, 2009Co-Authors: Michael R. Borich, Sanjeev Arora, Teresa Jacobson KimberleyAbstract:Purpose: Focal Hand Dystonia (FHD) is a rare but potentially devastating disorder involving involuntary muscle spasms and abnormal posturing that impairs functional Hand use. Increased cortical excitability and lack of inhibitory mechanisms have been associated with these symptoms. This study investigated the short- and long-term effects of repeated administrations of repetitive-transcranial magnetic stimulation (rTMS) on cortical excitability and Handwriting performance. Methods: Six subjects with FHD and nine healthy controls were studied. All subjects with FHD received rTMS (1Hz) to the premotor cortex (PMC) for five consecutive days; of those, three subjects received five days of sham rTMS completed ten days prior to real treatment. Healthy subjects received one real rTMS session. Cortical silent period (CSP) and measures of Handwriting performance were compared before and after treatment and at ten-day post-treatment follow-up. Results: At baseline, significant differences in CSP and pen pressure were observed between subjects with FHD and healthy controls. Differences in CSP and pen velocity between subjects in real and sham rTMS groups were observed across treatment sessions and maintained at follow-up. Conclusions: After five days of rTMS to PMC, reduced cortical excitability and improved Handwriting performance were observed and maintained at least ten days following treatment in subjects with FHD. These preliminary results support further investigation of the therapeutic potential of rTMS in FHD.
Satoshi Goto - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Lesioning of the Thalamic Vo Nucleus for the Treatment of Writer's Cramp (Focal Hand Dystonia)
Frontiers in Neurology, 2018Co-Authors: Takeshi Shimizu, Tomoyuki Maruo, Shimpei Miura, Haruhiko Kishima, Yukitaka Ushio, Satoshi GotoAbstract: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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THALAMIC VO-COMPLEX VS PALLIDAL DEEP BRAIN STIMULATION FOR Focal Hand Dystonia
Neurology, 2008Co-Authors: Satoshi Goto, Hideki Shimazu, Kazuhito Matsuzaki, T. Tamura, Nagako Murase, Shinji Nagahiro, Ryuji KajiAbstract:Focal Hand Dystonia (FHD) is a primary Dystonia produced by the excessive co-contraction of antagonistic muscles of the Hand and forearm.1,2 Although deep brain stimulation (DBS) is now recognized as a beneficial option to treat a wide spectrum of Dystonias,3 little is known regarding its effects on FHD. This is a report of DBS of the thalamic Vo-complex nucleus or the globus pallidus internus (GPi) effecting the complete, sustained relief of medically intractable FHD. The term Vo-complex refers to the combination of the ventralis oralis anterior nucleus (Voa) and ventralis oralis posterior nucleus (Vop) of the thalamus. ### Case report. A 34-year-old right-Handed man without a notable medical history experienced gradual onset of writer's cramp of the right Hand beginning at age 31. At age 32 he also noted progressively worsening stiffness of the fingers and wrist of his left Hand. As the Focal injection of botulinum toxin and sequential pharmacologic trials that included clonazepam, baclofen, and etizolam produced unsatisfactory results, they were discontinued. On admission, his physical and mental condition was normal. Brain MRI and laboratory studies revealed no abnormal findings. The causes of secondary Dystonia were excluded as far as possible. There were no neurologic abnormalities except for …
