Diagnosis of Primary Task-Specific Lower Extremity Dystonia in a Runner

McClinton, Shane; Heiderscheit, Bryan C.

doi:10.2519/jospt.2012.3892

Cited by 14 publications

(21 citation statements)

References 39 publications

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“…Motor tricks are defined as those sensory tricks involving voluntary movement as the apparent critical feature. [5] The distinction between motor and sensory may be academic given the critical interrelationship of motor and sensory function including sensory feedback from any movement. [6] Originally, according to Meige and Feindel “the mere threat of the gesture suffices…before the patient has actually touched his face…”.…”

Section: Introductionmentioning

confidence: 99%

Tricks in dystonia: ordering the complexity

Ramos

Karp

Hallett

2014

Journal of Neurology, Neurosurgery & Psychiatry

101

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Sensory tricks are various maneuvers that can ameliorate dystonia. Common characteristics are well known, but their variety is wide, sensory stimulation is not necessarily the critical feature, and their physiology is unknown. To enumerate the various forms of sensory tricks and describe their nature, research findings and theories that may elucidate their neurophysiologic mechanism, we reviewed the literature pertaining to sensory tricks, including variants like motor tricks, imaginary tricks, forcible tricks and reverse sensory tricks. On the basis of this information, we propose a new classification of sensory tricks to include its variants. We highlight neurophysiologic evidence suggesting that sensory tricks work by decreasing abnormal facilitation. We tie this with established dystonia pathogenesis and postulate that sensory tricks decrease abnormally increased facilitation-to-inhibition ratios in the dystonic brain. It appears worthwhile for patients to search for possible sensory tricks.

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Section: Introductionmentioning

confidence: 99%

Tricks in dystonia: ordering the complexity

Ramos

Karp

Hallett

2014

Journal of Neurology, Neurosurgery & Psychiatry

101

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show abstract

“…At first, they often attribute their symptoms to overuse, a change in shoes or a different running surface. They may also suspect “foot drop,” an injury (muscle strain/sprain), or other musculoskeletal complaint (48). Commonly reported symptoms in RD include a limp when running, dragging of the foot or leg, inversion of the foot, scuffing of the toe, clipping an ankle with the opposite foot, trunk tilt, and/or pain.…”

Section: Clinical Featuresmentioning

confidence: 99%

Research Priorities in Limb and Task-Specific Dystonias

et al. 2017

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Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.

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“…In patients presenting with foot dystonia one should always consider dopamine-responsive dystonia; fluctuations across the day are a suggestive supporting feature (improvement with sleep, and worsening over the day). Primary, focal dystonia of the foot does exist (but is rare) and can be task-specific, as in professional dancers7 or long-distance runners 8. However, dystonia of the foot after age 30 years is more suggestive of an underlying cause, such as a structural lesion or neurodegenerative disease.…”

Section: Abnormal Postures Of Hands and Feetmentioning

confidence: 99%

The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa)

et al. 2016

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The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of 'looking through the wrong end of the telescope' in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.

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Diagnosis of Primary Task-Specific Lower Extremity Dystonia in a Runner

Cited by 14 publications

References 39 publications

Tricks in dystonia: ordering the complexity

Tricks in dystonia: ordering the complexity

Research Priorities in Limb and Task-Specific Dystonias

The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa)

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