Mixed effectiveness of rTMS and retraining in the treatment of focal hand dystonia

Kimberley, Teresa Jacobson; Schmidt, Rebekah; Chen, Mo; Dykstra, Dennis D.; Buetefisch, Cathrin M.

doi:10.3389/fnhum.2015.00385

Cited by 38 publications

(55 citation statements)

References 52 publications

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“…The global rating score improved in the two study groups throughout the study with an efficacy maintained until the second follow-up period (1.5-month post inclusion) showing the benefit of repeated rTMS sessions on the duration of rTMS beneficial effect. However, this study did not demonstrate an additional benefit of sensorimotor retraining, some patients being improved while other patients remained stable or deteriorated, suggesting that the appropriate timing of both therapies remains to be determined (Kimberley et al, 2015b). …”

Section: Therapeutic Procedures In Dystoniamentioning

confidence: 72%

Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia

Lozeron

Poujois

Richard

et al. 2016

Front. Neural Circuits

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Dystonias represent a heterogeneous group of movement disorders responsible for sustained muscle contraction, abnormal postures, and muscle twists. It can affect focal or segmental body parts or be generalized. Primary dystonia is the most common form of dystonia but it can also be secondary to metabolic or structural dysfunction, the consequence of a drug’s side-effect or of genetic origin. The pathophysiology is still not elucidated. Based on lesion studies, dystonia has been regarded as a pure motor dysfunction of the basal ganglia loop. However, basal ganglia lesions do not consistently produce dystonia and lesions outside basal ganglia can lead to dystonia; mild sensory abnormalities have been reported in the dystonic limb and imaging studies have shown involvement of multiple other brain regions including the cerebellum and the cerebral motor, premotor and sensorimotor cortices. Transcranial magnetic stimulation (TMS) is a non-invasive technique of brain stimulation with a magnetic field applied over the cortex allowing investigation of cortical excitability. Hyperexcitability of contralateral motor cortex has been suggested to be the trigger of focal dystonia. High or low frequency repetitive TMS (rTMS) can induce excitatory or inhibitory lasting effects beyond the time of stimulation and protocols have been developed having either a positive or a negative effect on cortical excitability and associated with prevention of cell death, γ-aminobutyric acid (GABA) interneurons mediated inhibition and brain-derived neurotrophic factor modulation. rTMS studies as a therapeutic strategy of dystonia have been conducted to modulate the cerebral areas involved in the disease. Especially, when applied on the contralateral (pre)-motor cortex or supplementary motor area of brains of small cohorts of dystonic patients, rTMS has shown a beneficial transient clinical effect in association with restrained motor cortex excitability. TMS is currently a valuable tool to improve our understanding of the pathophysiology of dystonia but large controlled studies using sham stimulation are still necessary to delineate the place of rTMS in the therapeutic strategy of dystonia. In this review, we will focus successively on the use of TMS as a tool to better understand pathophysiology, and the use of rTMS as a therapeutic strategy.

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Section: Therapeutic Procedures In Dystoniamentioning

confidence: 72%

Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia

Lozeron

Poujois

Richard

et al. 2016

Front. Neural Circuits

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“…Yang et al (2013) stimulated the contralateral primary motor cortex at high-frequency to “more affected side” in patients with Parkinson’s disease. Kimberley et al (2015) stimulated the unaffected pre-motor cortex at low-frequency in patients with hand dystonia. One study (Lim et al, 2010) studied hemispatial neglect and stimulated the left parietal area (P5; affected side for all participants) at low-frequency.…”

Section: Literature Analysismentioning

confidence: 99%

A Framework for Combining rTMS with Behavioral Therapy

Tsagaris

Labar

Edwards

2016

Front. Syst. Neurosci.

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Upon its inception, repetitive transcranial magnetic stimulation (rTMS) was delivered at rest, without regard to the potential impact of activity occurring during or around the time of stimulation. rTMS was considered an experimental intervention imposed on the brain; therefore, the myriad features that might suppress or enhance its desired effects had not yet been explored. The field of rTMS has since grown substantially and therapeutic benefits have been reported, albeit with modest and inconsistent improvements. Work in this field accelerated following approval of a psychiatric application (depression), and it is now expanding to other applications and disciplines. In the last decade, experimental enquiry has sought new ways to improve the therapeutic benefits of rTMS, intended to enhance underlying brain reorganization and functional recovery by combining it with behavioral therapy. This concept is appealing, but poorly defined and requires clarity. We provide an overview of how combined rTMS and behavioral therapy has been delineated in the literature, highlighting the diversity of approaches. We outline a framework for study design and reporting such that the effects of this emerging method can be better understood.

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“…Studies in this category tested some modality of motor training paired with neuromodulation methods ( n = 5), such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), or intermittent theta burst stimulation (iTBS) . Stimulation sites tested included the premotor cortex, primary motor cortex, and the cerebellum …”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Rehabilitation in Focal Dystonias: Classification and Recommendations

Prudente

Zetterberg

Bring

et al. 2018

Movement Disord Clin Pract

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BackgroundRehabilitation interventions are rarely utilized as an alternative or adjunct therapy for focal dystonias. Reasons for limited utilization are unknown, but lack of conclusive evidence of effectiveness is likely a crucial factor.Methods and FindingsThe purpose of this systematic review was to determine the level of evidence for rehabilitation interventions in focal dystonias. Rehabilitation interventions were classified based upon the underlying theoretical basis of different approaches, and the strength of evidence for each category was evaluated to identify gaps in the field. Prospective studies using rehabilitation methods in cervical, hand, and foot dystonia were reviewed. The key elements of treatments tested were identified and studies were grouped into six categories based on the theoretical basis of the intervention: (1) movement practice, (2) training with constraint, (3) sensory reorganization, (4) normalization of muscle activity with external techniques, (5) neuromodulation with training, and (6) compensatory strategies. Quality of the body of evidence ranged from very low‐to‐low according to the grades of recommendation, assessment, development, and evaluation (GRADE). Despite inconclusive evidence for these rehabilitation approaches, data suggest that intensive movement practice and neuromodulation combined with motor training should be further explored.ConclusionsThis systematic review presents a novel approach to classify studies of rehabilitation in focal dystonias based on the theoretical basis of intervention. The proposed classification system will move toward a unified theoretical understanding of rehabilitation interventions in dystonia. Moreover, it will help provide recommendations for clinical applications and future investigations.

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Mixed effectiveness of rTMS and retraining in the treatment of focal hand dystonia

Cited by 38 publications

References 52 publications

Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia

Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia

A Framework for Combining rTMS with Behavioral Therapy

Systematic Review of Rehabilitation in Focal Dystonias: Classification and Recommendations

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