Reversible reorganisation of the motor cortical representation of the hand in cervical dystonia

Thickbroom, Gary; Byrnes, Michelle; Stell, Rick; Mastaglia, Frank

doi:10.1002/mds.10383

Cited by 82 publications

(61 citation statements)

References 43 publications

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“…This study suggested that changes in the primary motor cortex of dystonic patients might be secondary to abnormal afferent inputs that injected BoNT-A may transiently modulate. A reversible reorganization of the hand motor cortical representation after BoNT-A injections was demonstrated by the same group also in patients with cervical dystonia (Thickbroom et al, 2003) and primary writing tremor (Byrnes et al, 2005).…”

Section: Effects Of Bont-a On Cortical Mechanismsmentioning

confidence: 95%

Neurophysiological effects of botulinum toxin type a

Abbruzzese

Berardelli

2006

neurotox res

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Botulinum toxin type A (BoNT-A) acts peripherally by inhibiting acetylcholine release from the presynaptic neuromuscular terminals, thus weakening muscle contraction, and its clinical benefit depends primarily on the toxin's peripheral action. In addition to acting directly at the neuromuscular junction, the toxin alters sensory inputs to the central nervous system, thus indirectly inducing secondary central changes. Some of the long-term clinical benefits of BoNT-A treatment may also reflect plastic changes in motor output after the reorganization of synaptic density.

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Section: Effects Of Bont-a On Cortical Mechanismsmentioning

confidence: 95%

Neurophysiological effects of botulinum toxin type a

Abbruzzese

Berardelli

2006

neurotox res

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“…BTX has been hypothesized to exert additional therapeutic effects by indirectly altering motor afferent feedback to the brain and thereby altering brain activity [7,8]. Empirical evidence for this has been shown in a study in which cortical (gray matter) functional mapping abnormalities known to exist in focal dystonias [9,10] reversed during BTX treatment [11]. In the present study, we sought to determine whether BTX exerts beneficial effects in subcortical motor circuitry, and whether such effects manifest in the white matter of this circuitry.…”

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confidence: 99%

White matter abnormalities in dystonia normalize after botulinum toxin treatment

Blood

Tuch²,

Makris³

et al. 2006

NeuroReport

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The pathophysiology of dystonia is still poorly understood. We used diffusion tensor imaging to screen for white matter abnormalities in regions between the basal ganglia and the thalamus in cervical and hand dystonia patients. All patients exhibited an abnormal hemispheric asymmetry in a focal region between the pallidum and the thalamus. This asymmetry was absent 4 weeks after the same patients were treated with intramuscular botulinum toxin injections. These findings represent a new systems-level abnormality in dystonia, which may lead to new insights about the pathophysiology of movement disorders. More generally, these findings demonstrate central nervous system changes following peripheral reductions in muscle activity. This raises the possibility that we have observed activity-dependent white matter plasticity in the adult human brain.

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“…Accordingly, DTI studies have shown normalization of white-matter abnormalities after botulinum toxin treatment in some dystonia patients, 67 and in TMS studies in cervical dystonia patients treated with botulinum toxin, abnormalities in hand motor cortex were reversed. 68 …”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Advances in Our Understanding of Dystonia—Pathophysiology and Treatment Options

Lubarr¹,

Bressman²

2010

US Neurology

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Although the pathophysiology of dystonia remains incompletely understood, advances in two major areas of research over the past two decades have led to important insights into the mechanisms of dystonia. First, with the identification of dystonia genes, investigations using cellular and animal models of dystonia have become possible. Second, advances in functional neuroimaging have led to the possibility of identification of distinct functional, anatomic, and neurochemical abnormalities in dystonia patients. Dystonia is currently conceptualized as a neurofunctional disorder characterized by alterations at various levels and multiple points along the sensorimotor circuit. There are multiple causes of these disruptions, and lesions along different points in interconnected pathways can yield similar motor dysfunction. The existence of dystonia endophenotypes in genetic forms of dystonia suggests that it may be a ‘second hit’ disorder, in which genetically predisposed brains can be thrown into an unbalanced dystonic state by environmental or genetic factors. Ultimately, a more complete understanding of the pathophysiology of dystonia should lead to better, more rational, targeted therapies.

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Reversible reorganisation of the motor cortical representation of the hand in cervical dystonia

Cited by 82 publications

References 43 publications

Neurophysiological effects of botulinum toxin type a

Neurophysiological effects of botulinum toxin type a

White matter abnormalities in dystonia normalize after botulinum toxin treatment

Advances in Our Understanding of Dystonia—Pathophysiology and Treatment Options

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