Restoration of motor inhibition through an abnormal premotor-motor connection in dystonia
Identifieur interne : 002B18 ( Ncbi/Checkpoint ); précédent : 002B17; suivant : 002B19Restoration of motor inhibition through an abnormal premotor-motor connection in dystonia
Auteurs : Ying-Zu Huang [Taïwan] ; John C. Rothwell [Royaume-Uni] ; Chin-Song Lu [Taïwan] ; Jiunjie Wang [Taïwan] ; Rou-Shayn Chen [Taïwan]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2010.
English descriptors
- KwdEn :
- Adult, Analysis of Variance, Biophysics, Dystonia (genetics), Dystonia (pathology), Dystonia (therapy), Dystonic Disorders (pathology), Dystonic Disorders (therapy), Electric Stimulation (methods), Electromyography (methods), Evoked Potentials, Motor (physiology), Female, Hand (innervation), Humans, Male, Middle Aged, Molecular Chaperones (genetics), Motor Cortex (physiopathology), Neural Inhibition (physiology), Transcranial Magnetic Stimulation, Treatment Outcome, Writing.
- MESH :
- chemical , genetics : Molecular Chaperones.
- genetics : Dystonia.
- innervation : Hand.
- methods : Electric Stimulation, Electromyography.
- pathology : Dystonia, Dystonic Disorders.
- physiology : Evoked Potentials, Motor, Neural Inhibition.
- physiopathology : Motor Cortex.
- therapy : Dystonia, Dystonic Disorders.
- Adult, Analysis of Variance, Biophysics, Female, Humans, Male, Middle Aged, Transcranial Magnetic Stimulation, Treatment Outcome, Writing.
Abstract
To clarify the rationale for using rTMS of dorsal premotor cortex (PMd) to treat dystonia, we examined how the motor system reacts to an inhibitory form of rTMS applied to the PMd in healthy subjects and in a group of patients with focal hand dystonia and DYT1 gene carriers. Continuous theta burst transcranial magnetic stimulation (cTBS) with 300 and 600 pulses (cTBS300 and cTBS600) was applied to PMd and its after-effects were quantified by measuring the amplitude of MEPs evoked by single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1), short interval intracortical inhibition/facilitation (SICI/ICF) within M1, the third phase of spinal reciprocal inhibition (RI) and writing tests. In addition, in DYT1 gene carriers, the effects of cTBS300 over M1 and PMd on MEPs were studied in separate experiments. In healthy subjects cTBS300 and cTBS600 over PMd suppressed MEPs for 30min or more and cTBS600 decreased SICI and RI. In contrast, neither form of cTBS over PMd had any significant effect on MEPs, while cTBS600 increased effectiveness of SICI and RI and improved writing in patients with writer's cramp. NMDYT1 had a normal response to cTBS300 over left PMd. We suggest that the reduced PMd to M1 interaction in dystonic patients is likely to be due to reduced excitability of PMd-M1 connections. The possible therapeutic effects of premotor rTMS may therefore involve indirect effects of PMd on SICI and RI, which this study has shown can be normalised by cTBS.
Url:
DOI: 10.1002/mds.22814
PubMed: 20309999
PubMed Central: 3000921
Affiliations:
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<affiliation wicri:level="1"><nlm:aff id="A1"> Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan</nlm:aff>
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<term>Dystonia (pathology)</term>
<term>Dystonia (therapy)</term>
<term>Dystonic Disorders (pathology)</term>
<term>Dystonic Disorders (therapy)</term>
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<term>Middle Aged</term>
<term>Molecular Chaperones (genetics)</term>
<term>Motor Cortex (physiopathology)</term>
<term>Neural Inhibition (physiology)</term>
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<front><div type="abstract" xml:lang="en"><p id="P1">To clarify the rationale for using rTMS of dorsal premotor cortex (PMd) to treat dystonia, we examined how the motor system reacts to an inhibitory form of rTMS applied to the PMd in healthy subjects and in a group of patients with focal hand dystonia and DYT1 gene carriers. Continuous theta burst transcranial magnetic stimulation (cTBS) with 300 and 600 pulses (cTBS300 and cTBS600) was applied to PMd and its after-effects were quantified by measuring the amplitude of MEPs evoked by single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1), short interval intracortical inhibition/facilitation (SICI/ICF) within M1, the third phase of spinal reciprocal inhibition (RI) and writing tests. In addition, in DYT1 gene carriers, the effects of cTBS300 over M1 and PMd on MEPs were studied in separate experiments. In healthy subjects cTBS300 and cTBS600 over PMd suppressed MEPs for 30min or more and cTBS600 decreased SICI and RI. In contrast, neither form of cTBS over PMd had any significant effect on MEPs, while cTBS600 increased effectiveness of SICI and RI and improved writing in patients with writer's cramp. NMDYT1 had a normal response to cTBS300 over left PMd. We suggest that the reduced PMd to M1 interaction in dystonic patients is likely to be due to reduced excitability of PMd-M1 connections. The possible therapeutic effects of premotor rTMS may therefore involve indirect effects of PMd on SICI and RI, which this study has shown can be normalised by cTBS.</p>
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