Evidence of rehabilitation therapy in task-specific focal dystonia: a systematic review

Hautekiet, Arne; Raes, Katrien; Geers, S.; Santens, Patrick; Oostra, Kristine

doi:10.23736/s1973-9087.21.06677-6

Cited by 5 publications

(10 citation statements)

References 38 publications

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“…Because abnormal sensorimotor reorganization for specific movements has been postulated as a pathophysiological mechanism of TSD, proposed rehabilitation methods have attempted to avoid excessive sensory input and have attempted to reorganize sensory information processing. 15 ) Strength training, stretching, relaxation, and postural exercises incorporated in this patient were considered potentially effective for TSD as learning-based motor-sensory exercises to reorganize sensory information processing, 16 ) but no effective results were obtained. Excessive muscle strength training and joint range of motion training in the affected area may cause an increase in sensory input and exacerbate dystonia.…”

Section: Discussionmentioning

confidence: 96%

“…As a limitation in this study, noninvasive neuromodulation therapies such as transcranial magnetic stimulation and botulinum toxin injections, which have been reported to improve TSD by normalizing brain excitability through sensorimotor reorganization, should have been considered as rehabilitation treatment options for TSD. 16 ) Therefore, considering the difficulty of rehabilitating TSD and the difficulty of avoiding forward walking in daily life, it may have been beneficial for the patient to have been transferred to a convalescent hospital to continue rehabilitation for a period of 2 months or longer.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking

Hatori

Tagawa

Hatano

et al. 2023

PRM

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Background: Task-specific dystonia (TSD) confined to the lower extremities (LE) is relatively rare. This report describes dystonia confined to the LE only during forward walking. This case required careful neurological and diagnostic assessment because the patient was taking several neuropsychiatric drugs that cause symptomatic dystonia, such as aripiprazole (ARP). Case: A 53-year-old man visited our university hospital with a complaint of abnormalities in the LE that appeared only during walking. Neurological examinations other than walking were normal. Brain magnetic resonance imaging revealed meningioma in the right sphenoid ridge. The patient had been treated for depression with neuropsychiatric medications for a long time, and his abnormal gait appeared about 2 years after additional administration of ARP. After the meningioma was removed, his symptoms remained. Surface electromyography showed dystonia in both LE during forward walking, although his abnormal gait appeared to be accompanied by spasticity. The patient was tentatively diagnosed with tardive dystonia (TD). Although dystonia did not disappear clinically, it was alleviated after discontinuing ARP. Administration of trihexyphenidyl hydrochloride and concomitant rehabilitation improved his dystonia until return to work, but some residual gait abnormalities remained. Discussion: We report an unusual case of TD with task specificity confined to the LE. The TD was induced by the administration of ARP in combination with multiple psychotropic medications. Careful consideration was required for clinical diagnosis, rehabilitation, and assessment of its relevance to TSD.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking

Hatori

Tagawa

Hatano

et al. 2023

PRM

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“…Rehabilitation approaches in task-specific dystonia (mainly involving OT for focal hand dystonia) include movement practice, sensory reeducation, exploiting sensory tricks, and biofeedback training, combined with sensorimotor training and the use of compensatory strategies. 94,95 Neck PT has been used as an adjuvant for cervical dystonia, with strategies including electromyography (EMG) biofeedback, muscular elongation, postural exercises, and electrical-based therapy, and the use of a neck brace for mechanical correction, although results are varied. 96 Sensorimotor retraining (such as practicing picking up objects from a container of rice or dried pulses, or using Braille), and motor imagery may be helpful in the rehabilitative treatment of focal dystonia.…”

Section: Rehabilitation Strategies In Dystoniamentioning

confidence: 99%

Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing

et al. 2023

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Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system eatures. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.

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“…Physical therapies and rehabilitation have been reported to provide some improvement, but this evidence is not definitive. 14 Unlike generalised or segmental dystonia syndromes, where the GPi (globus pallidus internus) is preferred, small non-randomised trials suggest that focal hand dystonia responds well to targeted intervention of the thalamus; specifically, the Vo complex. 15 Thalamic deep brain stimulation (DBS) is an effective treatment option for individuals with writer's cramp 16 17 ; however, there are inherent risks associated with DBS, including perioperative anaesthetic complications, intraparenchymal haemorrhage, electrode/lead breakage or infection.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Current treatment options for focal dystonia are limited to short term symptom relief with low efficacy oral medications or local treatment with botulinum toxin. Physical therapies and rehabilitation have been reported to provide some improvement, but this evidence is not definitive 14. Unlike generalised or segmental dystonia syndromes, where the GPi (globus pallidus internus) is preferred, small non-randomised trials suggest that focal hand dystonia responds well to targeted intervention of the thalamus; specifically, the Vo complex 15.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial

Maamary,

Peters,

Kyle

et al. 2023

BMJ Neurol Open

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IntroductionMRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit.Methods and analysisA total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present.Ethics and disseminationThis trial was reviewed and approved by the St Vincent’s Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences.Trial registration numberCTRN12622000775718.

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Evidence of rehabilitation therapy in task-specific focal dystonia: a systematic review

Cited by 5 publications

References 38 publications

A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking

A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking

Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing

Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial

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