Task-specific dystonia: pathophysiology and management

Sadnicka, Anna; Kassavetis, Panagiotis; Pareés, Isabel; Meppelink, Anne Marthe; Butler, Katherine; Edwards, Mark J.

doi:10.1136/jnnp-2015-311298

Cited by 47 publications

(41 citation statements)

References 73 publications

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“…1 Pathophysiology may be related to altered neuroplasticity and disordered sensory integration. 2 Minor secondary segmental spread or generalization after onset is not uncommon, as observed in this patient, and may be related to alteration in neural networks. 2 Dystonia can present in any body part, though onset in adulthood is typically focal and most commonly involving the craniocervical region.…”

Section: Discussionmentioning

confidence: 54%

A Wilted Flower: Lotus Position Dystonia

Martin

McGrath

Fung

2020

Movement Disord Clin Pract

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Adult-onset axial dystonia is a rare disorder and may be idiopathic or secondary to another systemic condition. It may, moreover, be under-recognized or misdiagnosed because of the unusual phenomenology. The pathophysiological mechanisms are poorly understood. Task specificity, common to other forms of dystonia, is moreover difficult to demonstrate in axial dystonia. We present herein a case of adult-onset axial dystonia related to a partial "lotus" position, with task specificity and sensory trick.

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Section: Discussionmentioning

confidence: 54%

A Wilted Flower: Lotus Position Dystonia

Martin

McGrath

Fung

2020

Movement Disord Clin Pract

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“…Further studies more precisely evaluating stress and overwork from a psychiatric standpoint are necessary. In order to be associated with dystonia, a task needs to have been performed over a sufficient amount of time, as evidenced by a study of the occurrence of dystonia in occupational tasks ( 19 ). In that study, the mean duration of employment in the occupation was 15.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…Multivariate logistic regression models were constructed to estimate the factors that might influence the development of lingual dystonia. Inclusion of variables in a model was according to existing knowledge of risk factors for task-specific dystonia ( 19 ). At the beginning, occupational speaking, stress, overwork, neuroleptic use, and gender were selected as five covariates for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Task-specific focal hand dystonia can affect people who engage in occupations involving repetitive, highly practiced movements. Examples are writer’s cramp, musician’s dystonia, embouchure dystonia, and cramps in golfers, tennis players, and billiards players ( 19 , 20 ). Additional manifestations arising from occupations have been reported in tailors, shoemakers, and hair stylists ( 19 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Phenomenological Characteristics of Patients with Task-Specific Lingual Dystonia: Possible Association with Occupation

Yoshida

2017

Front. Neurol.

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BackgroundLingual dystonia is a subtype of oromandibular dystonia, which is a movement disorder characterized by involuntary sustained or intermittent contraction of the masticatory and/or tongue muscles. Lingual dystonia interferes with important daily activities, such as speaking, chewing, and swallowing, resulting in vocational and social disability.ObjectiveThe aim of this study was to investigate a possible relationship between occupation and the development of lingual dystonia.MethodsPhenomenological and clinical characteristics of 95 patients [53 females (55.8%) and 42 males (44.2%), mean age 48.0 years] with task-specific, speech-induced lingual dystonia were analyzed. Structured interviews were carried out to obtain information regarding primary occupation, including overtime work and stress during work. The factors that might have influenced the development of lingual dystonia were estimated using multivariate logistic regression analysis of the 95 patients with lingual dystonia and 95 controls [68 females (71.6%) and 27 males (28.4%), mean age 47.2 years] with temporomandibular disorders.ResultsOverall, 84.2% of the patients had regular occupations; 73.8% of the patients with regular occupations reported working overtime more than twice a week, and 63.8% of them experienced stress at the workplace. Furthermore, 82.1% of the patients had engaged in occupations that required them to talk to customers or other people under stressful situations over prolonged periods of time for many years (mean: 15.6 years). The most common occupation was sales representative (17.9%), followed by telephone operator (13.7%), customer service representative (10.5%), health care worker (9.5%), waiter or waitress (5.3%), receptionist (5.3%), and cashier (5.3%). Twenty-nine patients (30.5%) had tardive lingual dystonia. Logistic regression analyses revealed that frequent requirements for professional speaking (p = 0.011, odds ratio: 5.66), high stress during work (p = 0.043, odds ratio: 5.4), and neuroleptic use (p = 0.032, odds ratio: 2.52) were significant contributors to the manifestation of lingual dystonia.ConclusionProfessions in which conversations in stressful situations are unavoidable may trigger lingual dystonia. Therefore, speech-induced lingual dystonia can be regarded as occupational dystonia in certain cases.

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“…Standardized scales or outcome measures capturing all types of task-specific or limb dystonia are lacking. In addition, the very nature of task specificity makes it difficult to generalize, and its clinical manifestation and prevalence tend to change with occupational skills relevant to the era and to the particular society (133). The impact on quality of life is very patient-dependent, and treatment response is at times radically different from other conditions responsive to BoNT therapy (134).…”

Section: Therapymentioning

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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Task-specific dystonia: pathophysiology and management

Cited by 47 publications

References 73 publications

A Wilted Flower: Lotus Position Dystonia

A Wilted Flower: Lotus Position Dystonia

Clinical and Phenomenological Characteristics of Patients with Task-Specific Lingual Dystonia: Possible Association with Occupation

Research Priorities in Limb and Task-Specific Dystonias

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