Neurology Medical News about psychogenic dystonia

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Abnormal sensorimotor plasticity in organic but not in psychogenic dystonia
Brain, 08/19/09

Quartarone A et al. – The authors found that plasticity (paired associative stimulation) was abnormally high only in the organic group, while there was no difference between the plasticity measured in psychogenic patients and healthy controls. They conclude that abnormal plasticity is a hallmark of organic dystonia; furthermore it is not a consequence of reduced inhibition since the latter is seen in psychogenic patients who have normal plasticity.

Exclusive Author Commentary
Dr Angelo Quartarone, 08/21/09

Dear Editor thank you for choosing our paper for MDXLINX.com site, I consider this a special honour. The data of our study strongly suggest that abnormal plasticity may be a primary causal factor in producing and/or maintaining dystonic symptoms. How abnormal plasticity can contribute to the pathophysiology of dystonia? It is well known that dystonic symptoms can be associated with periods of intensive training of a particular movement. This is very common in musician’s dystonia, in which the patients spend many hours per day with their attention focused on instrumental practice. It can be postulated that, if motor training is pushed to an extreme, it can produce a maladaptive sensory-motor reorganization, which interferes with the task performance rather than improving it. However, why do some patients develop dystonia after excessive training whereas others are completely healthy? One line of reasearch suggest that focal dystonias in humans, caused by excess practice or injury, only occur in individuals with preexisting abnormalities of neural plasticity that are probably under genetic influence (Quartarone et al Trend Neurosci, 2006). It could be hypothesized that in susceptible individuals during the acquisition of new motor skills, the mechanisms of neuroplasticity are subtly abnormal (genetic influence). Work trying to identify abnormal genes controlling plasticity in patients with focal dystonia is ongoing, but this is very difficult given the low penetrance. On top of that, several environmental factors such as repetitive training or peripheral nervous system injury in the presence of this genetic predisposition can trigger an abnormal maladaptive plasticity, which can lead to an overt dystonia. PAS abnormalities may be an important link in demonstrating how environmental influences can trigger dystonia.

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