Surmounting retraining limits in musicians' dystonia by transcranial stimulation.


Surmounting retraining limits in musicians' dystonia by transcranial stimulation.

Ann Neurol. 2014 Apr 7. doi: 10.1002/ana.24151.

Objective: Abnormal cortical excitability is evident in various movement disorders that compromise fine motor control. Here we tested whether skilled finger movements can be restored in musicians with focal hand dystonia through behavioural training assisted by transcranial direct current stimulation to the motor cortex of both hemispheres. Methods: The bilateral motor cortices of twenty pianists (ten with focal dystonia, ten healthy controls) were electrically stimulated non-invasively during bimanual mirrored finger movements. Results: We found improvement in the rhythmic accuracy of sequential finger movements with the affected hand during and after cathodal stimulation over the affected cortex and simultaneous anodal stimulation over the unaffected cortex. The improvement was retained four days after intervention. Neither a stimulation with the reversed montage of electrodes nor sham stimulation yielded any improvement. Furthermore, the amount of improvement was positively correlated with severity of the symptoms. Bi-hemispheric stimulation without concurrent motor training failed to improve fine motor control, underlining the importance of combined retraining and stimulation for restoring the dystonic symptoms. For the healthy pianists, none of the stimulation protocols enhanced movement accuracy. Interpretation: These results suggest a therapeutic potential of behavioural training assisted by bi-hemispheric, non-invasive brain stimulation in restoring fine motor control in focal dystonia. ANN NEUROL 2014. © 2014 American Neurological Association.

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