Dystonia Clinical Trial
Official title:
The Physiology of Tricks
This study will examine the action of sensory tricks on an occurrence known as surround
inhibition when there is a disorder of muscle tone affecting a single body part in
isolation. Surround inhibition refers to a situation that suppresses unwanted movements,
known as dystonia, in surrounding muscles during voluntary actions. There are tricks-various
actions-that people use to temporarily stop those unwanted movements. Such tricks can
include touching the affected body part, placing an object in the mouth, pulling the hair,
and others. Often these tricks are beneficial early in the illness but become less effective
as it progresses. This study is guided by a hypothesis that sensory tricks will restore
surround inhibition and by another hypothesis that it is the application of the tricks, not
simply sensory input, that is effective in doing that restoring. Emphasis is on cervical
dystonia, involuntary actions affecting the neck, in which the tricks commonly involve the
cheeks and chin. The technique used in the study is transcranial magnetic stimulation (TMS).
Patients ages 18 and older who have cervical dystonia with at least one effective trick and
patients with no effective trick may be eligible for this study. There will also be a
control group of healthy participants.
Participants will be asked to show the sensory trick and may be asked to be videotaped.
During the TMS procedure, they will be seated in a comfortable chair, with hands placed on a
pillow on the lap. Small electrodes-soft strips that stick to the skin-will be placed on the
skin to record the electrical activity of some muscles in the neck that are activated by the
stimulation from TMS. In TMS, there will be a wire coil held over the scalp. A brief
electrical current will be passed through the coil, creating a magnetic pulse that
stimulates the brain. Patients will hear a click and may feel a pulling sensation on the
skin under the coil. There may be muscle twitches of the face, arm, or leg. In addition,
patients may be asked to tense certain muscles slightly or perform other simple actions so
that the coil can be positioned appropriately. Patients will sometimes be asked to bite down
and tap their teeth slightly for about 1-1/2 minutes at a time. They will be asked to show
the sensory trick. The stimulation is usually not painful, although sometimes strong
contractions of the scalp muscles can cause discomfort or a headache. Patients can ask to
have the procedure discontinued at any time. The testing session takes about 2 hours, done
on an outpatient basis.
The purpose of this study is to investigate the mechanism of sensory tricks on surround inhibition in the motor cortex in focal dystonia. Sensory tricks or Geste antagoniste, are various manoeuvres used by dystonic patients to transiently diminish their spasms. Many of these manoeuvres involve motor as well as sensory input and here we use the term 'tricks' to refer to both phenomena. Little is known of this unique feature that is an evidence for the abnormality of sensorimotor integration in focal dystonia. The relief of dystonic symptoms by the application of tricks suggests its potential as a clue to the understanding of the yet unclear mechanism of dystonia. There is evidence that surround inhibition, a cortical phenomenon that functions to suppress unwanted movements in surrounding muscles during voluntary actions, is impaired in dystonia. Since tricks transiently relieve the dystonic symptoms, we hypothesize that the mechanism of tricks is the normalization of surround inhibition which is defective in dystonia. ;
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