Kojovic, M;
Caronni, A;
Bologna, M;
Rothwell, JC;
Bhatia, KP;
Edwards, MJ;
(2011)
Botulinum Toxin Injections Reduce Associative Plasticity in Patients with Primary Dystonia.
MOVEMENT DISORD
, 26
(7)
1282 - 1289.
10.1002/mds.23681.
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Abstract
Botulinum toxin injections ameliorate dystonic symptoms by blocking the neuromuscular junction and weakening dystonic contractions. We asked if botulinum toxin injections in dystonia patients might also affect the integrity of sensorimotor cortical plasticity, one of the key pathophysiological features of dystonia. We applied a paired associative stimulation protocol, known to induce long-term potentiation-like changes in the primary motor cortex hand area to 12 patients with cervical dystonia before and 1 and 3 months after botulinum toxin injections to the neck muscles. Primary motor cortex excitability was probed by measuring transcranial magnetic stimulation-evoked motor evoked potentials before and after paired associative stimulation. We also measured the input-output curve, short-interval intracortical inhibition, intracortical facilitation, short afferent inhibition, and long afferent inhibition in hand muscles and the clinical severity of dystonia. Before botulinum toxin injections, paired associative stimulation significantly facilitated motor evoked potentials in hand muscles. One month after injections, this effect was abolished, with partial recovery after 3 months. There were significant positive correlations between the facilitation produced by paired associative stimulation and (1) the time elapsed since botulinum toxin injections and (2) the clinical dystonia score. One effect of botulinum toxin injection treatment is to modulate afferent input from the neck. We propose that subsequent reorganization of the motor cortex representation of hand muscles may explain the effect of botulinum toxin on motor cortical plasticity. (C) 2011 Movement Disorder Society
| Type: | Article |
|---|---|
| Title: | Botulinum Toxin Injections Reduce Associative Plasticity in Patients with Primary Dystonia |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/mds.23681 |
| Publisher version: | http://dx.doi.org/10.1002/mds.23681 |
| Additional information: | © 2011 Movement Disorder Society. Full text made available to UCL Discovery by kind permission of Wiley. |
| Keywords: | botulinum toxin, primary dystonia, cervical dystonia, cortical plasticity, paired associative stimulation, transcranial magnetic stimulation, TMS, HUMAN MOTOR CORTEX, TRANSCRANIAL MAGNETIC STIMULATION, WRITERS CRAMP, CERVICAL DYSTONIA, RECIPROCAL INHIBITION, CORTICAL EXCITABILITY, FOREARM MUSCLES, DEAFFERENTATION, REORGANIZATION, REPRESENTATION |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1302522 |
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