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Structural abnormalities in the cerebellum and sensorimotor circuit in writer's cramp

From INSERM U610 (C.D., S.L.), Departments of Neurology (M.V., A.E., F.B., J.-P.B., A.T., S.S.) and Neuroradiology (S.L.), INSERM U708 (A.E.), INSERM U731 (S.M.), INSERM U679 (M.V.) and CENIR (Center for Neuroimaging Research, www.cenir.org) (S.L.), Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie–Paris 6, and Raymond Garcin Rehabilitation Center (J.-P.B.), Department of Neurology, Hôpital Sainte-Anne, Paris, France.

Address correspondence and reprint requests to Dr. S. Lehéricy, Service de Neuroradiologie, Bâtiment Babinski, Hôpital de la Salpêtrière, 47 boulevard de l'Hôpital, 75651 Paris CEDEX 13, France stephane.lehericy{at}psl.aphp.fr

Background: Structural abnormalities were detected in bilateral primary sensorimotor areas in writer's cramp. Evidence in other primary dystonia, including blepharospasm and cervical dystonia, suggest that structural abnormalities may be observed in other brain areas such as the cerebellum in writer's cramp.

Objective: To test the hypothesis that structural abnormalities are present along the sensorimotor and cerebellar circuits in patients with writer's cramp.

Methods: Using voxel-based morphometry, the authors compared the brain structure of 30 right-handed patients with writer's cramp with that of 30 healthy control subjects matched for gender, age, and handedness.

Results: Gray matter decrease was found in the hand area of the left primary sensorimotor cortex, bilateral thalamus, and cerebellum (height threshold p < 0.01, cluster significant at p < 0.05 corrected for multiple comparisons).

Conclusions: These results demonstrate in writer's cramp the presence of structural abnormalities in brain structures interconnected within the sensorimotor network including the cerebellum and the cortical representation of the affected hand. These abnormalities may be related to the pathophysiology of writer's cramp, questioning the role of the cerebellum, or to maladaptive plasticity in a task-related dystonia.

Editorial, see page 331

Supported by grants from the Clinical Investigation Center of the Salpêtrière Hospital, Paris, the Action Concertée Incitative 2001-CR UFR 6503H, and the IFR49 and INSERM French Dystonia Network and GIS maladies rares.

Disclosure: The authors report no conflicts of interest.

Received October 2, 2006. Accepted in final form March 15, 2007.

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Writer’s cramp: Questions of causation

Joel S. Perlmutter and W. Thomas Thach
Neurology 2007 69: 331-332. [Full Text] [PDF]

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