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33 - Therapy of focal hand dystonia

Published online by Cambridge University Press:  23 December 2009

By
Kirsten E. Zeuner ,
B. Baur  and
H. R. Siebner
Edited by
Dennis A. Nowak  and
Joachim Hermsdörfer
Dennis A. Nowak
Affiliation:
Klinik Kipfenberg, Kipfenberg, Germany
Joachim Hermsdörfer
Affiliation:
Technical University of Munich
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Summary

Summary

Focal hand dystonia (FHD) is a disabling movement disorder. Affected patients show abnormal patterns of muscle activity of the forearm and hand while performing a specific task. This includes co-contractions of agonist and antagonist muscles and overflow of motor activity to muscles that are normally not involved in a given movement. Patients with writer's or musician's cramp may present with dystonic symptoms that only occur during a selective task (referred to as “simple” writer's cramp or musician's cramp) or may develop symptoms with multiple tasks (referred to as “dystonic” writer's or musician's cramp). Neurophysiological and neuroimaging studies in humans have identified several mechanisms that may be relevant to the pathophysiology of FDH. These mechanisms include impaired sensorimotor integration, maladaptive plasticity and deficient inhibition at various levels in the sensorimotor system. This work has been complemented by the successful establishment of a primate model in which excessive training of skilled finger movements induced a dystonia-like phenotype. Based on these lines of research, novel non-pharmacological interventions have been developed to improve dystonia in patients with FDH. In this chapter, we give an update on the range of therapeutic approaches that have been proposed for FDH.

Clinical presentation of focal hand dystonia

Task-specific dystonia of the hand often develops in individuals whose work involves skilled repetitive movements, requiring a high level of performance (Byl & Melnick, 1997; Frucht, 2004). In some patients, dystonia may show a progression and they may develop dystonia with other less specific motor actions of the involved limb.

Type
Chapter
Information
Sensorimotor Control of Grasping
Physiology and Pathophysiology
 , pp. 469 - 481
Publisher: Cambridge University Press
Print publication year: 2009

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