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Cortical and spinal abnormalities in psychogenic dystonia.

Alberto J Espay1, Francesca Morgante, Jamie Purzner

  • 1Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada.

Annals of Neurology
|April 25, 2006
PubMed
Summary
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Psychogenic dystonia and organic dystonia share similar physiological abnormalities, suggesting aberrant sensory input may cause these changes. Both conditions exhibit reduced cortical inhibition and altered spinal excitability.

Area of Science:

  • Neuroscience
  • Movement Disorders
  • Clinical Physiology

Background:

  • The underlying pathophysiology of psychogenic dystonia remains largely unexamined.
  • Existing research suggests repetitive movements can induce plastic cortical changes via abnormal sensory input.
  • Reduced cortical and spinal inhibition are established features of organic dystonia.

Purpose of the Study:

  • To investigate the pathophysiology of psychogenic dystonia.
  • To test the hypothesis that aberrant sensory input from abnormal posture can induce similar physiological abnormalities as seen in organic dystonia.
  • To compare cortical and spinal inhibitory circuits in patients with psychogenic dystonia, organic dystonia, and healthy controls.

Main Methods:

  • Assessed cortical inhibitory circuits (resting short- and long-interval intracortical inhibition, cortical silent period) and cortical activity during voluntary movement.

Related Experiment Videos

  • Measured cutaneous silent period and forearm spinal reciprocal inhibition.
  • Included 10 patients with psychogenic dystonia, 8 with organic dystonia, and 12 healthy controls.

    • Main Results:

    • Reduced cortical inhibition (short- and long-interval intracortical inhibition, cortical silent period) was observed in both psychogenic and organic dystonia groups.
    • Increased cutaneous silent period (spinal circuitry) was found in both dystonia types.
    • Reduced forearm spinal reciprocal inhibition was specific to psychogenic dystonia.

    Conclusions:

    • Psychogenic and organic dystonia exhibit shared physiological abnormalities.
    • These abnormalities might be a consequence of dystonia rather than its cause, or represent predisposing endophenotypic traits.
    • Findings challenge the traditional view of organic dystonia's pathophysiology and highlight similarities with psychogenic forms.