Abnormal sensorimotor integration in writer's cramp: study of contingent negative variation

To investigate the pathophysiology of idiopathic focal dystonia, we recorded contingent negative variation (CNV) as a physiological index of sensorimotor integration in 14 right-handed patients with writer's cramp and compared it with normative data. CNV was recorded in the S2 choice reaction time paradigm: Two kinds of auditory S2 (Go or No-Go) were given 2 s after the auditory S1, and the subject reacted only to the Go signal by extending the wrist. In normal subjects, the late CNV amplitude had no difference at Cz between left- and right-hand tasks and was symmetric without significant amplitude laterality irrespective of the side of hand movement. In patients with writer's cramp, the late CNV amplitude at Cz was relatively larger for the left-hand task than the right-hand task (p < 0.03), and a significant amplitude laterality of the late CNV (larger on the right) was present especially at the central area for the right-hand task (p < 0.03). Since the late CNV is known to be generated, at least in part, from primary and supplementary motor cortices, the significant laterality of the late CNV seen with the right-hand task in patients with writer's cramp might represent functional abnormality of motor cortices possibly as the result of basal ganglia function.