Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial
OBJECTIVE: To determine the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS) delivered to the left inferior parietal lobule (IPL) on the severity of task-specific focal hand dystonia. METHODS: In this randomized, sham-controlled, double-blind crossover study, participants rec...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-05-01
|
| Series: | Annals of Movement Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.4103/aomd.aomd_18_24 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850074324966309888 |
|---|---|
| author | Seetha Lekshmi Bhadran Anandapadmanabhan Reghu Rajiv Gupta Divya M. Radhakrishnan Aayushi Vishnoi Anu Gupta Venugopalan Y. Vishnu Ashish Upadhyay Senthil Kumaran Nand Kumar Renu Bhatia Rohit Bhatia Mamta Bhushan Singh Achal K. Srivastava Padma Srivastava Roopa Rajan |
| author_facet | Seetha Lekshmi Bhadran Anandapadmanabhan Reghu Rajiv Gupta Divya M. Radhakrishnan Aayushi Vishnoi Anu Gupta Venugopalan Y. Vishnu Ashish Upadhyay Senthil Kumaran Nand Kumar Renu Bhatia Rohit Bhatia Mamta Bhushan Singh Achal K. Srivastava Padma Srivastava Roopa Rajan |
| author_sort | Seetha Lekshmi Bhadran |
| collection | DOAJ |
| description | OBJECTIVE: To determine the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS) delivered to the left inferior parietal lobule (IPL) on the severity of task-specific focal hand dystonia. METHODS: In this randomized, sham-controlled, double-blind crossover study, participants received single sessions of low-frequency (1 Hz) inhibitory rTMS (1200 pulses) and sham stimulation to the left IPL. At baseline and after each session, we assessed the Writer’s Cramp Rating Scale (WCRS), kinematic analysis using an electrogoniometer, a torsiometer, and the patient-reported improvement on a Likert scale. RESULTS: We recruited 16 right-handed patients with task-specific focal hand dystonia [age: 33.3 ± 11.7 years, 13 male). The mean WCRS score at baseline was 5.8 ± 3.4 in group A (where first 1 Hz rTMS and then sham was applied) and 13.4 ± 5.2 in group B (where first sham and then 1 Hz rTMS were applied). An inhibitory rTMS protocol applied to the left IPL resulted in a statistically significant improvement in the WCRS total score [WCRS difference real minus sham mean (SD): −1 (1.3), (95% confidence interval (CI): −2, −1), p = 0.002] and writing movement score [WMS mean difference (SD): −1 (1.4), CI: (−2, 0), p = 0.005], irrespective of the sequence in which they received the intervention. Secondary outcomes were similar between the groups. CONCLUSION: In patients with task-specific focal hand dystonia, a single session of rTMS to the left IPL resulted in a modest reduction of focal hand dystonia severity. The results serve as a proof-of-concept for future studies to assess the clinical effects of multiple sessions of left IPL inhibition to modulate the abnormally hyperexcitable premotor–parietal–putaminal circuitry in task-specific focal hand dystonia. |
| format | Article |
| id | doaj-art-aee95eb89fe747acb9ccc2f1edc3be04 |
| institution | DOAJ |
| issn | 2590-3446 2590-3454 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Movement Disorders |
| spelling | doaj-art-aee95eb89fe747acb9ccc2f1edc3be042025-08-20T02:46:36ZengWolters Kluwer Medknow PublicationsAnnals of Movement Disorders2590-34462590-34542024-05-01729410110.4103/aomd.aomd_18_24Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trialSeetha Lekshmi BhadranAnandapadmanabhan ReghuRajiv GuptaDivya M. RadhakrishnanAayushi VishnoiAnu GuptaVenugopalan Y. VishnuAshish UpadhyaySenthil KumaranNand KumarRenu BhatiaRohit BhatiaMamta Bhushan SinghAchal K. SrivastavaPadma SrivastavaRoopa RajanOBJECTIVE: To determine the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS) delivered to the left inferior parietal lobule (IPL) on the severity of task-specific focal hand dystonia. METHODS: In this randomized, sham-controlled, double-blind crossover study, participants received single sessions of low-frequency (1 Hz) inhibitory rTMS (1200 pulses) and sham stimulation to the left IPL. At baseline and after each session, we assessed the Writer’s Cramp Rating Scale (WCRS), kinematic analysis using an electrogoniometer, a torsiometer, and the patient-reported improvement on a Likert scale. RESULTS: We recruited 16 right-handed patients with task-specific focal hand dystonia [age: 33.3 ± 11.7 years, 13 male). The mean WCRS score at baseline was 5.8 ± 3.4 in group A (where first 1 Hz rTMS and then sham was applied) and 13.4 ± 5.2 in group B (where first sham and then 1 Hz rTMS were applied). An inhibitory rTMS protocol applied to the left IPL resulted in a statistically significant improvement in the WCRS total score [WCRS difference real minus sham mean (SD): −1 (1.3), (95% confidence interval (CI): −2, −1), p = 0.002] and writing movement score [WMS mean difference (SD): −1 (1.4), CI: (−2, 0), p = 0.005], irrespective of the sequence in which they received the intervention. Secondary outcomes were similar between the groups. CONCLUSION: In patients with task-specific focal hand dystonia, a single session of rTMS to the left IPL resulted in a modest reduction of focal hand dystonia severity. The results serve as a proof-of-concept for future studies to assess the clinical effects of multiple sessions of left IPL inhibition to modulate the abnormally hyperexcitable premotor–parietal–putaminal circuitry in task-specific focal hand dystonia.https://doi.org/10.4103/aomd.aomd_18_24focal hand dystoniatranscranial magnetic stimulationwriter’s cramp |
| spellingShingle | Seetha Lekshmi Bhadran Anandapadmanabhan Reghu Rajiv Gupta Divya M. Radhakrishnan Aayushi Vishnoi Anu Gupta Venugopalan Y. Vishnu Ashish Upadhyay Senthil Kumaran Nand Kumar Renu Bhatia Rohit Bhatia Mamta Bhushan Singh Achal K. Srivastava Padma Srivastava Roopa Rajan Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial Annals of Movement Disorders focal hand dystonia transcranial magnetic stimulation writer’s cramp |
| title | Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial |
| title_full | Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial |
| title_fullStr | Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial |
| title_full_unstemmed | Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial |
| title_short | Inferior parietal lobule stimulation in task-specific focal hand dystonia: A randomized, crossover clinical trial |
| title_sort | inferior parietal lobule stimulation in task specific focal hand dystonia a randomized crossover clinical trial |
| topic | focal hand dystonia transcranial magnetic stimulation writer’s cramp |
| url | https://doi.org/10.4103/aomd.aomd_18_24 |
| work_keys_str_mv | AT seethalekshmibhadran inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT anandapadmanabhanreghu inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT rajivgupta inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT divyamradhakrishnan inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT aayushivishnoi inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT anugupta inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT venugopalanyvishnu inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT ashishupadhyay inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT senthilkumaran inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT nandkumar inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT renubhatia inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT rohitbhatia inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT mamtabhushansingh inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT achalksrivastava inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT padmasrivastava inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial AT rooparajan inferiorparietallobulestimulationintaskspecificfocalhanddystoniaarandomizedcrossoverclinicaltrial |