Cause or effect: Altered brain and network activity in cervical dystonia is partially normalized by botulinum toxin treatment.

BACKGROUND: Idiopathic cervical dystonia (CD) is a chronic movement disorder characterized by impressive clinical symptoms and the lack of clear pathological findings in clinical diagnostics and imaging. At present, the injection of botulinum toxin (BNT) in dystonic muscles is an effective therapy to control motor symptoms and pain in CD. OBJECTIVES: We hypothesized that, although it is locally injected to dystonic muscles, BNT application leads to changes in brain and network activity towards normal brain function. METHODS: Using 3 T functional MR imaging along with advanced analysis techniques (functional connectivity, Granger causality, and regional homogeneity), we aimed to characterize brain activity in CD (17 CD patients vs. 17 controls) and to uncover the effects of BNT treatment (at 6 months). RESULTS: In CD, we observed an increased information flow within the basal ganglia, the thalamus, and the sensorimotor cortex. In parallel, some of these structures became less responsive to regulating inputs. Furthermore, our results suggested an altered somatosensory integration. Following BNT administration, we noted a shift towards normal brain function in the CD patients, especially within the motor cortex, the somatosensory cortex, and the basal ganglia. CONCLUSION: The changes in brain function and network activity in CD can be interpreted as related to the underlying cause, the effort to compensate or a mixture of both. Although BNT is applied in the last stage of the cortico-neuromuscular pathway, brain patterns are shifted towards those of healthy controls.

The Influence of Eye Closure on Somatosensory Discrimination: A Trade-off Between Simple Perception and Discrimination.

We often close our eyes to improve perception. Recent results have shown a decrease of perception thresholds accompanied by an increase in somatosensory activity after eye closure. However, does somatosensory spatial discrimination also benefit from eye closure? We previously showed that spatial discrimination is accompanied by a reduction of somatosensory activity. Using magnetoencephalography, we analyzed the magnitude of primary somatosensory (somatosensory P50m) and primary auditory activity (auditory P50m) during a one-back discrimination task in 21 healthy volunteers. In complete darkness, participants were requested to pay attention to either the somatosensory or auditory stimulation and asked to open or close their eyes every 6.5 min. Somatosensory P50m was reduced during a task requiring the distinguishing of stimulus location changes at the distal phalanges of different fingers. The somatosensory P50m was further reduced and detection performance was higher during eyes open. A similar reduction was found for the auditory P50m during a task requiring the distinguishing of changing tones. The function of eye closure is more than controlling visual input. It might be advantageous for perception because it is an effective way to reduce interference from other modalities, but disadvantageous for spatial discrimination because it requires at least one top-down processing stage.

Habituation within the somatosensory processing hierarchy.

Habituation is a basic process of learning evident in a decrement in neuronal/behavioral responses to repeated sensory stimulation. It is generally accepted that habituation affects all sensory systems in the human brain, including the somatosensory network. However, it is not clear where habituation originates within this hierarchically organized network. In this study, we examined whether habituation effects increase relatively uniformly along the processing hierarchy or rather distinctly at a particular processing stage. We addressed these questions by performing functional magnetic resonance imaging (fMRI) on 43 healthy subjects during unilateral electrical median nerve stimulation using a block design. We found a time-dependent decrease in the positive BOLD response (indicative of habituation) in all areas of the somatosensory network with the exception of Brodmann area (BA) 3b. The increase in habituation within the presumed processing stream was most pronounced between subareas of the primary somatosensory cortex (BA3b, BA1, BA2), and no further increase in habituation effects was observed in the subsequent processing stages within either the secondary somatosensory cortex or the insula. Moreover, we found a relatively strong habituation effect within the thalamus. These findings indicate that the increase in habituation along the processing hierarchy is measurable primarily between subareas of the primary somatosensory cortex, and we hypothesize that this increase originates in thalamocortical interactions early in the processing stream.