In order to explore the pathophysiological basis of a new rehabilitation therapy in writer's cramp (WC), healthy controls, untreated WC patients and WC patients who recovered a legible handwriting after rehabilitation were explored using magnetoencephalography, and the somatosensory evoked fields of fingers I, II, III and V in the sensory cortex were studied. In the cortex controlling the dystonic limb, the size of the hand representation in the trained patients was similar to that of healthy controls, and significantly different from that of untrained patients. Trained patients exhibited ‘super-normal’ reorganisation of the finger maps. In the cortex controlling the non-dystonic limb, there was little difference between trained and untrained patients, and the hand representation was enlarged and disorganised. The authors hypothesise that prolonged tailored rehabilitation in WC may induce long-term plasticity phenomena, lateralised to the cortex controlling the dystonic hand.
- Writer's cramp
- cortical mapping
- brain mapping
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JPB, MV and FB contributed equally.
Competing interests None.
Funding This work was supported by the INSERM National Dystonia Network,GIS-Maladies Rares and the patients' association AMADYS. FB was supported by a grant from Société Française de Neurologie. SM was supported by grants from AP-HP, INSERM and MESR (Unité de recherche mixte U731 INSERM/UPMC), IRME and Institut Garches.
Ethics approval Ethics approval was provided by the Ethical Committee Salpetriere Hospital, Paris, France.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.