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Review
Tricks in dystonia: ordering the complexity
  1. Vesper Fe Marie Llaneza Ramos1,
  2. Barbara I Karp2,
  3. Mark Hallett1
  1. 1Human Motor Control, National Institutes of Health, Bethesda, Maryland, USA
  2. 2National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Mark Hallett, NIH, NINDS, Building 10, Room 7D 37, 10 Center Drive, Bethesda, MD 20814, USA; hallettm{at}ninds.nih.gov

Abstract

Sensory tricks are various manoeuvres that can ameliorate dystonia. Common characteristics are well known, but their variety is wide, sensory stimulation is not necessarily the critical feature, and their physiology is unknown. To enumerate the various forms of sensory tricks and describe their nature, research findings and theories that may elucidate their neurophysiologic mechanism, we reviewed the literature pertaining to sensory tricks, including variants like motor tricks, imaginary tricks, forcible tricks and reverse sensory tricks. On the basis of this information, we propose a new classification of sensory tricks to include its variants. We highlight neurophysiologic evidence suggesting that sensory tricks work by decreasing abnormal facilitation. We tie this with established dystonia pathogenesis and postulate that sensory tricks decrease abnormally increased facilitation to inhibition ratios in the dystonic brain. It appears worthwhile for patients to search for possible sensory tricks.

  • Dystonia
  • Neurophysiology, Motor
  • Motor Control
  • Movement Disorders

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