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Somatosensory cortical remodelling after rehabilitation and clinical benefit of in writer's cramp
  1. Jean Pierre Bleton1,2,
  2. Marie Vidailhet3,4,5,6,
  3. Frédéric Bourdain7,
  4. Antoine Ducorps4,5,6,8,
  5. Denis Schwartz4,5,6,8,
  6. Christine Delmaire5,6,9,
  7. Stéphane Lehéricy4,5,6,10,
  8. Bernard Renault4,5,8,
  9. Line Garnero4,5,6,8,
  10. Sabine Meunier4,11,12
  1. 1Université Paris Descartes EA 4055/ISERM U894, Paris, France
  2. 2Service de Neurologie, Hôpital Sainte-Anne, Paris, France
  3. 3AP-HP, Groupe hospitalier Pitié-Salpétrière, Fédération de Neurologie, Paris, France
  4. 4UPMC University Pierre et Marie Curie-Paris6, Paris, France
  5. 5CRICM, INSERM UMR_S 975, CNRS UMR 7225, Paris, France
  6. 6Federative Institute of Research on Functional Neuroimaging (IFR49), NeuroSpin, Gif-sur-Yvette, France
  7. 7Service de Neurologie, Hôpital Foch, Suresnes, France
  8. 8Centre de Magnétoencéphalographie CNRS LENA UPR 640 Université Paris VI, Paris, France
  9. 9Service de Neuroradiologie, CRHU Lille, Lille, France
  10. 10CENIR—Centre de Neuroimagerie de Recherche, Groupe hospitalier Pitié-Salpétrière, Paris, France
  11. 11UPMC Université Pierre et Marie Curie-Paris6, ER6, Physiologie et physiopathologie de la motricité chez l'homme Paris, France
  12. 12Médecine Physique et Réadaptation, Hôpital Pitié-Salpêtrière, Paris, France
  1. Correspondence to Professor Marie Vidailhet, Fédération de Neurologie, Hôpital de la Salpêtrière, Paris 75013, France; marie.vidailhet{at}


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.

  • Dystonia
  • Writer's cramp
  • magnetoencephalography
  • rehabilitation
  • somatotopy
  • plasticity
  • cortical mapping
  • brain mapping

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  • 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.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethical Committee Salpetriere Hospital, Paris, France.

  • Provenance and peer review Not commissioned; externally peer reviewed.