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Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin?
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  • Published on:
    Response
    • Ryuji Kaji, Neurologist Department of Neurology, Tokushima University

    Ryuji Kaji MD, PhD
    Department of Neurology, Tokushima University

    I appreciate Dr Popkirov’s unique and interesting views and comments related to our paper [1]. This reminds me of the gating of sensory inputs at various levels of the nervous system, and their perception is not a passive but is a very active process. In addition to the fact that it is not possible to tickle oneself, other sensory phenomena associated with abnormal movements deserve mention. Restless legs syndrome is characterized by constant urge to move legs, and is successfully managed by dopamine agonists. Tics are also preceded by sensory symptoms. These could be examples of aberrant sensory inputs coming to the conscious level, which would normally be handled at subconscious pathways. At this moment, the exact role of the cerebellar pathway in these conditions is not clear, but should be investigated in the future aside from dystonia.

    1. Kaji R, Bhatia K, Graybiel AM. Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin? J Neurol Neurosurg Psychiatry. 2017 Oct 31. pii: jnnp-2017-316250. doi: 10.1136/jnnp-2017-316250. [Epub ahead of print]
    No conflict of interest declared

    Conflict of Interest:
    None declared.
  • Published on:
    No laughing matter
    • Stoyan Popkirov, Medical doctor (Neurology) University Hospital Knappaschaftskrankenhaus Bochum, Germany

    In their recent article on the pathogenesis of dystonia, Kaji and colleagues argue that aberrant cerebellar inputs can induce dystonic movement mediated by the basal ganglia.[1] In this framework, the sensory trick (geste antagoniste) leads to a realignment between predicted and actual sensory information, thus reduces (or overrides) the sensorimotor mismatch forwarded to the basal ganglia, and in turn alleviates dystonic contractions.
    A similar model of sensorimotor mismatch response has been implicated in the physiology of being tickled[2]. Specifically, it has been proposed that the inability to tickle oneself is related to a sensory attenuation mediated by the cerebellum during self-generated tactile sensation[3]. This attenuation is proportional to the precision of the sensory prediction[4]. Whether the same cerebellar processes are responsible for the alleviation of dystonia during a sensory trick would be an interesting question to explore experimentally. At the risk of straining the analogy, one could even describe the postures and movements one produces when being tickled as dystonic-like. Neurologists are reminded of this when interpreting ambiguous plantar responses in very ticklish patients -- a problem that can be avoided by employing the patient's cerebellar sensory attentuation[5].

    1. Kaji R, Bhatia K, Graybiel AM. Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin? J Neurol Neurosurg Psychiatry. 2017 Oct 31. pii: jnnp-20...

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    Conflict of Interest:
    None declared.