Brain, Vol 120, Issue 12 2179-2185, Copyright © 1997 by Oxford University Press
RA Grunewald, Y Yoneda, JM Shipman and HJ Sagar
As muscle spindles are involved in the sensation of position and movement
of the body, we tested their involvement in the pathophysiology of
idiopathic focal dystonia. Twenty patients with torticollis, nine with
writer's cramp, two with blepharospasm and 16 healthy control subjects
participated. In the first task, the blindfolded subject matched the
position of the passively moved forearm with the opposite forearm when the
elbow joint was slowly flexed. In a second matching task, passive movement
was replaced by stimulation of one biceps tendon with a 50-Hz vibratory
stimulus (a selective stimulus for muscle spindle Ia afferents). In normal
individuals, this stimulus produces flexion of the vibrated arm around the
elbow joint. Movement in both arms was recorded electronically. In
experiments without vibratory stimuli, dystonic subjects showed normal
movement of the tracking arm during attempts to match the position of the
passively moved arm and no difference between the arms in the initial and
final steady state positions. In experiments using vibratory stimuli,
vibration of biceps tendons in normal subjects elicited flexion of the
stimulated arm at the elbow and a matching movement of the opposite arm. In
patients with dystonia, there was a similar flexion response to the
vibratory stimulus in the stimulated arm but movement of the tracking arm
was reduced. Taken together, these experiments suggest that there is
abnormal perception of motion, but not position, in dystonic subjects.
Dystonic subjects showed bilateral abnormalities of perception of the tonic
vibration reflex which were remote from the clinically affected site. These
findings are discussed in relationship to the role of muscle spindle Ia
afferents in focal dystonia.
ARTICLES
Idiopathic focal dystonia: a disorder of muscle spindle afferent processing?
Department of Clinical Neurology, University of Sheffield, Royal Hallamshire Hospital, UK.
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