Brain, Vol 121, Issue 5 977-988, Copyright © 1998 by Oxford University Press
ML Byrnes, GW Thickbroom, SA Wilson, P Sacco, JM Shipman, R Stell and FL Mastaglia
Transcranial magnetic stimulation was used to investigate the properties of
the corticomotor pathway and to map the primary motor cortex projection to
hand and forearm muscles during a sustained isometric contraction in a
group of subjects with writer's cramp of varying duration. Corticomotor
threshold, motor evoked potential amplitude and latency, and silent-period
duration were normal on both sides in all subjects. The maps of the
corticomotor projection were displaced relative to normal in all subjects,
and in some cases were distorted in shape, with extensions of the lateral
borders and the emergence of almost discrete secondary motor areas. The
degree of map distortion and displacement was greatest in subjects with
long-standing writer's cramp (> 5 years), and was bilateral in some
cases. Injection of botulinum toxin into affected muscles demonstrated that
the alterations in map topography were not fixed, and could be temporarily
reversed during the period when the clinical effects of the injection were
greatest, with the maps returning to their original positions as the
effects of the injection wore off. It is concluded from this study that
there are slowly evolving reorganizational changes in the primary motor
cortex in writer's cramp, and that these changes may be secondary to
altered afferent inputs from both clinically affected and unaffected
muscles.
ARTICLES
The corticomotor representation of upper limb muscles in writer's cramp and changes following botulinum toxin injection
Australian Neuromuscular Research Institute, Department of Neurology, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Australia.
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