Brain Advance Access published online on August 18, 2006
Brain, doi:10.1093/brain/awl221
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1 Human Cortical Physiology and Motor Control Laboratory, Department of Neurology, University of Wuerzburg, Wuerzburg, Germany
* To whom correspondence should be addressed. Neuronal plasticity is to be kept within operational limits to serve its purpose as a safe memory system that shapes and focuses sensory and motor representations. Temporal and spatial properties of motor cortical plasticity were assessed in patients with writer's cramp using a model of long-term potentiation (LTP) and long-term depression (LTD) of synaptic efficacy. Paired associative stimulation (PAS) combined repetitive electric stimulation of the median or ulnar nerve (MN or UN) with subsequent transcranial magnetic stimulation of the contralateral dominant motor cortex at 21.5 ms (MN-PAS21.5; UN-PAS21.5) or 10 ms (MN-PAS10). Motor-evoked potentials were recorded from abductor pollicis brevis (APB) muscle and abductor digiti minimi (ADM) muscles in 10 patients with writer's cramp and 10 matched healthy control subjects. Following MN-PAS21.5 or UN-PAS21.5 in non-dystonic subjects, motor responses increased if the afferent PAS-component came from a homologous peripheral region and remained stable with a non-homologous input. In contrast, following either MN-PAS21.5 or UN-PAS21.5, both APB- and ADM-amplitudes increased in patients. Compared with controls, this increase started earlier, its magnitude was larger and its duration longer. Following MN-PAS10 in controls, APB-amplitudes decreased, while ADM-amplitudes increased. In writer's cramp, the decrease of APB-amplitudes started earlier and lasted longer. Of note, ADM-amplitudes were decreased, too. LTP-like as well as LTD-like plasticity is abnormal with respect to both gain and spatial organization. These findings may help to develop a pathophysiological model explaining core features of focal dystonia.
Received March 8, 2006
Revised July 11, 2006
Accepted July 12, 2006
Article
The two sides of associative plasticity in writer's cramp
David Weise 1, Axel Schramm 1, Katja Stefan 2, Alexander Wolters 3, Karlheinz Reiners 1, Markus Naumann 4, and Joseph Classen 1 *
2 Human Cortical Physiology and Motor Control Laboratory, Department of Neurology, University of Wuerzburg, Wuerzburg, Germany; Present address: Department of Neurology, University of Rostock, Rostock, Germany
3 Department of Neurology, University of Rostock, Rostock, Germany
4 Human Cortical Physiology and Motor Control Laboratory, Department of Neurology, University of Wuerzburg, Wuerzburg, Germany; Present address: Neurologische Klinik und klinische Neurophysiologie, Augsburg, Germany
Joseph Classen, E-mail: classen_j{at}klinik.uni-wuerzburg.de
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