Disruption of sensorimotor integration in writer's cramp : A pathophysiological study combining functional magnetic resonance imaging and high-resolution electroencephalographydécembre 2012 Directeur(s) de thèse : Pierre BURBAUD Résumé de thèse
Writer’s cramp is the most frequent form of task-specific dystonia. It is characterized by excessive and inappropriate muscle activation resulting in severe disturbance of writing. Writing is a complex sequential motor task requiring the on-line continuous monitoring of proprioceptive information to adjust the position of the upper limb and finger pressure on the pen. In this experimental work, we postulated that the main feature in the pathophysiology of writer’s cramp is a sensorimotor integration disorder. To test this hypothesis, we used two behavioral tasks that does not induce dystonic symptoms. The subject performed a motor sequence, either spontaneously (SGT task), or on the basis of a sequence of proprioceptive stimuli previously presented (ST). Changes in brain activity during both tasks were studied by coupling functional magnetic resonance imaging (fMRI) with quantitative electroencephalography (qEEG).
Our results show that writer’s cramp patients had impaired motor performances in both tasks whereas they did not exhibit any dystonic symptoms. During the analysis of proprioceptive information, fMRI shows a Bold signal decrease in the primary somatosensory cortex, the supplementary motor area (SMA) and parietal cortex. EEGq data revealed a decrease of β desynchronization (βERD) in SMA and intra-cortical coherence a disruption of the functional connectivity of parieto-premotor networks. During the motor phase, fMRI reveals no between-group difference, but EEGq showed an increase of βERD in the posterior parietal regions for the SGT task associated with an increased intra-cortical coherence. During the post-movement period, abnormal β synchronization (βERS) are also found in both tasks.
This data shows that writer’s cramp patient exhibited a disruption in the sequential analysis of proprioceptive information, as well as abnormalities in sensorymotor integration during motor planning. These features are related to an alteration of the functional relationships between the parietal and premotor cortices. These phenomenons explain why writer’s cramp patient fail to develop an appropriate motor response on the basis of sequential proprioceptive information, as in writing.