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Motor network reorganization associated with rTMS-induced writing improvement in writer's cramp dystonia
Journal article   Open access   Peer reviewed

Motor network reorganization associated with rTMS-induced writing improvement in writer's cramp dystonia

Noreen Bukhari-Parlakturk, Patrick J. Mulcahey, Michael W. Lutz, Rabia Ghazi, Ziping Huang, Moritz Dannhauer, Pichet Termsarasab, Burton Scott, Zeynep B. Simsek, Skylar Groves, …
Brain stimulation, v 18(2), pp 198-210
01 Mar 2025
DOI: https://doi.org/10.1016/j.brs.2025.02.005
PMID: 39924101
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.brs.2025.02.005View
Published, Version of Record (VoR) Open

Abstract

Motor network Transcranial magnetic stimulation Writer's cramp Dystonia
Writer's cramp (WC) dystonia is an involuntary movement disorder with distributed abnormalities in the brain's motor network. Prior studies established the potential for repetitive transcranial magnetic stimulation (rTMS) to either premotor cortex (PMC) or primary somatosensory cortex (PSC) to modify symptoms. However, clinical effects have been modest with limited understanding of the neural mechanisms hindering therapeutic advancement of this promising approach. This study aimed to understand the motor network effects of rTMS in WC that correspond with behavioral efficacy. We hypothesized that behavioral efficacy is associated with modulation of cortical and subcortical regions of the motor network. In a double-blind, cross-over design, twelve WC participants underwent rTMS in one of three conditions (Sham-TMS, 10 Hz PSC-rTMS, 10 Hz PMC-rTMS) while engaged in a writing task to activate dystonic movements and measure writing fluency. Brain connectivity was evaluated using task-based fMRI after each TMS session. 10 Hz rTMS to PSC, but not PMC, significantly improved writing dysfluency. PSC-TMS also significantly weakened cortico-basal ganglia, cortico-cerebellum, and intra-cerebellum functional connectivity (FC), and strengthened striatal FC relative to Sham. Change in PSC and SPC BOLD activity were associated with reduced dysfluent writing behavior. 10 Hz rTMS to PSC improved writing dysfluency by redistributing motor network connectivity and strengthening somatosensory-parietal connectivity. A key signature for effective stimulation at PSC and improvement in writing dysfluency may be strengthening of intra-cortical connectivity between primary somatosensory and superior parietal cortices. These findings offer mechanistic hypotheses to advance the therapeutic application of TMS for dystonia. •10 Hz repetitive TMS to somatosensory cortex reduces writing dysfluency in dystonia.•Increased somatosensory cortex activity correlates with reduced writing dysfluency.•In dystonia + sham-TMS, writing dysfluency correlates with cerebellar connectivity.•10 Hz rTMS to somatosensory cortex induces reorganization of the motor network.

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Domestic collaboration
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Web of Science research areas
Clinical Neurology
Neurosciences
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