Somatosensory Processing in Focal Hand Dystonia
Recruitment status was: Recruiting
Patients with focal dystonia experience uncontrollable movements of the hand during certain types of skilled movements. Though the origin of the disorder is not fully understood, it is thought that brain areas involved in moving the hands and receiving touch information from the hands, are involved. For example, patients with dystonia affecting the hand show changes in their ability to perceive touch - this is something that typically escapes the patients own awareness. Further, the area of the brain receiving touch information has a disrupted representation of the finger skin surfaces.
The goal of our research is to improve dystonia symptoms in patients with hand dystonia. We will attempt to achieve this goal by implementing an intensive training treatment that requires patients to attend to, and use touch information applied to specific fingertips. Previous work has attempted to alter touch perception using sensory training and improvements in motor control (hand writing) of dystonia patients were observed. For example, learning to read Braille improves tactile perception and handwriting in focal hand dystonia. A different approach to treat focal hand dystonia involves a technique called repetitive transcranial magnetic stimulation (rTMS), and this can also temporarily improve hand writing in dystonia patients. The proposed research will attempt to alter touch processing using touch training alone, or in combination with rTMS. Rather than train using Braille reading, the sensory training will be applied using a systematic, experimenter controlled stimulus set that focuses on touch stimuli applied to individual digits. Importantly patients will have to associate certain types of touch information with rewards and other touch input with the lack of a reward.
The study will first involve measuring the location and representation of the touch in the brain using multiple brain mapping tools. These tools include functional magnetic resonance imaging and magnetoencephalography; when both tools are used a very accurate picture of finger representation can be obtained, and we also know what brain areas respond to touch stimuli. Dystonia symptoms and touch perception will also be assessed. Next, patients will participate in a training intervention that involves 15 days(2.5 hr/day) of touch training applied to the fingertips of the dystonia affected hand. Patients will identify the touch targets amongst distractors and receive on-line performance feedback. The goal of the training is to provide the cortex with regular boundaries of fingers and in this way, attempt to re-shape the sensory cortex to accept these boundaries. Another group of patients will receive rTMS. The goal of the rTMS is to create an environment in sensory cortex that is open or 'ready' to accept changes induced by tactile stimulation. The rTMS will be immediately followed by the tactile training. A third group of patients will receive a placebo version of rTMS followed by tactile training. The latter group will allow us to understand if rTMS has a definite effect on the physiology of the patient. Following the 15-day training, we will assess the brains representation of fingertips, changes in dystonia symptoms and changes in the perception of touch stimuli.
This research will advance the treatment of focal hand dystonia and assist the design of precise remediation training tailored to the dystonia patient.
|Focal Hand Dystonia Musician's Dystonia Writer's Cramp Dystonic Cramp||Other: Tactile training + sham rTMS Other: Tactile training + rTMS|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Tactile Operant Conditioning To Alleviate Focal Hand Dystonia Symptoms|
- Dystonia Rating Scale [ Time Frame: 4 weeks ]
- Neuroimaging maps of digit representation [ Time Frame: 4 weeks ]
|Study Start Date:||May 2007|
|Estimated Study Completion Date:||July 2008|
|Sham Comparator: 1||
Other: Tactile training + sham rTMS
tactile training for 2.5/hr/day for 15 days - this plus the sham rTMS
|Active Comparator: 2||
Other: Tactile training + rTMS
tactile training 2.5/hr/day for 15 days plus daily 5Hz rTMS
Please refer to this study by its ClinicalTrials.gov identifier: NCT00579033
|Contact: Aimee J Nelson, PhDfirstname.lastname@example.org|
|Contact: Robert Chen, MDemail@example.com|
|Toronto Western Hosptial||Recruiting|
|Toronto, Ontario, Canada, M5T2S8|
|Contact: Aimee J Nelson, PhD 416-603-5792 firstname.lastname@example.org|
|Contact: Carolyn Gunraj, MSc 416-603-5792 email@example.com|
|Principal Investigator: Aimee J Nelson, PhD|
|Principal Investigator: Chen Robert, MSc, MBB CHir|
|Principal Investigator:||Aimee J Nelson, PhD||Toronto Western Research Institute, University of Waterloo|