title: Evidence for altered basal ganglia-brainstem connections in cervical dystonia.
abstract: BACKGROUND
  There has been increasing interest in the interaction of the basal ganglia with the cerebellum and the brainstem in motor control and movement disorders. In addition, it has been suggested that these subcortical connections with the basal ganglia may help to coordinate a network of regions involved in mediating posture and stabilization. While studies in animal models support a role for this circuitry in the pathophysiology of the movement disorder dystonia, thus far, there is only indirect evidence for this in humans with dystonia.
  
  
  RESULTS
  In the current study we investigated probabilistic diffusion tractography in DYT1-negative patients with cervical dystonia and matched healthy control subjects, with the goal of showing that patients exhibit altered microstructure in the connectivity between the pallidum and brainstem. The brainstem regions investigated included nuclei that are known to exhibit strong connections with the cerebellum. We observed large clusters of tractography differences in patients relative to healthy controls, between the pallidum and the brainstem. Tractography was decreased in the left hemisphere and increased in the right hemisphere in patients, suggesting a potential basis for the left/right white matter asymmetry we previously observed in focal dystonia patients.
  
  
  CONCLUSIONS
  These findings support the hypothesis that connections between the basal ganglia and brainstem play a role in the pathophysiology of dystonia.
authors.affiliation: Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America. ablood@nmr.mgh.harvard.edu
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Blood
authors.forename: John K
authors.initials: JK
authors.lastname: Kuster
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Woodman
authors.forename: Namik
authors.initials: N
authors.lastname: Kirlic
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Makhlouf
authors.forename: Trisha J
authors.initials: TJ
authors.lastname: Multhaupt-Buell
authors.forename: Nikos
authors.initials: N
authors.lastname: Makris
authors.forename: Martin
authors.initials: M
authors.lastname: Parent
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Sudarsky
authors.forename: Greta
authors.initials: G
authors.lastname: Sjalander
authors.forename: Henry
authors.initials: H
authors.lastname: Breiter
authors.forename: Hans C
authors.initials: HC
authors.lastname: Breiter
authors.forename: Nutan
authors.initials: N
authors.lastname: Sharma
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000503:physiopathology*; D001921:Brain / Q000473:pathology; D001931:Brain Mapping / Q000379:methods; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology*; D016000:Cluster Analysis; D004058:Diffusion; D056324:Diffusion Tensor Imaging; D020821:Dystonic Disorders / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D011336:Probability; D014103:Torticollis / Q000503:physiopathology*