title: Effects of two weeks of cerebellar theta burst stimulation in cervical dystonia patients.
abstract: Dystonia is generally regarded as a disorder of the basal ganglia and their efferent connections to the thalamus and brainstem, but an important role of cerebellar-thalamo-cortical (CTC) circuits in the pathophysiology of dystonia has been invoked. Here in a sham controlled trial, we tested the effects of two-weeks of cerebellar continuous theta burst stimulation (cTBS) in a sample of cervical dystonia (CD) patients. Clinical evaluations were performed by administering the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). We used TMS to measure the inhibitory connectivity between the cerebellum and the contralateral motor cortex (cerebellar brain inhibition [CBI]), and the excitability of the contralateral primary motor cortex assessing intracortical inhibition (SICI), intracortical facilitation (ICF) and cortical silent period (CSP). Paired associative stimulation (PAS) was tested to evaluate the level and the topographical specificity of cortical plasticity, which is abnormally enhanced and non-focal in CD patients. Two weeks of cerebellar stimulation resulted in a small but significant clinical improvement as measured by the TWSTRS of approximately 15%. Cerebellar stimulation modified the CBI circuits and reduced the heterotopic PAS potentiation, leading to a normal pattern of topographic specific induced plasticity. These data provide novel evidence CTC circuits could be a potential target to partially control some dystonic symptoms in patients with cervical dystonia.
authors.affiliation: Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy; University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. Electronic address: g.koch@hsantalucia.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
authors.affiliation: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: Paolo
authors.initials: P
authors.lastname: Porcacchia
authors.affiliation: Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Ponzo
authors.affiliation: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: Fatima
authors.initials: F
authors.lastname: Carrillo
authors.affiliation: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Cáceres-Redondo
authors.affiliation: UOC Neurologia, Ospedale S. Eugenio, P.le dell'Umanesimo 10, 00144 Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Brusa
authors.affiliation: UOC Neurologia, Ospedale S. Eugenio, P.le dell'Umanesimo 10, 00144 Rome, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Desiato
authors.affiliation: UOC Neurologia, Ospedale S. Eugenio, P.le dell'Umanesimo 10, 00144 Rome, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Arciprete
authors.affiliation: Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Lorenzo
authors.affiliation: University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
authors.affiliation: Non-invasive Brain Stimulation Unit, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179 Rome, Italy; University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.affiliation: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Palomar
authors.affiliation: Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain. Electronic address: pmir@us.es.
authors.forename: Pablo
authors.initials: P
authors.lastname: Mir
mesh_terms: D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology; D014103:Torticollis / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation
keywords: Cerebellar-thalamo-cortical circuits; Cervical dystonia; Paired associative stimulation; cerebellar theta burst stimulation