title: Diffuse decreased gray matter in patients with idiopathic craniocervical dystonia: a voxel-based morphometry study.
abstract: BACKGROUND
  Recent studies have addressed the role of structures other than the basal ganglia in the pathophysiology of craniocervical dystonia (CCD). Neuroimaging studies have attempted to identify structural abnormalities in CCD but a clear pattern of alteration has not been established. We performed whole-brain evaluation using voxel-based morphometry (VBM) to identify patterns of gray matter (GM) changes in CCD.
  
  
  METHODS
  We compared 27 patients with CCD matched in age and gender to 54 healthy controls. VBM was used to compare GM volumes. We created a two-sample t-test corrected for subjects' age, and we tested with a level of significance of p < 0.001 and false discovery rate (FDR) correction (p < 0.05).
  
  
  RESULTS
  Voxel-based morphometry demonstrated significant reductions of GM using p < 0.001 in the cerebellar vermis IV/V, bilaterally in the superior frontal gyrus, precuneus, anterior cingulate and paracingulate, insular cortex, lingual gyrus, and calcarine fissure; in the left hemisphere in the supplementary motor area, inferior frontal gyrus, inferior parietal gyrus, temporal pole, supramarginal gyrus, rolandic operculum, hippocampus, middle occipital gyrus, cerebellar lobules IV/V, superior, and middle temporal gyri; in the right hemisphere, the middle cingulate and precentral gyrus. Our study did not report any significant result using the FDR correction. We also detected correlations between GM volume and age, disease duration, duration of botulinum toxin treatment, and the Marsden-Fahn dystonia scale scores.
  
  
  CONCLUSIONS
  We detected large clusters of GM changes chiefly in structures primarily involved in sensorimotor integration, motor planning, visuospatial function, and emotional processing.
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil.
authors.forename: Camila C
authors.initials: CC
authors.lastname: Piccinin
authors.affiliation: Department of Neurology, University of Campinas , Campinas , Brazil.
authors.forename: Luiza G
authors.initials: LG
authors.lastname: Piovesana
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil.
authors.forename: Maria C A
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Guimarães
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil.
authors.forename: Brunno M
authors.initials: BM
authors.lastname: De Campos
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil.
authors.forename: Thiago J R
authors.initials: TJ
authors.lastname: Rezende
authors.affiliation: Department of Neurology, University of Campinas , Campinas , Brazil.
authors.forename: Lidiane S
authors.initials: LS
authors.lastname: Campos
authors.affiliation: Department of Medical Genetics, University of Campinas , Campinas , Brazil.
authors.forename: Fabio R
authors.initials: FR
authors.lastname: Torres
authors.affiliation: Department of Radiology, University of Campinas , Campinas , Brazil.
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Amato-Filho
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil ; Department of Neurology, University of Campinas , Campinas , Brazil.
authors.forename: Marcondes C
authors.initials: MC
authors.lastname: França
authors.affiliation: Department of Medical Genetics, University of Campinas , Campinas , Brazil.
authors.forename: Iscia
authors.initials: I
authors.lastname: Lopes-Cendes
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil ; Department of Neurology, University of Campinas , Campinas , Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cendes
authors.affiliation: Neuroimaging Laboratory, University of Campinas , Campinas , Brazil ; Department of Neurology, University of Campinas , Campinas , Brazil.
authors.forename: Anelyssa
authors.initials: A
authors.lastname: D'Abreu
keywords: cervical dystonia; craniocervical dystonia; gray matter; neuroimaging; segmental dystonia; voxel-based morphometry