title: Increased volume and impaired function: the role of the basal ganglia in writer's cramp.
abstract: BACKGROUND
  The pathophysiology of writer's cramp, a task-specific dystonia, remains unclear. The objective of this study was to investigate the basal ganglia circuit and the cerebellum during a complex motor sequence learning task carried out with the nonaffected hand in writer's cramp patients.
  
  
  METHODS
  We applied structural and functional imaging in 22 writer's cramp patients and 28 matched controls using 3T MRI. With the asymptomatic left hand all participants learned a complex, sequential, five-element sequence-tapping task as accurately and quickly as possible. Functional imaging was measured during a repeated (15 times), fixed block design with tapping (30 sec) and rest (30 sec). Additionally, gray matter volume of the basal ganglia was analyzed using voxel-based morphometry (VBM).
  
  
  RESULTS
  While behavior was comparable between groups, after small volume correction the anterior part of the right putamen and the left globus pallidus exhibited reduced blood oxygen level-dependent (BOLD) activity in patients during the sequential finger-tapping task. VBM analysis showed larger gray matter volume bilateral in the posterior part of the putamen and globus pallidus. There were no group differences in the cerebellum.
  
  
  CONCLUSIONS
  The results indicate an impairment of anterior basal ganglia loops involved in producing complex sequential movements of the unaffected hand. These findings are in line with previous reports of reduced neuronal activity in the globus pallidus internus. Higher gray matter volume of the putamen and globus pallidus may stem from elevated activity of the direct pathway, which could reflect a compensatory phenomenon or a primary predisposition, that is, endophenotypic trait.
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Kirsten E
authors: KE
authors: Zeuner
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Arne
authors: A
authors: Knutzen
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Oliver
authors: O
authors: Granert
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Julia
authors: J
authors: Götz
authors: Department of Neuroradiology, Kiel University Kiel, Germany.
authors: Stephan
authors: S
authors: Wolff
authors: Department of Neuroradiology, Kiel University Kiel, Germany.
authors: Olav
authors: O
authors: Jansen
authors: Movement Disorders Section, Department of Neurology, Hannover Medical School Hannover, Germany.
authors: Dirk
authors: D
authors: Dressler
authors: Department of Neurology, University of Düsseldorf Düsseldorf, Germany.
authors: Harald
authors: H
authors: Hefter
authors: Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland.
authors: Mark
authors: M
authors: Hallett
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Günther
authors: G
authors: Deuschl
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Thilo
authors: T
authors: van Eimeren
authors: Department of Neurology, Kiel University Kiel, Germany.
authors: Karsten
authors: K
authors: Witt
mesh_terms: D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology; D020821:Dystonic Disorders / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged
keywords: Focal hand dystonia; functional magnetic resonance imaging; motor learning; voxel-based morphometry; writer's cramp
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