title: Anodal transcranial direct current stimulation to the cerebellum improves handwriting and cyclic drawing kinematics in focal hand dystonia.
abstract: There is increasing evidence that the cerebellum has a role in the pathophysiology of primary focal hand dystonia and might provide an intervention target for non-invasive brain stimulation to improve function of the affected hand. The primary objective of this study was to determine if cerebellar transcranial direct current stimulation (tDCS) improves handwriting and cyclic drawing kinematics in people with hand dystonia, by reducing cerebellar-brain inhibition (CBI) evoked by transcranial magnetic stimulation (TMS). Eight people with dystonia (5 writer's dystonia, 3 musician's dystonia) and eight age-matched controls completed the study and underwent cerebellar anodal, cathodal and sham tDCS in separate sessions. Dystonia severity was assessed using the Writer's Cramp Rating Scale (WRCS) and the Arm Dystonia Disability Scale (ADDS). The kinematic measures that differentiated the groups were; mean stroke frequency during handwriting and fast cyclic drawing and average pen pressure during light cyclic drawing. TMS measures of cortical excitability were no different between people with FHD and controls. There was a moderate, negative relationship between TMS-evoked CBI at baseline and the WRCS in dystonia. Anodal cerebellar tDCS reduced handwriting mean stroke frequency and average pen pressure, and increased speed and reduced pen pressure during fast cyclic drawing. Kinematic measures were not associated with a decrease in CBI within an individual. In conclusion, cerebellar anodal tDCS appeared to improve kinematics of handwriting and circle drawing tasks; but the underlying neurophysiological mechanism remains uncertain. A study in a larger homogeneous population is needed to further investigate the possible therapeutic benefit of cerebellar tDCS in dystonia.
authors.affiliation: Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW, Australia ; Discipline of Physiotherapy, School of Health Sciences, Flinders University Adelaide, SA, Australia.
authors.forename: Lynley V
authors.initials: LV
authors.lastname: Bradnam
authors.affiliation: Discipline of Physiotherapy, School of Health Sciences, Flinders University Adelaide, SA, Australia.
authors.forename: Lynton J
authors.initials: LJ
authors.lastname: Graetz
authors.affiliation: Sansom Institute for Health Research, School of Health Sciences, University of South Australia Adelaide, SA, Australia.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: McDonnell
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide Adelaide, SA, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ridding
keywords: cerebellar-brain inhibition; cerebellum; focal hand dystonia; handwriting; kinematics; transcranial direct current stimulation