Impaired white matter integrity between premotor cortex and basal ganglia in writer's cramp

Abstract

Introduction: Writer's cramp (WC) as a focal hand dystonia is characterized by abnormal postures of the hand during writing. Impaired inhibition and maladaptive plasticity in circuits linking the basal ganglia and sensorimotor cortices have been described. In particular, a dysfunction of lateral premotor cortices has been associated with impaired motor control in WC. We applied diffusion tensor imaging to identify changes in white matter connectivity between premotor regions and important cortical and subcortical structures.

Methods: Whole brain white matter tracts were reconstructed in 18 right-handed WC patients and 18 matched controls, using probabilistic fiber tracking. We restricted our analyses to left-hemispheric fibers between the middle frontal gyrus (MFG) and basal ganglia, thalamus, primary motor, and sensory cortex. Diffusion parameters (fractional anisotropy and linear anisotropy) were compared between both groups.

Results: A significant reduction in fractional anisotropy values was shown for patients (mean ± SD: 0.37 ± 0.02) vs. controls (0.39 ± 0.03) regarding fibers between the left-sided MFG and the putamen (p < 0.05). The same applied for linear anisotropy values in this connection (p < 0.05).

Conclusions: Our results suggest an impaired structural connectivity between the left-hemispheric MFG and putamen with a loss of equally aligned fibers in WC patients. This could reflect a structural basis for functional findings interpreted as altered inhibition and plasticity, both within the premotor cortex and the basal ganglia, that at last lead to the clinical symptoms of WC.

Keywords: Writer’s cramp; diffusion tensor imaging; dystonia; fiber tracking.

Figure 1

Boxplots of fractional anisotropy (FA) values of the fibers between left‐sided middle frontal gyrus and putamen (controls on the left, patients on the right)

Figure 2

All fiber tracts between left‐sided middle frontal gyrus and putamen for controls (left) and patients (right) using DEC color coding for fibers (upper row) and voxelwise FA value coding (lower row, color‐coded from blue [FA = 0] to red [FA = 1])

Figure 3

Boxplots of linear anisotropy (CL) values of the fibers between left‐sided middle frontal gyrus and putamen/pallidum (controls on the left, patients on the right)