Cerebellar Modulation of Sensorimotor Associative Plasticity Is Impaired in Cervical Dystonia

BackgroundIn recent years, cervical dystonia (CD) has been recognized as a network disorder that involves not only the basal ganglia but other brain regions, such as the primary motor and somatosensory cortex, brainstem, and cerebellum. So far, the role of the cerebellum in the pathophysiology of dystonia is only poorly understood.ObjectiveThe objective of this study was to investigate the role of the cerebellum on sensorimotor associative plasticity in patients with CD.MethodsSixteen patients with CD and 13 healthy subjects received cerebellar transcranial direct current stimulation (ctDCS) followed by a paired associative stimulation (PAS) protocol based on transcranial magnetic stimulation that induces sensorimotor associative plasticity. Across three sessions the participants received excitatory anodal, inhibitory cathodal, and sham ctDCS in a double-blind crossover design. Before and after the intervention, motor cortical excitability and motor symptom severity were assessed.ResultsPAS induced an increase in motor cortical excitability in both healthy control subjects and patients with CD. In healthy subjects this effect was attenuated by both anodal and cathodal ctDCS with a stronger effect of cathodal stimulation. In patients with CD, anodal stimulation suppressed the PAS effect, whereas cathodal stimulation had no influence on PAS. Motor symptom severity was unchanged after the intervention.ConclusionsCerebellar modulation with cathodal ctDCS had no effect on sensorimotor associative plasticity in patients with CD, in contrast with the net inhibitory effect in healthy subjects. This is further evidence that the cerebello-thalamo-cortical network plays a role in the pathophysiology of dystonia. & COPY; 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Automated summary

This study aimed to investigate the role of the cerebellum in sensorimotor associative plasticity in patients with cervical dystonia (CD). Through cerebellar transcranial direct current stimulation (ctDCS) and a paired associative stimulation (PAS) protocol, it was found that cerebellar modulation had no effect on sensorimotor associative plasticity in CD patients. This provides further evidence of the role of the cerebello-thalamo-cortical network in the pathophysiology of dystonia.