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Applications of Transcranial Magnetic Stimulation for Understanding and Treating Dystonia

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Basic and Translational Applications of the Network Theory for Dystonia

Part of the book series: Advances in Neurobiology ((NEUROBIOL,volume 31))

Abstract

Transcranial magnetic stimulation (TMS)-based studies have led to an advanced understanding of the pathophysiology of dystonia. This narrative review summarizes the TMS data contributed to the literature so far. Many studies have shown that increased motor cortex excitability, excessive sensorimotor plasticity, and abnormal sensorimotor integration are the core pathophysiological substrates for dystonia. However, an increasing body of evidence supports a more widespread network dysfunction involving many other brain regions. Repetitive TMS pulses (rTMS) in dystonia have therapeutic potential as they can induce local and network-wide effects through modulation of excitability and plasticity. The bulk of rTMS studies has targeted the premotor cortex with some promising results in focal hand dystonia. Some studies have targeted the cerebellum for cervical dystonia and the anterior cingulate cortex for blepharospasm. We believe that therapeutic potential could be leveraged better when rTMS is implemented in conjunction with standard-of-care pharmacological treatments. However, due to several limitations in the studies conducted to date, including small samples, heterogeneous populations, variability in the target sites, and inconsistencies in the study design and control arm, it is hard to draw a definite conclusion. Further studies are warranted to determine optimal targets and protocols yielding the most beneficial outcomes that will translate into meaningful clinical changes.

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Acknowledgments

We would like to acknowledge Tyler’s Hope for a Dystonia Cure Foundation.

Author Contributions

JF contributed to the writing of the first draft, conceptualization of the topic, and major revisions. ARZ was responsible for major revisions. AWS was responsible for conceptualization of the topic and major revisions. All authors agree to be accountable for the content of the work.

Financial Disclosure

AWS reports grants from the NIH and has received grant support from Benign Essential Blepharospasm Research Foundation, Dystonia Coalition, Dystonia Medical Research Foundation, National Organization for Rare Disorders, and grant support from NIH (KL2 and K23 NS092957-01A1). JF reports grants from the Dystonia Medical Research Foundation.

Funding

No funding was acquired for the writing of this article.

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Authors and Affiliations

  1. Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA

    Jessica Frey, Adolfo Ramirez-Zamora & Aparna Wagle Shukla

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  1. Jessica Frey
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  2. Adolfo Ramirez-Zamora
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  3. Aparna Wagle Shukla
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Correspondence to Aparna Wagle Shukla .

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Editors and Affiliations

  1. Departments of Neurology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA

    Aasef Shaikh

  2. Clinical Lecturer, Movement Disorders and Neuromodulation Group, St George’s University of London, London, UK

    Anna Sadnicka

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Frey, J., Ramirez-Zamora, A., Wagle Shukla, A. (2023). Applications of Transcranial Magnetic Stimulation for Understanding and Treating Dystonia. In: Shaikh, A., Sadnicka, A. (eds) Basic and Translational Applications of the Network Theory for Dystonia. Advances in Neurobiology, vol 31. Springer, Cham. https://doi.org/10.1007/978-3-031-26220-3_7

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