Sabino Dagostino1, Tommaso Ercoli2, Angelo F Gigante3, Roberta Pellicciari3, Laura Fadda2, Giovanni Defazio2. 1. Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, AOU Cagliari, SS 554 bivio per Sestu, Cagliari, Italy. Electronic address: sab.dagostino@gmail.com. 2. Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, AOU Cagliari, SS 554 bivio per Sestu, Cagliari, Italy. 3. Department of Basic Medical Sciences, Neurosciences and Sense Organs, "Aldo Moro" University of Bari, AOUC - Policlinico Bari, Piazza Giulio Cesare 11, Bari, Italy.
Abstract
INTRODUCTION: Sensory trick is a specific maneuver that temporarily improves dystonia that is usually observed in 44%-89% of patients with cranial-cervical dystonia and in 20% of patients with upper limb dystonia. This study aimed to assess the prevalence of sensory trick in a cohort of 37 patients with idiopathic adult-onset upper limb dystonia and to determine whether sensory trick can be a useful tool to distinguish dystonic and non-dystonic tremor. METHODS: Thirty-seven right-handed patients with idiopathic upper limb dystonia and disturbed handwriting and 19 patients with non-dystonic action tremor in the upper limb causing writing disturbances participated into the study. Patients were asked to write a standard sentence twice, before and after applying a standardized sensory trick (gently grabbing right wrist with his left hand). Readability of the two sentences was assessed by three observers blinded to diagnosis. RESULTS: Five/37 patients (13%) self-discovered ST over disease history, while performing the standardized trick maneuver improved handwriting in 14/37 patients (38%). Interobserver agreement on the effectiveness of sensory trick among the three observers yielded a kappa value of 0.86 (p < 0.0001). The standardized trick was effective in 8/19 patients with dystonic tremor (42%) and in 0/19 patients with non-dystonic tremor (p = 0.003). CONCLUSION: The results of applying a standardized non-spontaneous trick demonstrated that, in upper limb dystonia, ST may be more frequent than usually observed. Effective sensory trick, when present, may be a hallmark of idiopathic dystonia. The lack of effective sensory trick may help to identify non dystonic upper limb tremor.
INTRODUCTION: Sensory trick is a specific maneuver that temporarily improves dystonia that is usually observed in 44%-89% of patients with cranial-cervical dystonia and in 20% of patients with upper limb dystonia. This study aimed to assess the prevalence of sensory trick in a cohort of 37 patients with idiopathic adult-onset upper limb dystonia and to determine whether sensory trick can be a useful tool to distinguish dystonic and non-dystonic tremor. METHODS: Thirty-seven right-handed patients with idiopathic upper limb dystonia and disturbed handwriting and 19 patients with non-dystonic action tremor in the upper limb causing writing disturbances participated into the study. Patients were asked to write a standard sentence twice, before and after applying a standardized sensory trick (gently grabbing right wrist with his left hand). Readability of the two sentences was assessed by three observers blinded to diagnosis. RESULTS: Five/37 patients (13%) self-discovered ST over disease history, while performing the standardized trick maneuver improved handwriting in 14/37 patients (38%). Interobserver agreement on the effectiveness of sensory trick among the three observers yielded a kappa value of 0.86 (p < 0.0001). The standardized trick was effective in 8/19 patients with dystonic tremor (42%) and in 0/19 patients with non-dystonic tremor (p = 0.003). CONCLUSION: The results of applying a standardized non-spontaneous trick demonstrated that, in upper limb dystonia, ST may be more frequent than usually observed. Effective sensory trick, when present, may be a hallmark of idiopathic dystonia. The lack of effective sensory trick may help to identify non dystonic upper limb tremor.
Authors: Giovanni Defazio; Mark Hallett; Alfredo Berardelli; Joel S Perlmutter; Brian D Berman; Joseph Jankovic; Tobias Bäumer; Cynthia Comella; Tommaso Ercoli; Gina Ferrazzano; Susan H Fox; Han-Joon Kim; Emile Sami Moukheiber; Sarah Pirio Richardson; Anne Weissbach; Angelo F Gigante; Hyder A Jinnah Journal: Mov Disord Clin Pract Date: 2022-08-15
Authors: Giovanni Defazio; Hyder A Jinnah; Alfredo Berardelli; Joel S Perlmutter; Gamze Kilic Berkmen; Brian D Berman; Joseph Jankovic; Tobias Bäumer; Cynthia Comella; Adam C Cotton; Tommaso Ercoli; Gina Ferrazzano; Susan Fox; Han-Joon Kim; Emile Sami Moukheiber; Sarah Pirio Richardson; Anne Weissbach; Laura J Wrigth; Mark Hallett Journal: Parkinsonism Relat Disord Date: 2021-09-08 Impact factor: 4.402
Authors: Tommaso Ercoli; Giovanni Defazio; Christian Geroin; Enrico Marcuzzo; Giovanni Fabbrini; Francesco Bono; Alessandro Mechelli; Roberto Ceravolo; Luigi Michele Romito; Alberto Albanese; Antonio Pisani; Maurizio Zibetti; Maria Concetta Altavista; Luca Maderna; Martina Petracca; Paolo Girlanda; Marcello Mario Mascia; Alfredo Berardelli; Michele Tinazzi Journal: Mov Disord Clin Pract Date: 2021-09-10