Article

The pathophysiology of focal hand dystonia (FHD) has not yet
been completely clarified. Although there is a loss of inhibition at multiple
levels of the central nervous system, maladaptive plasticity of the cerebral
cortex as well as impairments in sensory and motor representations have also been
reported. All of these abnormalities can be viewed as an epiphenomenon of the
primary--still unknown--abnormality underlying focal dystonia. The purpose of
this review is to describe the underlying constructs of novel nonpharmacologic
approaches for the treatment
of FHD. Alternative or complementary approaches to
botulinum toxin injections such as behavioral training strategies and brain
stimulation techniques are reviewed. None of the proposed treatments appears to
be definitive and applicable to all patients with FHD. Each treatment strategy
elicited some benefit in a fraction of patients. The combination of more than one
approach (retraining, immobilization, botulinum toxin, neuromodulation, etc.)
could lead to a better control of FHD.

Langue : ANGLAIS