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Christine Delmaire, MD; Marie Vidailhet, MD, PhD; Demian Wassermann; Maxime Descoteaux, PhD; Romain Valabregue, PhD; Frédéric Bourdain, MD; Christophe Lenglet, PhD; Sophie Sangla, MD, PhD; Axel Terrier, MD; Rachid Deriche, PhD; Stéphane Lehéricy, MD, PhD

Arch Neurol. 2009;66(4):502-508.

Objective  To determine whether there are diffusion abnormalities along the fibers connecting sensorimotor regions, including the primary sensorimotor areas and the striatum, in patients with writer's cramp using voxel-based diffusion analysis and fiber tracking. Recent studies have shown structural changes in these regions in writer's cramp.

Design  Patient and control group comparison.

Setting  Referral center for movement disorders.

Participants  Twenty-six right-handed patients with writer's cramp and 26 right-handed healthy control subjects matched for sex and age.

Interventions  Clinical motor evaluations.

Main Outcome Measures  Fractional anisotropy changes and results of fiber tracking in writer's cramp.

Results  Diffusion-tensor imaging revealed increased fractional anisotropy bilaterally in the white matter of the posterior limb of the internal capsule and adjacent structures in the patients with writer's cramp. Fiber tracking demonstrated that fractional anisotropy changes involve fiber tracts connecting the primary sensorimotor areas with subcortical structures.

Conclusions  Diffusion abnormalities are present in fiber tracts connecting the primary sensorimotor areas with subcortical structures in writer's cramp. These abnormalities strengthen the role of the corticosubcortical pathways in the pathophysiologic mechanisms of writer's cramp.

Author Affiliations: Department of Neuroradiology, Centre Hospitalier Régional Universitaire Roger Salengro, Lille, France (Dr Delmaire); Center for NeuroImaging Research (Drs Delmaire, Valabregue, and Lehéricy), Institut National de la Santé et de la Récherche Médicale (INSERM) U610 (Drs Delmaire and Lehéricy), Departments of Neurology (Drs Vidailhet and Sangla) and Neuroradiology (Dr Lehéricy), and INSERM U679 (Dr Vidailhet), Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris, and Department of Neurology, Hôpital Foch (Dr Bourdain), Paris, France; Institut National de Recherche en Informatique et en Automatique, Odyssee Project Team, Sophia Antipolis, France (Mr Wassermann and Drs Descoteaux and Deriche); Siemens, Princeton, New Jersey (Dr Lenglet); and Department of Physiology, Centre Hospitalier Universitaire Nantes, Nantes, France (Dr Terrier).

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