Novel nonpharmacologic perspectives for the treatment of task-specific focal hand dystonia

Narrative Review: 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. J HAND THER. 2009;22:156-62