Objective: Aim of this study is to evaluate sensori-motor connectivity associated with a multimodal BoNT/MLT teratment in CD patients using advanced Resonance Imaging (MRI) techniques.

Background: Previous neurophysiological and MRI studies in CD reported changes in cerebral circuitry and grey matter morphometry after BoNT injections [1,2], but there are no conclusive data about central effects of specific rehabilitation programs.

Methods: A cohort of CD (n=9) patients performed a longitudinal 6 months study with five MRI and clinical evaluations (TWSTRS) every 6 weeks. Timetable: T0, BoNT injection; T1 BoNT maximum effect; T2, BoNT fading effect and reinjection; T3 evaluation after 18 45 minutes session thrice a week performed with an experimental rehabilitation program of MLT called SPRInt approach (Sensorimotor Perceptive Rehabilitation Integrated approach-Clinical trial.gov NCT03247868), T4, follow-up. MRI acquisitions (1.5 T Siemens) included [a] High-resolution 3D-T1 sequence to perform cortical segmentation and [b] Diffusion Weighting Images (DWI, 64 directions; 7 b0; TR/TE=7800/109 ms, FoV=255×255 mm2, voxel 2.5 mm isometric , 46 axial slices) to perform white matter tractography. Cortical gray matter (GM) areas have been parcellated using Freesurfer (https://surfer.nmr.mgh.harvard.edu/fswiki), and used as seed points to launch white matter tractography (deterministic approach) between couples of GM cortical areas. According to literature (1,2) we studied white matter projections starting from pre and post-central sensori-motor areas, as well as on secondary motor areas. In order to investigate longitudinal changes associated with different treatments, we performed a Repeated-measure ANOVA. Results were considered statistically significant if surviving pcorr <0.05 threshold.

Results: 9 CD patients were recruited (4 M, mean age 53,7 ± 15,6 years). An increased connectivity in T3 compared with T1 was found between right precentral areas and both bilateral pericallosal sulcus and left cingulate. This results correlated with a significative reduction in TWSTRS score. Moreover, an increased connectivity was found in the interval T4-T3 between right postcentral sulcus and inferior temporal gyrus.

Conclusions: These results highlight the association between a combined therapeutic approach and changes in brain connectivity in CD patients. Recorded changes mostly involve areas of sensori-motor integration and are associated with symptoms severity reduction and with an increasing in quality of life.

References: 1) Delnooz CCS, et al. Neurobiology of Disease 2015; 73:327–333. 2) Delnooz CCS, et al. PLOS ONE 2013; 8(5): e62877.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-a-combined-approach-with-botulinum-toxin-bont-and-motor-learning-techniques-mlt-on-sensori-motor-functional-connectivity-in-patients-with-cervical-dystonia-cd/