Focal Dystonia is a disorder characterized as excessive energy going from the brain to specific muscle groups whether it be the muscles around the eyes, jaw, neck, hands or a combination of these. The cause of this over activity is always the underlying question. There are those with a definite family history that have an obvious genetic trait leading to dystonia. There may be an unidentified genetic trait in many others that predisposes people to the onset of focal dystonia when their brain is triggered by some activating stimulus in life. In all circumstances, a specific overactive circuit develops that leads to isolated muscles becoming overstimulated resulting in involuntary movements and pain. For whatever reason, there is a group of neurons (brain cells) that begin to fire off overactive impulses to specific muscles. It is a well-used phrase that “neurons that fire together – wire together” meaning that when this group of neurons begin to fire off excessively, they wire together in a circuit to perpetuate that abnormal activity from that time on resulting in a person having to live with dystonia.
It may be an abnormality of the sensory input of the brain that develops to throw off the ability of the brain to regulate the precise motor output to those muscles. We know that the sensory tricks that most people with focal dystonia have can temporarily give the brain the sensory input that it needs to suppress the movements. In some people it may be a trauma to their body that causes an abnormal sensory input that then activates an abnormal motor output that causes the dystonia. Once those overactive neurons have wired together, the excessive motor output may then persist despite healing of the original injury. In the case of musician and other types of occupational dystonia, neurons that fired together for countless times become wired together to begin firing off in an overactive manner causing dystonic posturing of the muscles controlling the hand whenever the person plays their instrument or activity associated with their occupational dystonia.
We try to suppress this abnormal dystonic activity to the muscles with oral medication, deep brain stimulation, botulinum toxins or cutting the nerves with selective denervation. However, the dream for all people with dystonia would be to reprogram those misbehaving circuits back to their normal level or rewire these abnormally wired together neurons in order to eliminate the need for all the other medical therapies.
Neuroplasticity treatment is based on reprograming or rewiring the circuits that cause dystonia. The word Neuroplasticity means that the brain cells and their circuits are moldable and not fixed as was once thought. Our brains are not rigid organs but instead are in a dynamic ever changing state continually adapting to environmental and internal stimuli. Neuroplasticity is the basis for the benefits of positive thought as Howard Thiel has promoted for decades and discussed in many books to include the Biology of Belief, Mind over Medicine, and the books by Norman Doige- The Brain that Changes Itself and The Brain’s Way of Healing.
I have been preaching for years about the irreplaceable value of exercise as medicine (remember that I refer to this medicine’s brand name as Doesital) for improving the pain and movement control for cervical dystonia. The basis for this improvement is by promoting Neuroplasticity reprograming in the brain through the sensory feedback to the brain afforded by exercise and by activating neurotransmitter chemicals in the brain especially the chemical- brain derived neurotrophic factor (BDNF). BDNF is able to transcribe genes that promote new brain cell formations and connections (synapses ) between the neurons. This results in formation of healthier circuitry that seem to take over for the abnormal circuitry. This effect on the brain by positive thought and exercise involves the principles of Epigenetics that means “above genetics”. This indicates that rather than being victims to the genes we are born with, we can turn on or turn off genes to our benefit through the right activation such as thought, diet and exercise. I have observed people with dystonia have permanent improvement through these techniques that promote Neuroplasticity either on their own and through programs such as currently with Mikki Townsend, Phd RPT, or previously Abigail’s ST Recovery Clinic. We now need to determine the way to bring these benefits of Neuroplasticity to a larger group of people with dystonia.
Departments of Neuroplasticity are being formed in many Universities to do research to discover how to use these techniques for treating many brain disorders to include traumatic brain injury, MS, autism and stroke while others are working specifically for determining how to promote Neuroplasticity to treat dystonia. One of these researchers is Dr Joaquin Farias from the University of Toronto. After his initial training and research in Spain, he has been working on the Dystonia project since 1995 and has been successful in helping many patients to establish better control of their dystonic movements to include professional musicians with occupational limb dystonia and others with cervical dystonia. He has done a TED talk on this topic that you can watch on his web site or on you tube. He has written a book called Intertwined that gives examples of dystonia patients treated through Neuroplasticity techniques and will have a book released in 2016 describing more specific procedures for treating dystonia. He has stated that he uses specific exercises, music and thought to produce more efficient motor inhibition of dystonic movements. The process is specific to each individual based on what fits with that person’s unique brain and what sensory tricks work for each individual. WE ARE FORTUNATE THAT DR FARIAS HAS AGREED TO SPEAK AT OUR NEXT SYMPOSIUM COMING UP IN CHATTANOOGA, TENNESSEE NEXT OCTOBER 1 AT WHICH TIME HE WILL DISCUSS HIS NEW BOOK and we can all learn how this process can add to our therapeutic armamentarium.
I think that we are on the verge of discovering another dimension in the treatment of dystonia at its source through the process of Neuroplasticity training. Something we already know is that the Neuroplastic changes do not occur well if the person is in a state of stress. This flight or fight state that activates the sympathetic nervous system is a condition that too many people are in on a daily basis although it is meant for survival in emergency situations and derails healing. In order for Neuroplastic healing to occur, we need to activate the parasympathetic nervous system response that counteracts the sympathetic response to produce a calm and restful state that prepares the ground to reap the benefits of the Neuroplasticity exercises. This can be accomplished through stress release practices to include mindful breathing, yoga and meditation that everyone can do now to prepare yourself for what is to come in the field of Neuroplasticity training.
There is also promise in the near future in promoting Neuroplasticity changes through devices that stimulate brain circuits to include the PONS ( Portable Neuromodulation Stimulator) device, the Cranial Electrotherapy stimulator or Transcranial Magnetic stimulator. The DBS (deep brain stimulator device) that many people with dystonia have had implanted surgically is likely working on the basis of Neuroplasticity. It typically takes months for the benefits of DBS to be realized after the surgery during which time the abnormal brain circuits of dystonia are being rewired. It is the hope that there will become a way to accomplish this rewiring without surgical intervention.
It is also recognized by researchers that when using the devices or doing the exercises, Neuroplastic changes occur better when an active thought process is engaged. Neuroplasticity requires an active participation of the entire person. An example of this and of someone who has worked with Neuroplastic exercises on his own is one of my patients, Mark Galligan of Gig Harbor, WA. He has given permission to use his name and see the video of his accomplishments. He has very prominent segmental dystonia involving disabling anterocollis cervical dystonia, jaw dystonia and blepharospasm. He has had his sensory trick of putting his arm on top of his head so his wife suggested trying a weight like a book on his head. However it was only when he focused on balancing the book on his head would the dystonic movements be suppressed. He has worked on this daily with smaller objects to the point that he can now suppress the dystonia movements by balancing his keys on his head. Without this trick he could not tolerate walking for more than a few minutes, but is now able to walk for miles as long as he is balancing even a small object on his head. It is the goal to work toward him being able to just visualize balancing an object to control his previously severe dystonia.
We have yet much to learn how much these Neuroplastic concepts will help and which individuals with dystonia will respond to these options. However, in the meantime, I would like to challenge you to utilize physical exercise, positive thought and nutritious dietary means to promote positive brain circuitry changes. Each of these are demonstrated at the annual ST/Dystonia symposium. I also encourage people to try to work with your sensory tricks in a way to produce sustained suppression of the dystonia. We will be learning better how specifically to do this from guidance from those researching this topic such as Dr Farias. I would appreciate many people trying balancing a book on your head trick as Mark did by starting to balance a wide large book. It will benefit us all to learn how many others can be helped by this trick or other innovative tricks that will give your brain the sensori-motor feedback and me the feedback on what you observe at Hoganpsn@aol.com along with any other insights you may have into the principles of Neuroplasticity.
Dr Patrick Hogan
Puget Sound Neurology
Puget Sound Neurology
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