Explicit Agency in Patients with Cervical Dystonia: Altered Recognition of Temporal Discrepancies between Motor Actions and Their Feedback.

Cécile Delorme,Emmanuel Roze,Marie Vidailhet,Jean-Michel Mayer,David Grabli,Yulia Worbe,Bertrand Degos,Yuqing Li

doi:10.1371/journal.pone.0162191

Abstract

BackgroundAbnormalities in the cognitive processing of movement have been demonstrated in patients with dystonia. The sense of agency, which is the experience of initiating and controlling one’s own actions, has never before been studied in these patients.ObjectivesWe investigated whether the sense of agency is altered in patients with cervical dystonia.MethodsWe used an explicit metacognitive agency task in which participants had to catch targets with a cursor by moving a computer’s mouse. The task included several conditions in which the control over the cursor could be disrupted by adding a spatial or a temporal discrepancy between the mouse and the cursor’s movements. Participants had to acknowledge these discrepancies and reflect them in metacognitive judgements of agency.ResultsTwenty cervical dystonia patients and 20 matched controls were included in the study. Despite performing equally well as the matched controls, cervical dystonia patients did not fully recognize alterations of agency when a temporal lag was added between their movement and the visual feedback. Moreover, they relied predominantly on their perceived performance to provide judgements of agency and less on their objective degree of controls. There was no correlation between agency scores and clinical severity of dystonia measured by the Toronto Western Spasmodic Torticollis Rating Scale.ConclusionWe demonstrated an abnormal processing of agency in cervical dystonia patients, even for motor actions not affected by dystonia. The exact contribution of abnormal agency to dystonia pathophysiology remains to be clarified.

Highlights

Dystonia is characterized by sustained or intermittent involuntary muscle contractions causing abnormal, repetitive movements, or abnormal postures [1]
Twenty cervical dystonia patients and 20 matched controls were included in the study
Despite performing well as the matched controls, cervical dystonia patients did not fully recognize alterations of agency when a temporal lag was added between their movement and the visual feedback

Summary

Introduction

Dystonia is characterized by sustained or intermittent involuntary muscle contractions causing abnormal, repetitive movements, or abnormal postures [1]. Primary dysfunctions associated with dystonia include loss of inhibition at various levels of the central nervous system, alteration of synaptic plasticity, and sensory dysfunction [2]. Experimental studies have noted alterations of spatial [5] and temporal discrimination [6] of sensory stimuli in a variety of focal and generalized dystonia syndromes. Beyond motor organization and execution, abnormal cognitive processing of movement has been shown in dystonia, including alterations of movement and body representation [9], mental rotation of body parts [10], and temporal processing of movement [11]. Abnormalities in the cognitive processing of movement have been demonstrated in patients with dystonia. The sense of agency, which is the experience of initiating and controlling one’s own actions, has never before been studied in these patients

Objectives

Results

Conclusion