Targeting Sensory Systems in the Treatment of Dystonia: Outcomes from a Case Series

Abstract

Substantial scientific evidence has been gathered on the pathophysiology of dystonia, leading to proposed theoretical treatment protocols for rehabilitating patients with this disorder. This study aimed to assess patient outcomes following the application of novel functional neurology treatment protocols based on basic neuroscience research. A consecutive case series of patients diagnosed with dystonia and treated in a private practice setting was studied for their response to neural rehabilitation techniques based on published basic neuroscience research. Sensory stimulation techniques including non-invasive spinal cord stimulation, vestibular nerve neuromodulation based on targeted skull vibration and stimulation of reciprocal inhibitory nerve activity of dystonic muscles was used as novel add on therapy to standard care. The subjects included 6 cases of cervical dystonia and 3 cases of more generalized dystonia. The proposed rehabilitation procedures were explained in detail to the patients, including the investigational nature of these procedures, and written informed consent was obtained from each patient prior to treatment. Based on the comparison of total dystonia scores upon admission and prior to treatment with total dystonia scores at the completion of a course of care, all 9 patients in this case series demonstrated improvement in their dystonic symptoms after treatment. The group average pre-treatment dystonia score was 11.4, while the post-treatment group averaged dystonia score was 5.2 points. This represents a moderate, but clinically important improvement in global dystonia scores in a series of 9 patients treated in a private practice setting. Considering that dystonia is highly resistant to treatment, the improvement seen in this case series suggests that the methods involved warrant further investigation in a more formal research setting. The clinically meaningful improvements (approximately 50% for the group average) seen in these cases argue for more research into the role of the sensory systems in both the pathophysiology and treatment of dystonic conditions.