Increased sensorimotor and superior parietal activation correlate with reduced writing dysfluency in writer's cramp dystonia

Writers cramp (WC) dystonia is a disabling brain disorder characterized by abnormal postures during writing tasks. Although abnormalities were identified in the sensorimotor, parietal, basal ganglia, and cerebellum, the network-level interactions between these brain regions and dystonia symptoms are not well understood. This study investigated the relationship between peak accelerations, an objective measure of writing dysfluency, and functional network (FN) activation in WC and healthy volunteers (HVs). Twenty WC and 22 HV performed a writing task using a kinematic software outside an MRI scanner and repeated it during functional MRI. Group independent component analysis identified 21 FNs, with left sensorimotor, superior parietal, cerebellum, and basal ganglia FNs selected for further analysis. These FNs were activated during writing and no group differences in FN activity were observed. Correlational analysis between FN activity and peak acceleration behavior revealed that reduced activity in left sensorimotor and superior parietal FNs correlated with greater writing dysfluency in WC, a pattern distinct from HVs. These findings suggest that enhanced activation of the left sensorimotor and superior parietal networks may mitigate writing dysfluency in WC. This study provides a mechanistic hypothesis to guide the development of network-based neuromodulation therapies for WC dystonia. Authors summaryA critical barrier to advancing clinical therapies for writers cramp (WC) dystonia is the limited understanding of how brain activation patterns associate with worsening disease severity. Our study addressed this gap by integrating an objective behavioral measure of WC dystonia symptom with changes in functional network activity, revealing the direction of brain activity associated with increased symptom severity. We showed that reduced activity in the left sensorimotor and superior parietal cortices correlated with greater writing dysfluency. These findings suggested that neuromodulation strategies aimed at increasing activity in these cortical regions may offer a promising avenue for developing network-based therapies for WC dystonia. Conflict of InterestAll authors report no financial disclosures or conflicts of interest relevant to this research. Authors rolesNBP: conceptualization, data collection, data analysis, statistical analysis, and manuscript writing. PJM: data analysis, and manuscript writing. MF: data analysis. MWL: statistical analysis and manuscript review. JV: study design. SWD: data analysis advice and manuscript critique. AMM: conceptualization, data analysis critique, manuscript writing and critique.