Journal of the Neurological Sciences
Volume 201, Issue 1 , Pages 79-83, 15 September 2002

Immobilization dystonia

  • Michael S Okun

      Affiliations

    • The Neurology Service, Department of Neurology, University of Florida College of Medicine, 100 S. Newell Drive, L3-100, Gainesville, FL 32610-0236, USA
    • ,
  • Stephen E Nadeau

      Affiliations

    • The Neurology Service, Department of Neurology, University of Florida College of Medicine, 100 S. Newell Drive, L3-100, Gainesville, FL 32610-0236, USA
    • The Geriatric Research, Education and Clinical Center, Malcom Randall DVA Medical Center, Gainesville, FL, USA
    • ,
  • Fabian Rossi

      Affiliations

    • The Neurology Service, Department of Neurology, University of Florida College of Medicine, 100 S. Newell Drive, L3-100, Gainesville, FL 32610-0236, USA
    • ,
  • William J Triggs

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +1-352-392-3491; fax: +1-352-392-6893
    • The Neurology Service, Department of Neurology, University of Florida College of Medicine, 100 S. Newell Drive, L3-100, Gainesville, FL 32610-0236, USA

Received 5 October 2001; received in revised form 9 June 2002; accepted 10 June 2002.

Abstract 

The mechanisms underlying dystonia after injury are unclear. Pain has been implicated as an important factor. We report four patients who exhibited segmental dystonia following removal of a cast, only two of whom experienced pain during casting. Recent work implicates the cerebral cortex as an important site of neural plasticity underlying the development of dystonia. Cortical changes may be induced by peripheral stimuli that are repetitive, spatially and temporally proximate, stereotyped, and attended. Immobilization by casting may meet these requirements if there is sufficiently persistent sensation of the immobilized limb to assure that it is regularly attended. The fact that all of our patients were immobilized but only two experienced pain during casting suggests that pain is not necessary and immobilization alone may be sufficient for the development of segmental dystonia after peripheral injury, consistent with the implications of animal studies.

Keywords:  Immobilization, Dystonia, Peripheral injury

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PII: S0022-510X(02)00198-3

Journal of the Neurological Sciences
Volume 201, Issue 1 , Pages 79-83, 15 September 2002

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