Inhibitory rTMS in Dystonic Wilson Patients
Inhibitory rTMS in Dystonic Wilson Patients
Wilson disease is a genetic disorder resulting in copper accumulation in liver, brain and
 eye. The neurologic complications include dystonic syndrome, which is a prolonged and
 excessive muscle activation responsible for abnormal postures. Hand dystonia prevents daily
 life activities such as writing, which is particularly disabling, since writing is the only
 mean of communication in these patients with significant slurred speech. Treatment is limited
 and only partially effective.

 Low frequency (<or=1Hz) repetitive transcranial magnetic stimulation (rTMS) has shown
 inhibiting properties when applied over the cortex. Since dystonia has been correlated to
 hyperactivation of the neurons of the somatosensory cortex (SSC), we hypothesize that one
 single 20-minute session of 1 Hz rTMS applied on left SSC will improve writing of the right
 dystonic hand, assessed immediately at the end of the session.
This study investigates the handwriting performance of an homogeneous cohort of patients with
 Wilson disease and right handed dystonia, after one single inhibitory repetitive transcranial
 magnetic stimulation (rTMS). Fifteen patients with focal right hand dystonia will receive
 randomly either active or sham rTMS (1 Hz) to the left somatosensory cortex (SSC) in one
 single 20 minutes session. Handwriting performance will be measured immediately after this
 unique session (Visual analogic scale of subjective discomfort in writing, DPRE and WCRS
 scales, pen pressure and pen velocity measured on touchpad), compared to scores obtained 24
 hours before the session. Three days later, the patient will receive the other session (sham
 rTMS or active rTMS) and the same parameters will be evaluated.

 This is a single-center, randomized, crossover, prospective, clinical and double-blind study
 (the rTMS session is performed by the neurophysiologist, but the patient and the neurologist
 who will perform the handwriting evaluation are blind to the session).
Inclusion Criteria:

 -  Wilson disease with focal right hand dystonia

 -  No modification of medical treatment for 6 months

 -  No botulinum toxin administration within the past four months

 -  Right handed

 -  Focal right hand dystonia

 -  Cerebral Magnetic Resonance performed the last 6 months with no other lesion than met
 in Wilson disease

 -  Over 18

 -  Insurance policy holder

 -  Informed consent

 Exclusion Criteria:

 -  Pregnant woman

 -  Guardianship procedure

 -  Seizure history

 -  Other cerebral lesions on cerebral MRI than met in Wilson Disease

 -  Unable to stay quiet for 30 minutes

 -  Handwriting impossible

 -  Contra-indications to repetitive Transcranial Magnetic Stimulation