An intriguing feature in a minority of OCD patients, that may go unnoticed as being linked to the disorder, is the so-called focal dystonia. Or rather: a focal dystonia, because there are diverse types of it. This is a problem with muscle co-ordination, and/or the inability to inhibit muscle contraction, or repeated, involuntary muscle contractions.
Apparently, dystonia is caused by a problem in a brain layer called the sensorimotor cortex. In this layer, that covers the brain, there is a topographical map of body parts, e.g. the fingers, and legs. Normally, fingers each have their own little space on this map, and they are separated. But in a dystonia, distinctions have become blurred, or separate spaced have simply fused. Thus, normal feedback signals from muscles, telling the brain about their current state, gets distorted. Movements are timed inappropriately, and even antagonist muscles in a hand may co-contract, thereby making trained and normally ‘unconscious’ movements impossible.
The following pictures give you an idea of how the mapping in the somatosensory cortex (adjacent to the sensorimotor cortex) actually occurs in the brain. Please try to grasp the idea; the weblog is not aiming to make an anatomist of you. The layer itself is pictured in the brain, and the diverse body parts are named at the spot where they are represented on the map:
I myself suffer from writer’s cramp, which means that my original writing hand, the left, can’t write anymore (well, so clumsy and full of conscious effort that it can hardly be called writing – I can’t write in any relaxed way for more than a minute, and it is awfully slow, so slow that I often write a word completely different from that what I had intended to, because my attention drifts away; I can’t keep that where I want it). I try to write occasionally with my right hand, but that is nigh on impossible, it simply is against my nature. I took a long therapy with a neuropsychologist, who works with feedback that tells one what exactly the current running though a muscle is; and by looking at the counter one has to try to keep that as low as possible. But that did not work either. The last resort in dystonias is the use of something we all know from the ghastly and ghostly world of celebrity culture: botox. Botox is derived from a bacterial poison, called botulinum toxin. In very diluted form it relaxes mucles (hence the expression-free faces at every Oscar Night…). But I decided not to go this way. Firstly, botox does not solve the problem, it removes the symptom, for a brief period. Second, I could not really find good information on the long-term effects of botox for movements that are fine-tuned and must be highly co-ordinated. So, perhaps someday my nerve-muscle pathways may get slowly re-programmed (starting in the sensorimotor cortex); or this may never happen. We will see.
This photo shows how contorted a writing hand can be with this form of cramp:
…and here’s a nice photo of actress Jenny McCarthy, who openly admits that she uses botox injections. Since she’s 38 years of age, I’m inclined to believe her:
(Oh yeah: I found the piccie of Jenny, above, on the priceless and very maliciously humouristic site http://www.awfulplasticsurgery.com – to be visited when you’ve had a few and want to know how you might look, if you’d have a lot of dosh on the side…)
Focal dystonias can end careers. That’s how taxing they can be. From the Wikipedia Encyclopedia, I copied the following paragraph. Then you’ll have better idea of how it affects a person:
Musicians affected by focal dystonia include Leon Fleisher, of the Peabody Conservatory of Music, who had suffered from this affliction in his right hand, as did Alex Klein, formerly the first oboist of the Chicago Symphony, Ernestine Whitman, former member of the Atlanta Symphony and currently a professor of flute at Lawrence University, pianist and keyboard player Keith Emerson, guitarist Dominic Frasca, and the pianist Gary Graffman, who performs exclusively with his left hand. Former principal tuba of the New York Philharmonic, Warren Deck was diagnosed with focal dystonia of the upper lip in 2001, ending his playing career. In 2005, New Age acoustic guitarist Billy McLaughlin announced via his website that he is suffering from focal dystonia, which severely limits his ability to play right-handed (and as a result, he taught himself to play left-handed). British-Canadian Classical Guitarist Liona Boyd had to give up her professional career as Canada’s “First Lady of the Guitar” due to focal dystonia drastically affecting her right hand. Another musician to be afflicted by this condition is shred guitarist Terry Syrek, who recorded his entire album “AUM” with just two fully functioning fingers of his fret hand. A well known bass guitarist, Andy Billups, who plays with British rock act The Hamsters, has also made a partial recovery from this disorder and continued to play by using modified guitar plectrums to make up for the limited function of his right hand. Classical guitarist David Leisner has recovered the full use of his hand and has returned successfully to the concert stage and recording studio in the early 1990s after a decade of disability. British guitarist Jon Berry of Black River Forge developed the condition in his left fretting hand in 2007 and has now started recovery by Prof. Joaquín Fabra’s method which has been successfully applied by many musicians, including guitar player Sebastián Gauna who made a short documentary about his complete recovery. Brazilian singer-guitarist Badi Assad was diagnosed with focal dystonia in 1999 (after having been misdiagnosed with carpal tunnel syndrome). She eventually recovered and was able to resume her career. Tom Adams, a professional bluegrass banjo player, has focal dystonia in his right hand, had to give up playing banjo, and now plays the guitar. Scott Adams, the writer of the Dilbert comics, is also afflicted with focal dystonia of the hand, which impedes his artwork.
Here’s a photo of a guitar player’s hand, of which the ring finger cannot be controlled, it turns ‘inwards’ to the palm all of the time:
Now a photo of famous rock keyboard player Keith Emerson, of Emerson, Lake, & Palmer fame:
And finally, a picture of comic writer Scott Adams, and his creation Dilbert. Scott has focal dystonia and therefore his drawing abilities are impaired:
A good scientific article connecting focal dystonias with psychiatric disorders is:
Lencer, R. et al (2009): Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles, in: J. Neurol. Neurosurg. Psychiatry, 80: 1176-1179. Click on: http://jnnp.bmj.com/content/80/10/1176.full.pdf
Here are a few facts from this article:
Prevalence of a psychiatric or personality disorder occurring in people with a focal dystonia is 70,9%. The nature of the disorder may be, in descending order of frequency:
- social phobia
- agoraphobia (intense fear for wide open spaces)
- panic disorder
- obsessive-compulsive disorder
- avoidant personality disorder
Except for social phobia, the psychiatric condition always precedes onset of the dystonia (and I can attest to this – my writer’s cramp became manifest in 1993, whereas OCD became gravely incapacitating in 1982 at the latest, first as very intrusive obsessions, and compulsions soon after that). Finally, Lencer et al profiled the character of patients with focal dystonias; these turned out to be agreeable (tendency to please); conscientious, but less open (perhaps the psychiatric problem made them more introvert and shameful).