BACKGROUND: Although dystonia is traditionally conceptualized as a basal ganglia disorder, increasing interest has been directed at a different neural network node, the cerebellum, which may play a significant role in the pathophysiology of dystonia. Abnormal sensorimotor processing and disturbed motor schemes, possibly attributable to cerebellar changes, remain unclear. METHODS: We sought to characterize the extent of cerebellar dysfunction within the motor network using functional MRI activation analysis, connectivity analysis, and voxel-based morphometry in cervical dystonia patients (n = 25, 15 women, mean age 45.8 years) and healthy volunteers (n = 25, 15 women, mean age 44.7 years) in a visuospatial task requiring predictive motor timing. RESULTS: Cervical dystonia patients showed decreased activation in the posterior cerebellar lobules as well as in the premotor areas, the associative parietal cortex, and visual regions. Patients also had decreased cerebellar connectivity with bilateral basal ganglia structures and the dorsolateral prefrontal cortex. CONCLUSIONS: This promotes the view that dystonia results from miscommunication between the basal ganglia and cerebellar loops, thus providing new insights into the brain regions essential for the development of cervical dystonia. © 2017 International Parkinson and Movement Disorder Society.

1st Department of Neurology Faculty of Medicine Masaryk University and St Anne's Teaching Hospital Brno Czech Republic

Central European Institute of Technology CEITEC MU Multimodal and Functional Neuroimaging Research Group Masaryk University Brno Czech Republic

Central European Institute of Technology Central European Institute of Technology Masaryk University Behavioral and Social Neuroscience Research Group Masaryk University Brno Czech Republic

Department of Imaging Methods Masaryk University and St Anne's Teaching Hospital Brno Czech Republic

Department of Neurology School of Medicine University of Minnesota Minneapolis USA

Department of Psychiatry Faculty of Medicine Masaryk University and Teaching Hospital Brno Brno Czech Republic

Department of Psychiatry Université de Montréal Montréal Québec Canada

Functional Neuroimaging Unit Research Center of the Geriatric Institute affiliated with the Université de Montréal Montréal Québec Canada

Institut du Cerveau et de la Moelle épinière ICM Centre de NeuroImagerie de Recherche Centre de Neuro Imagerie de Recherche Sorbonne Universités University Pierre and Marie CURIE Univ Paris 06 University of Minnesota Rochester UMR 7225 ICM F 75013 ICM team Control of Normal and Abnormal Movement Paris France

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