publications

2025

1. dystonia

   Long-term (seven-year) follow-up of sensory-motor rehabilitation therapy for task-specific focal hand dystonia

   Katherine Butler, Anna Sadnicka, Mark J Edwards, and Jennifer Freeman

   Journal of Hand Therapy, 2025

   Abs DOI

   Background: Medical treatments for task-specific dystonia (TSD) often have limited long-term success, leading to interest in rehabilitative approaches. Our previous feasibility study supported the acceptability and short-term benefits of sensory-motor rehabilitation for a cohort of 12 individuals. Long-term outcomes remain unknown. Purpose: Investigate the long-term (7 year) follow-up of clinical outcomes and treatment effectiveness in participants with TSD who engaged in our previous feasibility study. Methods: Online surveys and telephone interviews were undertaken at 1 and 7 years. A telephone interview was completed at 7 years. Results: All 12 participants (seven musicians dystonia, five writing dystonia) who had completed the original feasibility study took part. All showed improvements in clinical outcomes at one and 7 years (effect sizes 0.25-0.93). Interviews and surveys indicated continued use of effective rehabilitation strategies 7 years after completing the program. Discussion: Following treatment, people continue to use rehabilitative strategies, perceived by them as effective, with sustained benefits across varying domains for up to 7 years. Conclusions: Benefits of sensory-motor rehabilitation can be sustained. The underlying mechanisms of these changes require investigation.

2. functional

   

   Going ‘meta’: a systematic review of metacognition and functional neurological disorder

   Anna Sadnicka, Ann-Marie Strudwick, John P Grogan, Sanjay Manohar, and 1 more author

   Brain Communications, Jan 2025

   Abs DOI

   In functional neurological disorder (FND), there is a fundamental disconnect between an apparently intact nervous system and the individuals’ ability to consistently perform motor actions, perceive sensory signals and/or access effective cognition. Metacognition, the capacity to self-evaluate cognitive performance, appears highly relevant to FND pathophysiology. Poor metacognition is a potential mechanism via which abnormal models of self and the state of the world could arise and persist unchecked. There is therefore a justified enthusiasm that studies of metacognition may give substance to FND’s intangible nature. However, many assume an impairment in metacognition even though experimental studies are still in their infancy. This systematic review provides an analytical checkpoint of the evidence after the first five years of experimental work. We firstly summarize current methods for testing metacognition, prerequisite knowledge that allows readers to independently evaluate the evidence. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we then screened the 21 articles on this topic and review the experimental data of the eight studies that specifically tested metacognition in subjects with FND. Questionnaire metrics used to estimate global metacognition and general confidence in FND revealed a mixed picture of low or normal confidence. Of the five studies that used performance-controlled metrics, the gold-standard to estimate local metacognition in FND, four found metacognition to be equivalent to healthy controls and one paper supported impaired metacognition. We consequently try and broaden the debate and discuss alternative headline scenarios. We review how positive studies may offer insight and debate whether null studies could represent false negatives. However, since most studies find equivalent metacognition to controls, we also discuss whether metacognition could be intact and how this could inform mechanistic models of FND and have potential clinical utility. In summary, this review highlights signal of interest within the data, exposes current limitations and flags the many open questions.

3. dystonia

   The Lows of High Reward: Choking Under Pressure

   Anna Sadnicka, and Mark J. Edwards

   Jan 2025

   DOI

2024

1. clinical academia

   

   Core needs and diverse opportunity: A survey of academic clinical lecturers and the effects of the COVID-19 pandemic

   Anna Sadnicka, Anthony Howard, Rama Hakim, Jane Luker, and 2 more authors

   Future Healthcare Journal, Jan 2024

   Abs DOI PDF

   During a clinical lecturer role, parallel clinical and academic training is undertaken. The anticipation is that a lectureship represents an exciting and expansive time. However, a national crisis has been declared at the clinical lecturer level with a leaky pipeline of clinical academics resulting in dwindling numbers. Clinical lecturers are infrequently represented as a group partly due to their distributed nature and diverse job plans. We conducted a survey of clinical lecturers in the UK. Responses (n = 107) revealed a motivated but divided workforce. A content analysis revealed core elements that sculpt an individual’s success or failure, but these were variably present. COVID-19 had a negative effect on many with various strategies reported to try and reset academic trajectories. Feelings of isolation and anxiety about a viable future in academia were significant findings. This echoes calls for a greater number of secure longer-term grants to ensure that clinical academics and their skills are retained within the research workforce. A continued effort to analytically appraise whether supportive elements are in place for all lecturers will help focus initiatives to foster excellence in clinical academic training for everyone.

2. book chapter

   Cerebral Cavernous Malformations

   Anna Sadnicka, and Sumanjit K Gill

   In Stroke Medicine: Case Studies from Queen Square, Jan 2024
3. dystonia

   

   Boundaries of task-specificity: bimanual finger dexterity is reduced in musician’s dystonia

   Anna Sadnicka, Tobias Wiestler, Katherine Butler, Eckart Altenmuller, and 3 more authors

   Nature Scientific Reports, Jan 2024

   Abs DOI

   Task-specific dystonia leads to loss of sensorimotor control for a particular motor skill. Although focal in nature, it is hugely disabling and can terminate professional careers in musicians. Biomarkers for underlying mechanism and severity are much needed. In this study, we designed a keyboard device that measured the forces generated at all fingertips during individual finger presses. By reliably quantifying overflow to other fingers in the instructed (enslaving) and contralateral hand (mirroring) we explored whether this task could differentiate between musicians with and without dystonia. 20 right-handed professional musicians (11 with dystonia) generated isometric flexion forces with the instructed finger to match 25%, 50% or 75% of maximal voluntary contraction for that finger. Enslaving was estimated as a linear slope of the forces applied across all instructed/uninstructed finger combinations. Musicians with dystonia had a small but robust loss of finger dexterity. There was increased enslaving and mirroring, primarily during use of the symptomatic hand (enslaving p = 0.003; mirroring p = 0.016), and to a lesser extent with the asymptomatic hand (enslaving p = 0.052; mirroring p = 0.062). Increased enslaving and mirroring were seen across all combinations of finger pairs. In addition, enslaving was exaggerated across symptomatic fingers when more than one finger was clinically affected. Task-specific dystonia therefore appears to express along a gradient, most severe in the affected skill with subtle and general motor control dysfunction in the background. Recognition of this provides a more nuanced understanding of the sensorimotor control deficits at play and can inform therapeutic options for this highly disabling disorder.

2023

1. dystonia

   

   Intact finger representation within primary sensorimotor cortex of musician’s dystonia

   Anna Sadnicka, Tobias Wiestler, Katherine Butler, Eckart Altenmuller, and 3 more authors

   Brain, Jan 2023

   Abs DOI

   Musician’s dystonia presents with a persistent deterioration of motor control during musical performance. A predominant hypothesis has been that this is underpinned by maladaptive neural changes to the somatotopic organization of finger representations within primary somatosensory cortex. Here, we tested this hypothesis by investigating the finger-specific activity patterns in the primary somatosensory and motor cortex using functional MRI and multivariate pattern analysis in nine musicians with dystonia and nine healthy musicians. A purpose-built keyboard device allowed characterization of activity patterns elicited during passive extension and active finger presses of individual fingers. We analysed the data using both traditional spatial analysis and state-of-the art multivariate analyses. Our analysis reveals that digit representations in musicians were poorly captured by spatial analyses. An optimized spatial metric found clear somatotopy but no difference in the spatial geometry between fingers with dystonia. Representational similarity analysis was confirmed as a more reliable technique than all spatial metrics evaluated. Significantly, the dissimilarity architecture was equivalent for musicians with and without dystonia. No expansion or spatial shift of digit representation maps were found in the symptomatic group. Our results therefore indicate that the neural representation of generic finger maps in primary sensorimotor cortex is intact in musician’s dystonia. These results speak against the idea that task-specific dystonia is associated with a distorted hand somatotopy and lend weight to an alternative hypothesis that task-specific dystonia is due to a higher-order disruption of skill encoding. Such a formulation can better explain the task-specific deficit and offers alternative inroads for therapeutic interventions.

2. dystonia

   Physiology of dystonia: Human studies

   Petra Fischer, Dan Piña-Fuentes, Panagiotis Kassavetis, and Anna Sadnicka

   In International Review of Neurobiology, Jan 2023

   DOI PDF
3. phenomenology

   

   Between nothing and everything: phenomenology in movement disorders

   Anna Sadnicka, and Mark John Edwards

   Movement Disorders, Jan 2023

   Abs DOI

   In movement disorders, phenomenology refers to the science and art of classifying abnormal movements. Traditional clinical practice has been based on phenotype-driven investigation, diagnosis, and management. However, many have questioned our continued reliance on phenotype. Phenotype has been repeatedly demonstrated to be an unreliable guide to the precise lower-level pathophysiological process. After all, a single phenotype can be caused by multiple diseases and a single genetic disorder can be associated with varied phenotypes. There has been a growing call for molecular subtyping to have priority in scientific research. In this Viewpoint, we redebate the relevance of phenotype, arguing that we may be using phenotype in the wrong way. We discuss how a better appreciation of this many-diseases-to-few-phenotypes process can allow our experimental literature to be more effectively understood. We suggest that the convergence of many diseases onto a limited number of phenotypic patterns may reflect the fact that the sensorimotor system can only “break” in a limited number of ways. Therefore, if we can understand the system-level processes that underpin specific phenotypes, this could unlock novel phenotype-specific therapies regardless of the specific underlying disease process. Encouragingly, many existing therapeutic tools such as neuromodulation already target system-level processes.

4. hot topic

   A Caudal Twist in the Tale: The Spinal Cord and Dystonia

   Anna Sadnicka, and Anna Latorre

   Movement Disorders, Jan 2023

   PDF
5. book

   Basic and Translational Applications of the Network Theory for Dystonia

   Aasef Shaikh, and Anna Sadnicka

   Jan 2023

   DOI

2022

1. neurophysiology

   

   Consensus paper: novel directions and next steps of non-invasive brain stimulation of the cerebellum in health and disease

   Mario Manto, Georgios PD Argyropoulos, Tommaso Bocci, Pablo A Celnik, and 7 more authors

   The Cerebellum, Jan 2022

   DOI
2. dystonia

   

   Dystonia

   Anna Sadnicka, Anne-Marthe Meppelink, Adam Kalinowski, Pippa Oakeshott, and 1 more author

   bmj, Jan 2022

   DOI PDF
3. dystonia

   

   A critical investigation of cerebellar associative learning in isolated dystonia

   Anna Sadnicka, Lorenzo Rocchi, Anna Latorre, Elena Antelmi, and 7 more authors

   Movement Disorders, Jan 2022

   DOI

2021

1. letter

   Computational neuroscience with global accessibility

   Anna Sadnicka, Lydia Mardell, and Sven Bestmann

   The Lancet Neurology, Jan 2021

   PDF
2. neurophysiology

   

   The expanding horizon of neural stimulation for hyperkinetic movement disorders

   Anna Latorre, Lorenzo Rocchi, and Anna Sadnicka

   Frontiers in Neurology, Jan 2021

   DOI
3. editorial

   Advances in Invasive and Non-invasive Brain Stimulation for Dystonia and Other Hyperkinetic Movement Disorders

   Tommaso Bocci, Maria Knikou, Giacomo Koch, and Anna Sadnicka

   Jan 2021

   DOI

2020

1. functional

   

   Reduced drift rate: a biomarker of impaired information processing in functional movement disorders

   Anna Sadnicka, Corinna Daum, Anne-Marthe Meppelink, Sanjay Manohar, and 1 more author

   Brain, Jan 2020

   DOI PDF
2. dystonia

   

   Plasticity and dystonia: a hypothesis shrouded in variability

   Anna Sadnicka, and Masashi Hamada

   Experimental Brain Research, Jan 2020

   DOI PDF

2019

1. motor control

   

   Neural competitive queuing of ordinal structure underlies skilled sequential action

   Katja Kornysheva, Daniel Bush, Sofie S Meyer, Anna Sadnicka, and 2 more authors

   Neuron, Jan 2019

   PDF
2. dystonia

   Linking pathological oscillations with altered temporal processing in Parkinsons disease: neurophysiological mechanisms and implications for neuromodulation

   Martijn Beudel, Anna Sadnicka, Mark Edwards, and Bauke M De Jong

   Frontiers in Neurology, Jan 2019
3. dystonia

   

   What can kinematic studies tell us about the mechanisms of dystonia?

   Anna Sadnicka, Joseph Galea, and Mark J Edwards

   Progress in brain research, Jan 2019

   Abs PDF

   Background: Impaired eyeblink conditioning is often cited as evidence for cerebellar dysfunction in isolated dystonia yet the results from individual studies are conflicting and underpowered. Objective: To systematically examine the influence of dystonia, dystonia subtype, and clinical features over eyeblink conditioning within a statistical model which controlled for the covariates age and sex. Methods: Original neurophysiological data from all published studies (until 2019) were shared and compared to an age- and sex-matched control group. Two raters blinded to participant identity rescored all recordings (6732 trials). After higher inter-rater agreement was confirmed, mean conditioning per block across raters was entered into a mixed repetitive measures model. Results: Isolated dystonia (P = 0.517) and the subtypes of isolated dystonia (cervical dystonia, DYT-TOR1A, DYT-THAP1, and focal hand dystonia) had similar levels of eyeblink conditioning relative to controls. The presence of tremor did not significantly influence levels of eyeblink conditioning. A large range of eyeblink conditioning behavior was seen in both health and dystonia and sample size estimates are provided for future studies. Conclusions: The similarity of eyeblink conditioning behavior in dystonia and controls is against a global cerebellar learning deficit in isolated dystonia. Precise mechanisms for how the cerebellum interplays mechanistically with other key neuroanatomical nodes within the dystonic network remains an open research question. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.

4. dystonia

   

   A motor control model of task-specific dystonia and its rehabilitation

   Anna Sadnicka, and Jaume Rosset-Llobet

   Progress in Brain Research, Jan 2019

   PDF

2018

1. dystonia

   

   A unifying motor control framework for task-specific dystonia

   Anna Sadnicka, Katja Kornysheva, John C Rothwell, and Mark J Edwards

   Nature Reviews Neurology, Jan 2018

   PDF
2. dystonia

   

   High motor variability in DYT1 dystonia is associated with impaired visuomotor adaptation

   Anna Sadnicka, Anna Stevenson, Kailash P Bhatia, John C Rothwell, and 2 more authors

   Nature Scientific Reports, Jan 2018

   PDF
3. dystonia

   

   Sensory–motor rehabilitation therapy for task-specific focal hand dystonia: A feasibility study

   Katherine Butler, Anna Sadnicka, Jennifer Freeman, Anne-Marthe Meppelink, and 3 more authors

   Hand Therapy, Jan 2018

   PDF
4. myoclonus-dystonia

   

   Delineating cerebellar mechanisms in DYT11 myoclonus-dystonia

   Anna Sadnicka, Joseph M Galea, Jui-Cheng Chen, Thomas T Warner, and 3 more authors

   Movement Disorders, Jan 2018

   PDF
5. dystonia

   Reappraising the role of motor surround inhibition in dystonia

   Panagiotis Kassavetis, Anna Sadnicka, Tabish A Saifee, Isabel Pareés, and 4 more authors

   Journal of the Neurological Sciences, Jan 2018

   PDF
6. dystonia

   Cervical dystonia: Normal auditory mismatch negativity and abnormal somatosensory mismatch negativity

   Jui-Cheng Chen, Antonella Macerollo, Anna Sadnicka, Min-Kuei Lu, and 5 more authors

   Clinical Neurophysiology, Jan 2018
7. editorial

   

   What’s in a name? Conundrums common to the task-specific disorders

   Anna Sadnicka, and Katja Kornysheva

   Movement Disorders Clinical Practice, Jan 2018

   PDF

2017

1. dystonia

   

   Mind the gap: temporal discrimination and dystonia

   A Sadnicka, C Daum, C Cordivari, KP Bhatia, and 3 more authors

   European Journal of Neurology, Jan 2017

   PDF
2. clinical

   The crossed flexor plantar response in patients with Klippel-Feil syndrome

   Anna Sadnicka, and Simon F Farmer

   Case Reports in Neurology, Jan 2017

2016

1. neurophysiology

   Abnormal movement-related suppression of sensory evoked potentials in upper limb dystonia

   A Macerollo, JC Chen, I Parees, A Sadnicka, and 5 more authors

   European journal of neurology, Jan 2016
2. dystonia

   Task-specific dystonia: pathophysiology and management

   Anna Sadnicka, Panagiotis Kassavetis, Isabel Pareés, Anne Marthe Meppelink, and 2 more authors

   Journal of Neurology, Neurosurgery & Psychiatry, Jan 2016

   PDF

2015

1. dystonia

   All in the blink of an eye: new insight into cerebellar and brainstem function in DYT 1 and DYT 6 dystonia

   A Sadnicka, JT Teo, M Kojovic, I Pareés, and 7 more authors

   European journal of neurology, Jan 2015

   PDF
2. neurophysiology

   Tremor in Charcot-Marie-Tooth disease: no evidence of cerebellar dysfunction

   Tabish A Saifee, Isabel Pareés, Panagiotis Kassavetis, Diego Kaski, and 7 more authors

   Clinical Neurophysiology, Jan 2015
3. hot topic

   The influence of reward and punishment on motor learning

   Anna Sadnicka, and Mark J Edwards

   Movement disorders, Jan 2015

   PDF

2014

1. neurophysiology

   Non-invasive cerebellar stimulation—a consensus paper

   Giuliana Grimaldi, Georgios P Argyropoulos, Andreas Boehringer, Pablo Celnik, and 7 more authors

   The Cerebellum, Jan 2014
2. functional

   Physical precipitating factors in functional movement disorders

   Isabel Pareés, Maja Kojovic, Carolina Pires, Ignacio Rubio-Agusti, and 7 more authors

   Journal of the neurological sciences, Jan 2014
3. dystonia

   Motor sequence learning and motor adaptation in primary cervical dystonia

   Petra Katschnig-Winter, Petra Schwingenschuh, Marco Davare, Anna Sadnicka, and 4 more authors

   Journal of Clinical Neuroscience, Jan 2014
4. neurophysiology

   The neurophysiological features of myoclonus-dystonia and differentiation from other dystonias

   Traian Popa, Paolo Milani, Aliénor Richard, Cécile Hubsch, and 7 more authors

   JAMA neurology, Jan 2014
5. neurophysiology

   Cerebellar stimulation fails to modulate motor cortex plasticity in writing dystonia

   Anna Sadnicka, Masashi Hamada, Kailash P Bhatia, John C Rothwell, and 1 more author

   Movement Disorders, Jan 2014

   PDF
6. neurophysiology

   Motor ‘surround inhibition’is not correlated with activity in surround muscles

   Panagiotis Kassavetis, Anna Sadnicka, Tabish A Saifee, Daniele Belvisi, and 5 more authors

   European Journal of Neuroscience, Jan 2014
7. dystonia

   A reflection on plasticity research in writing dystonia

   Anna Sadnicka, Masashi Hamada, Kailash P Bhatia, John C Rothwell, and 1 more author

   Movement Disorders, Jan 2014

   PDF
8. neurophysiology

   Normal motor adaptation in cervical dystonia: a fundamental cerebellar computation is intact

   Anna Sadnicka, Bansi Patani, Tabish A Saifee, Panagiotis Kassavetis, and 6 more authors

   The Cerebellum, Jan 2014

   PDF

2013

1. functional

   Failure of explicit movement control in patients with functional motor symptoms

   Isabel Pareés, Panagiotis Kassavetis, Tabish A Saifee, Anna Sadnicka, and 5 more authors

   Movement Disorders, Jan 2013
2. dystonia

   Pallidal stimulation for cervical dystonia does not correct abnormal temporal discrimination

   Anna Sadnicka, Okka Kimmich, Claudia Pisarek, Diane Ruge, and 7 more authors

   Movement Disorders, Jan 2013

   PDF
3. neurophysiology

   Cerebellar transcranial direct current stimulation does not alter motor surround inhibition

   Anna Sadnicka, Panagiotis Kassavetis, Tabish A Saifee, Isabel Pareés, and 2 more authors

   International Journal of Neuroscience, Jan 2013

   PDF
4. clinical

   Primary progressive multiple sclerosis developing in the context of young onset Parkinson’s disease

   Anna Sadnicka, Una-Marie Sheerin, Charles Kaplan, Sophie Molloy, and 1 more author

   Multiple Sclerosis Journal, Jan 2013
5. functional

   Functional (psychogenic) symptoms in Parkinson’s disease

   Isabel Pareés, Tabish A Saifee, Maja Kojovic, Panagiotis Kassavetis, and 4 more authors

   Movement Disorders, Jan 2013

2012

1. dystonia

   The cerebellum in dystonia–help or hindrance?

   A Sadnicka, BS Hoffland, KP Bhatia, BP Van De Warrenburg, and 1 more author

   Clinical Neurophysiology, Jan 2012

   PDF
2. neurophysiology

   Cerebellar modulation of human associative plasticity

   Masashi Hamada, Gionata Strigaro, Nagako Murase, Anna Sadnicka, and 3 more authors

   The Journal of physiology, Jan 2012

   PDF
3. functional

   ‘Jumping to conclusions’ bias in functional movement disorders

   Isabel Pareés, Panagiotis Kassavetis, Tabish A Saifee, Anna Sadnicka, and 3 more authors

   Journal of Neurology, Neurosurgery & Psychiatry, Jan 2012
4. neurophysiology

   Adaptation of surround inhibition in the human motor system

   P Kassavetis, TA Saifee, A Sadnicka, I Pareés, and 3 more authors

   Experimental brain research, Jan 2012
5. dystonia

   The brighter side of music in dystonia

   Maja Kojovic, Isabel Pareés, Anna Sadnicka, Panagiotis Kassavetis, and 6 more authors

   Archives of neurology, Jan 2012

2011

1. clinical

   Rituximab in the treatment of three coexistent neurological autoimmune diseases: chronic inflammatory demyelinating polyradiculoneuropathy, Morvan syndrome and myasthenia gravis

   Anna Sadnicka, Mary M Reilly, Cath Mummery, Sebastian Brandner, and 2 more authors

   Journal of Neurology, Neurosurgery & Psychiatry, Jan 2011

2007

1. clinical

   Motor points for the neuromuscular blockade of the subscapularis muscle

   Tim P Harrison, Anna Sadnicka, and Deborah M Eastwood

   Archives of physical medicine and rehabilitation, Jan 2007

2006

1. education

   An evaluation of the introduction of computer-assisted learning into the dissection room

   Anna Sadnicka, Tim Harrison, and Ian Johnson

   Clinical Anatomy, Jan 2006

2004

1. clinical

   Morbidity and determinants of health on youth expeditions

   Anna Sadnicka, Roland Walker, and Jon Dallimore

   Wilderness & Environmental Medicine, Jan 2004