Increased cortico-striatal connectivity during motor practice contributes to the consolidation of motor memory in writer's cramp patients

• We examined the dynamics of brain processes during motor practice in writer's cramp.
• Patients over-recruited the premotor areas and striatum during motor practice.
• Practice-related activation and connectivity were reduced in hippocampal circuits.
• Premotor–striatal connectivity correlated with consolidation of motor performance.
• Patients recruited an alternative cortico-striatal circuit to create new motor memories.

Sensorimotor representations of movements are created in the sensorimotor network through repeated practice to support successful and effortless performance. Writer's cramp (WC) is a disorder acquired through extensive practice of finger movements, and it is likely associated with the abnormal acquisition of sensorimotor representations. We investigated (i) the activation and connectivity changes in the brain network supporting the acquisition of sensorimotor representations of finger sequences in patients with WC and (ii) the link between these changes and consolidation of motor performance 24 h after the initial practice. Twenty-two patients with WC and 22 age-matched healthy volunteers practiced a complex sequence with the right (pathological) hand during functional MRI recording. Speed and accuracy were measured immediately before and after practice (day 1) and 24 h after practice (day 2). The two groups reached equivalent motor performance on day 1 and day 2. During motor practice, patients with WC had (i) reduced hippocampal activation and hippocampal–striatal functional connectivity; and (ii) overactivation of premotor–striatal areas, whose connectivity correlated with motor performance after consolidation. These results suggest that patients with WC use alternative networks to reach equiperformance in the acquisition of new motor memories.