Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients.

RESUMO -Realizamos análise epidemiológica de 164 pacientes com AVC, cujo primeiro episódio ocorreu entre 15 e 49 anos de idade através de um estudo retrospectivo de pacientes ambulatoriais. O principal tipo de apresentação foi AVC isquêmico (AVCI) em 141 pacientes, ocorrendo AVC hemorrágico (AVCH) em16 casos e 7 pacientes com trombose venosa. A presença de fatores de risco aterotrombóticos foi prevalente, em 48,22% dos pacientes com AVCI sendo que a hipertensão arterial sistêmica (HAS), nos casos de AVCH, foi a etiologia mais frequente. Em 32% dos casos não se pode determinar a sua causa. Embora a população jovem possua determinantes diferentes e geralmente deva ter uma investigação etiológica mais abrangente, no grupo estudado foram prevalentes os fatores de risco conhecidos e potencialmente controláveis, sugerindo que campanhas de prevenção e detecção precoce devam ser incentivados.PALAVRAS-CHAVE: acidente vascular cerebral, fatores de riscos, epidemiologia. Stroke in young adults: analysis of 164 patientsABSTRACT -We retrospectively analyzed the epidemiological features of 164 out-clinic patients with a firstonset stroke between 15 and 49 years old. Ischemic stroke occurred in 141 patients, hemorrhagic stroke in 16 patients, and venous thrombosis in 7 patients. .orty-eight percent of ischemic strokes were atherothrombotic, but no etiology was found in 32% of patients with ischemic stroke. Systemic arterial hypertension was the most frequent etiology in the hemorrhagic stroke group. The most frequent risk factors were systemic arterial hypertension, smoking, hypercholesterolemia, alcoholism and diabetes mellitus. Although stroke in young adults deserves some specific etiological investigation, we found that ordinary risk factors such as hypertension, tabacco use, hypercolesteremia and diabetes were prevalent in our population. It seems that prevention campaigns should be the target of our work.

-We studied patients with cervical dystonia (CD) to determine clinical features and response to botulinum toxin A (BoNT/A). Patients were submitted to clinical, laboratory and neuroimaging evaluation. BoNT/A was injected locally in 81 patients using electromyographic guidance. Four patients who had had previous treatment were considered to be in remission. The average ages at onset of focal dystonia and segmental dystonia were greater than for generalized dystonia (p<0.0003). The severity of the abnormal head-neck movements were more severe among the patients with generalized dystonia (p<0.001). Pain in the cervical area was noted in 59 patients. It was not possible to determine the etiology of the disease in 62.3% of patients. Tardive dystonia was the most common secondary etiology. A major improvement in the motor symptoms of CD and pain was observed in patients following treatment with BoNT/A. The tardive dystonia subgroup did not respond to the treatment. Dysphagia was observed in 2.35% of the patients.Key WorDs: dystonia, cervical dystonia, botulinum toxin, dysphagia. Distonia cervical: aspectos clínicos e terapêuticos de 85 pacientesResumo -Para identificar os aspectos clínicos e a resposta a toxina botulínica A (TxBA), pacientes com distonia cervical (DC) foram submetidos a avaliação clínica, laboratorial e neuroimagem. o tratamento com TxBA foi aplicado a 81 pacientes guiado por eletroneuromiografia. Quatro pacientes, com tratamento prévio, foram considerados em remissão. A média de idade de início dos sintomas de pacientes com distonia focal e segmentar foi maior que a encontrada em pacientes com distonia generalizada (p<0,0003). A gravidade das alterações motoras cervicais foi maior entre os pacientes com distonia generalizada que nos pacientes com distonia focal (p<0,001). Graus diferentes de dor na região cervical foram relatados por 59 dos pacientes. Não foi possível determinar a etiologia da doença em 62,3% dos pacientes sendo distonia tardia a mais comum. Houve acentuada melhora dos sintomas motores e da dor da DC com a aplicação de TxBA. o subgrupo de pacientes com distonia tardia não respondeu ao tratamento. Disfagia ocorreu em 2,35% dos pacientes.PAlAvrAs-CHAve: distonia, distonia cervical, toxina botulínica, disfagia.