Idiopathic cervical dystonia: Clinical characteristics

Abstract

We reviewed detailed clinical features of 266 patients with idiopathic cervical dystonia, commonly called spasmodic torticollis. Mean age at onset (41 years), female-to-male ratio (1.9:1), clustering of onset between ages 30 and 59 (70%), familial history of dystonia (12%), and remissions (9.8%) were similar to those found in previous studies. In contrast to the single prior large clinical study of this disorder, no predominance of right-handers or significant thyroid disease was found. Pain, which occurred in 75% of patients and contributed to disability score (p less than 0.01), distinguishes this syndrome from all other focal dystonias. Pain was also strongly associated with constant (vs. intermittent) head turning, severity of head turning, and presence of spasm. Eighty-three percent of patients had deviation of the head of greater than 75% of the time when sitting with the head unsupported (constant head deviation at rest). Of the 97% who had head turning, 81% also had head tilting in various combinations. The 23% with hand tremor had an older age at onset (mean, 46 vs. 41 years; p less than 0.05). An earlier age at onset (p less than 0.05) was seen in patients with a family history of dystonia (mean, 36 years), with trauma shortly preceding symptoms (mean, 36 years), with a change in the direction of head turning (mean, 30 years), and with remissions (mean, 33 years). Jerky movements or forced transient spasms of the head occurred in 62% of the patients, and these patients would be the ones for whom the designation "spasmodic torticollis" could logically apply.(ABSTRACT TRUNCATED AT 250 WORDS)

Head tremor in patients with cervical dystonia: different outcome?

“…Another large series 2 reviewed 272 patients with CD and complete information about tremor and found that 71% had tremor; 60% had associated headneck tremor, and 27% had hand tremor phenomenologically identical to essential tremor. A larger series 6 showed a prevalence of head and hand tremor, respectively, of 50% and 32% in their 231 patients with CD, different from other report with similar sample that observed in 266 CD patients 28% had head tremor and 23% hand tremor 7 . our data are similar with the aforementioned studies; we found in 118 patients with CD, that 45 (38.2%) had head tremor and 24.5% of them also had postural hand tremor.…”

Botulinum toxin type A and cervical dystonia: a seven-year follow-up

“…The high prevalence of pain (around 70% of patients) distinguishes cervical dystonia from other focal dystonias and contributes significantly to patient disability 19 . BoNT/A is highly effective in controlling pain, and its analgesic effect is sustained for a long time 3 .…”

Retrocollis, anterocollis or head tremor may predict the spreading of dystonic movements in primary cervical dystonia

“…In fact, most of patients spreaded to cranial segment, but we found a high prevalence of generalized spreading (28% of patients). Unfortunately, we did not test them for DYT1 mutation; it is known that patients with CD who are DYT1 mutation carriers are more prone to spread to generalized dystonia 1,13 .…”