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

Abstract

-Background and Purpose: Few studies have attempted to develop clinical predictors for cervical dystonia (CD) aiming at progression of the dystonic movement. Method: We retrospectively evaluated 73 patients with primary CD who underwent treatment with Botulinum toxin type-A (BTX-A). The patients were assembled in two groups according to the spread of dystonia during follow-up: spreading and non-spreading CD. We performed a binary logistic regression model using spreading of cervical dystonia as dependent variable aiming to find covariates which increase the risk of spreading. Results: Our logistic regression model found the following covariates and their respective risk ratios: time of disease >18.5 months=2.4, retrocollis=1.9, anterocollis=1.8, head tremor=1.6. Conclusion: Time of disease >18.5 months, retrocollis, anterocollis and head tremor may predict spreading of dystonic movement to other regions of the body in CD patients.Key WOrDs: cervical dystonia, progression, retrocollis, anterocollis, head tremor. Retrocolis, anterocolis ou tremor cefálico podem predizer a progressão dos movimentos distônicos em pacientes com distonia cervical primáriaResumo -Introdução: Poucos estudos avaliam preditores clínicos de progressão dos movimentos distônicos, para além da região cervical, em pacientes com distonia cervical (DC) primária. Método: Avaliamos, retrospectivamente, 73 pacientes com DC primária, que tinham sido submetidos ao tratamento com a toxina botulínica tipo A (BTX-A). estes pacientes foram divididos em dois grupos de acordo com a progressão ou não da DC para outras áreas do corpo. Aplicamos um modelo de regressão logística binária usando a progressão da distonia como variável dependente com o objetivo de identificar co-variáveis que aumentassem o risco de progressão. Resultados: O modelo de regressão logístico identificou as seguintes co-variáveis como preditoras de progressão e seus respectivos índices de risco: tempo de doença >18,5 meses=2,4, retrocolis=1,9, anterocolis=1,8, tremor cefálico=1,6. Conclusão: Tempo de doença >18,5 meses, retrocolis, anterocolis, e tremor cefálico podem predizer a progressão do movimento distônico para outras regiões do corpo em pacientes com DC primária.PAlAvrAs-ChAve: distonia cervical, progressão, retrocolis, anterocolis, tremor cefálico.

Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study

“…Clinical features including tremor predominant dystonia, effectiveness of sensory tricks and alcohol responsivity were evaluated for their potential association with risk of dystonia spread. The presence of tremor related to an increased risk of spread in a recent long-term follow-up study of different primary focal dystonia patients,10 whereas in a separate retrospective study tremor did not relate to risk of spread in patients with CD 9. Our results suggest the presence of tremor-dominant dystonia is associated with an increased risk of spread, but this relationship did not reach our significance threshold (HR=1.98, p=0.061).…”

“…The most common form of isolated dystonia is adult-onset focal dystonia that primarily affects one body region, such as the upper face, neck, limb or larynx 3. At onset, dystonia typically affects only one body region, but with time dystonia can spread to involve other contiguous or distant regions of the body and lead to greater disability dependent on what body region or regions become involved 4–13…”

“…For example, age at onset and positive family history have been reported to relate to risk of spread,5 8 10 but other studies have not found such relationships 6 12 17. Tremor also may increase or decrease the risk of spread in patients with CD 9 10. Whether the presence of a sensory trick (geste antagoniste) or alcohol responsiveness contribute to risk of spread is not known.…”

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

“…This number is much smaller than the 33 to 34.3% of spreading found in other studies 13,18 . However, the difficulties in measuring the spread of symptoms because not all patients were available for the second assessment should also be stressed.…”

“…Of these, only one did not need further treatment and was thus considered to have had complete remission. The influence of BoNT/A on the spread of and remission from CD remains to be further elucidated 18 .…”