Cervical dystonia: clinical and therapeutic features in 85 patients

-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.

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confidence: 90%

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

Godeiro-Júnior

Felı́cio

Aguiar

et al. 2009

“…The pattern of CD may be of four types (torticollis, laterocollis, retrocollis or anterocollis) which may happen isolated (one type) or in combination (two or three types). Camargo et al 11 described a series with 85 patients with CD, and the most common clinical presentations were, according to the pattern: a) one type: torticollis (21 patients); b) two types: torticollis + retrocollis (19 patients); and c) three types: torticollis + laterocollis + retrocollis (09 patients). In our series, our results were different when the pattern of CD involved two or three types: a) two types: torticollis + laterocollis (12 patients in HT+ group and 17 in HT-); and in b) three type: torticollis +laterocollis + anterocollis (9 patients in each group).…”

Section: Groupsmentioning

confidence: 99%

Head tremor in patients with cervical dystonia: different outcome?

Godeiro-Júnior

Felı́cio

Aguiar

et al. 2008

-Objective:The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters. Method: We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups. Results: The occurrence of head tremor in our sample was of 38.2%. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT-one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT-group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07. Conclusion: According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.Key WorDs: cervical dystonia, head tremor, botulinum toxin type-A, outcome. Tremor cefálico em pacientes com distonia cervical: evolução diferente?Resumo -Objetivo: A associação de distonia cervical (DC) com outros transtornos do movimento já foi descrita, mas há poucos dados quanto à evolução clínica destes pacientes. Avaliamos se os pacientes com DC e tremor cefálico (TC) apresentam características clínicas e demográficas, assim como a resposta ao tratamento com toxina botulínica tipo A, diferentes. Métodos: Analisamos retrospectivamente 118 prontuários de pacientes com DC e os dividimos em dois grupos: com (TC+) e sem (TC-) tremor cefálico. Comparamos os seguintes parâmetros clínicos e demográficos entre os grupos: idade de início, duração da doença, progressão de sintomas, etiologia, história familiar, presença de tremor em mãos. Também analisamos a resposta ao tratamento com toxina botulínica de acordo com escore Tsui em ambos os grupos. Resultados: A ocorrência de tremor cefálico em nosso grupo de pacientes foi 38,2%. A ocorrência de tremor postural nas mãos em pacientes TC+ foi maior (p=0,015) e se compararmos a resposta ao tratamento com toxina botulínica em cada grupo, observamos que os pacientes com TC têm melhor evolução em uma situação de seguimento mais prolongado. No grupo TC+, o escore Tsui pré-tratamento foi 10 (6-12,5) e após o período de "follow-up" foi 8 (5,5-10,5); p<0,001. No grupo TC-, não houve diferença significante: 9 (7-12) no pré-tratamento e após período de "follow-up"; p=0,07. Conclusão: Nossos dados apontam que o tremor cefál...

“…Most voluntary muscles can be affected, and in the case of the neck muscles the condition is referred to as cervical dystonia (CD). CD is the commonest form of dystonia, and the majority of cases are focal 2,3 . The etiology of most cases of CD is unknown, but genetic and environmental factors are known to be implicated 3,4 .…”

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confidence: 99%

“…CD is the commonest form of dystonia, and the majority of cases are focal 2,3 . The etiology of most cases of CD is unknown, but genetic and environmental factors are known to be implicated 3,4 . Injections of botulinum toxin A (BoNT/A), a neurotoxin that has been extensively used to treat a variety of dystonic and non-dystonic movement disorders since the 1980s, is the treatment of choice nowadays for this condition 4,5 .…”

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confidence: 99%

“…Injections of botulinum toxin A (BoNT/A), a neurotoxin that has been extensively used to treat a variety of dystonic and non-dystonic movement disorders since the 1980s, is the treatment of choice nowadays for this condition 4,5 . The efficacy and safety of BoNT/A for CD has been proved in various studies [3][4][5][6][7] . Nevertheless, there is conflicting data regarding remission from the disease and long-term reactions to this medication 8,9 .…”

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confidence: 99%

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

Camargo

Teive

Becker

et al. 2011

Self Cite

Most cases of cervical dystonia (CD) are idiopathic, and focal injections of botulinum toxin A (BoNT/A) are the treatment of choice. The objective of our study was to document the effects of long-term BoNT/A treatment in idiopathic CD patients. Fifty-eight patients with idiopathic CD were recruited from March 2001 to May 2002. Twenty-eight of the subjects were available for reassessment after seven years. During this period, all had received regular treatment with BoNT/A injections. Clinical information about patients and the severity of CD (TWSTRS and VAPS) at baseline assessment (2001)(2002) and follow-up (2008-2009) was compared. Significant motor improvement was detected based on TWSTRS scale scores, which were used to analyze clinical severity (19.6±6.6 and 17.7±4.8; p<0.05). There was no improvement in the severity of cervical pain (p=0.43). In conclusion, BoNT/A was a safe and effective long-term therapy for CD.