Current Guidelines for Classifying and Diagnosing Cervical Dystonia: Empirical Evidence and Recommendations

Abstract

BackgroundBackground: The dystonias are phenotypically and etiologically heterogenous disorders. Many proposals and a consensus recommendation have been provided for the diagnosis and classification of the dystonias, but these recommendations serve only as general guidelines. Current diagnosis and classification may still depend on clinical judgment causing different opinions. Objective Objective: To delineate clinical features used by movement disorder specialists in the diagnosis and classification of isolated focal cervical dystonia, and to develop recommendations for a more consistent approach to classification according to anatomical regions involved. Methods Methods: Cross-sectional data for subjects diagnosed with isolated dystonia were acquired from the Dystonia Coalition, an international, multicenter collaborative research network. Data from many movement disorder specialists were evaluated to determine how diagnoses of cervical dystonia related to their recorded examinations. Cases were included if they were given a diagnosis of focal cervical dystonia. Cases were also included if they had dystonia of the neck on exam, but were given an alternative diagnosis such as segmental dystonia. ResultsResults: Among 2916 subjects with isolated dystonia, 1258 were diagnosed with focal cervical dystonia. Among these 1258 cases, 28.3% had dystonia outside of the neck region. Regions involved outside of the neck included the shoulder, larynx, and sometimes other regions. Analysis of the results pointed to several factors that may influence specialists' use of current diagnostic guidelines for making a diagnosis of isolated focal

Botulinum Toxin in the Treatment of Cervical Dystonia: Evidence-Based Review

“…CD (also referred to as spasmodic torticollis) is a form of focal dystonia manifested by abnormal postures or movements produced by involuntary contractions of muscles in the neck, often associated with tremor (31-34) and pain (1,6). In nearly a third of the cases of CD, regions outside of the neck are also involved with dystonia (35). Dystonia has an estimated prevalence of about 40 per 100,000 persons (36) and CD about 10 per 100,000, with an average age at onset of 40 years (1,(36)(37)(38)(39)(40).…”

A novel diagnostic approach for patients with adult-onset dystonia

“…In table 1, we summarised the clinical characteristics of AOIFD. Of note, the disease course of AOIFD is static, although dystonia extending to contiguous body regions can occur, usually in the 3–5 years after onset 1 6…”

Classification and Diagnosis of Cervical Dystonia: Revived Call for Consensus

“…It is with great interest that we read the article by Kilic-Berkmen et al 1 that delineated clinical features used by movement disorder specialists in the diagnosis and classification of isolated focal cervical dystonia (CD). The authors have also proposed recommendations for a more consistent approach to the classification of CD according to the anatomic regions involved.…”

“…Another concern of the study by Kilic-Berkmen et al 1 is not providing a clear solution regarding the rating scale for CD. The interpretation of treatment outcome in CD is mainly based on the rating scale applied.…”

“…To conclude, we appreciate the detailed phenotypic description of CD by Kilic-Berkmen and colleagues. 1 However, the current classification and rating scales of CD need to be updated to address the current and future challenges in clinical assessment, therapeutics, and scientific research. not required for this work.…”