Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson’s Disease and Movement Disorders, and the Italian Network on Botulinum Toxin

Romano, Marcello; Bagnato, Sergio; Altavista, Maria Concetta; Avanzino, Laura; Belvisi, Daniele; Bologna, Matteo; Bono, Francesco; Carecchio, Miryam; Castagna, Anna; Ceravolo, Roberto; Conte, Antonella; Cosentino, Giuseppe; Eleopra, Roberto; Ercoli, Tommaso; Esposito, Marcello; Fabbrini, Giovanni; Ferrazzano, Gina; Lalli, Stefania; Mascia, Marcello Maria; Osio, Maurizio; Pellicciari, Roberta; Petrucci, Simona; Valente, Enza Maria; Valentino, Francesca; Zappia, Mario; Zibetti, Maurizio; Girlanda, Paolo; Tinazzi, Michèle; Defazio, Giovanni; Berardelli, Alfredo

doi:10.1007/s10072-022-06424-x

Cited by 12 publications

(15 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In clinical practice, foot dystonia is often encountered early in the morning. Botulinum toxin injections are often the first line therapy for several forms of dystonia [ 66 ]. Our review has shown one blinded and at least two prospective studies reporting significant improvement of foot dystonia in PD following injection of BoNT into toe flexors.…”

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review

Jabbari

Comtesse

2023

Toxins

View full text Add to dashboard Cite

This review provides an up-to-date literature account on the efficacy of Botulinum toxin treatment for common motor disorders of Parkinson Disease. The reviewed disorders include the common motor disorders in PD such as tremor, focal foot dystonia, rigidity and freezing of gait (FOG). In the area of Parkinson tremor, two newly described evaluation/injection techniques (Yale method in USA and Western University method in Canada) offer efficacy with low incidence of hand and finger weakness as side effects. Blinded studies conducted on foot dystonia of PD indicate that botulinum toxin injections into toe flexors are efficacious in alleviating this form of dystonia. Small, blinded studies suggest improvement of Parkinson rigidity after botulinum toxin injection; proof of this claim, however, requires information from larger, blinded clinical trials. In FOG, the improvement reported in open label studies could not be substantiated in blinded investigations. However, there is room for further controlled studies that include the proximal lower limb muscles in the injection plan and/or use higher doses of the injected toxin for this indication.

show abstract

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review

Jabbari

Comtesse

2023

Toxins

View full text Add to dashboard Cite

show abstract

“…Inclusion criteria for both case and control subjects were age 18 or older, any sex, and the willingness and mental/physical ability to sign informed consent and participate in the protocol. Case patients were enrolled if they had a diagnosis of focal idiopathic CD made by an experienced movement disorder neurologist [ 25 , 26 ]. Exclusion criteria were secondary CD and co-existing medical conditions/surgical interventions that could confound assessment of CD.…”

Section: Methodsmentioning

confidence: 99%

Validation of a guideline to reduce variability in diagnosing cervical dystonia

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Cervical dystonia is characterized by a variable pattern of neck muscle involvement. Due to the lack of a diagnostic test, cervical dystonia diagnosis is based on clinical examination and is therefore subjective. The present work was designed to provide practical guidance for clinicians in confirming or refuting suspected cervical dystonia. Methods Participants were video recorded according to a standardized protocol to assess 6 main clinical features possibly contributing to cervical dystonia diagnosis: presence of repetitive, patterned head/neck movements/postures inducing head/neck deviation from neutral position (item 1); sensory trick (item 2); and red flags related to conditions mimicking dystonia that should be absent in dystonia (items 3–6). Inter-/intra-rater agreement among three independent raters was assessed by k statistics. To estimate sensitivity and specificity, the gold standard was cervical dystonia diagnosis reviewed at each site by independent senior neurologists. Results The validation sample included 43 idiopathic cervical dystonia patients and 41 control subjects (12 normal subjects, 6 patients with isolated head tremor, 4 with chorea, 6 with tics, 4 with head ptosis due to myasthenia or amyotrophic lateral sclerosis, 7 with orthopedic/rheumatologic neck diseases, and 2 with ocular torticollis). The best combination of sensitivity and specificity was observed considering all the items except for an item related to capability to voluntarily suppress spasms (sensitivity: 96.1%; specificity: 81%). Conclusions An accurate diagnosis of cervical dystonia can be achieved if, in addition to the core motor features, we also consider some clinical features related to dystonia mimics that should be absent in dystonia.

show abstract

“…Thirty-seven native Chinese-speaking WD patients with extremities dystonia and thirty-seven age-and sex-matched HCs were recruited from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine (AUTCM) between April 2021 and April 2022. Patient inclusion criteria were as follows: met the diagnostic guidelines for WD established by the European Association for Liver Research in 2012 [16]; 12-40 years old; normal communication, audio-visual reading and writing abilities; or diagnosed with multisegmental dystonia, mainly manifested in the extremities, by the relevant dystonic standard [17][18][19]. The exclusion criteria were as follows: obvious head shaking, which affects the magnetic resonance data acquisition; a history of craniocerebral surgery or metal implants in the body; the use of drugs that can affect muscle tension, such as baclofen and benzhexol, in the 2 months before the study; the disease in rapid progress; or other diseases that affect muscle tension and stiffness, such as brain injury, myositis, etc.…”

Section: Participantsmentioning

confidence: 99%

Dysfunction of the Lenticular Nucleus Is Associated with Dystonia in Wilson’s Disease

et al. 2022

View full text Add to dashboard Cite

Dysfunction of the lenticular nucleus is thought to contribute to neurological symptoms in Wilson’s disease (WD). However, very little is known about whether and how the lenticular nucleus influences dystonia by interacting with the cerebral cortex and cerebellum. To solve this problem, we recruited 37 WD patients (20 men; age, 23.95 ± 6.95 years; age range, 12–37 years) and 37 age- and sex-matched healthy controls (HCs) (25 men; age, 25.19 ± 1.88 years; age range, 20–30 years), and each subject underwent resting-state functional magnetic resonance imaging (RS-fMRI) scans. The muscle biomechanical parameters and Unified Wilson Disease Rating Scale (UWDRS) were used to evaluate the level of dystonia and clinical representations, respectively. The lenticular nucleus, including the putamen and globus pallidus, was divided into 12 subregions according to dorsal, ventral, anterior and posterior localization and seed-based functional connectivity (FC) was calculated for each subregion. The relationships between FC changes in the lenticular nucleus with muscle tension levels and clinical representations were further investigated by correlation analysis. Dystonia was diagnosed by comparing all WD muscle biomechanical parameters with healthy controls (HCs). Compared with HCs, FC decreased from all subregions in the putamen except the right ventral posterior part to the middle cingulate cortex (MCC) and decreased FC of all subregions in the putamen except the left ventral anterior part to the cerebellum was observed in patients with WD. Patients with WD also showed decreased FC of the left globus pallidus primarily distributed in the MCC and cerebellum and illustrated decreased FC from the right globus pallidus to the cerebellum. FC from the putamen to the MCC was significantly correlated with psychiatric symptoms. FC from the putamen to the cerebellum was significantly correlated with muscle tension and neurological symptoms. Additionally, the FC from the globus pallidus to the cerebellum was also associated with muscle tension. Together, these findings highlight that lenticular nucleus–cerebellum circuits may serve as neural biomarkers of dystonia and provide implications for the neural mechanisms underlying dystonia in WD.

show abstract

Diagnostic and therapeutic recommendations in adult dystonia: a joint document by the Italian Society of Neurology, the Italian Academy for the Study of Parkinson’s Disease and Movement Disorders, and the Italian Network on Botulinum Toxin

Cited by 12 publications

References 80 publications

Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review

Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review

Validation of a guideline to reduce variability in diagnosing cervical dystonia

Dysfunction of the Lenticular Nucleus Is Associated with Dystonia in Wilson’s Disease

Contact Info

Product

Resources

About