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Colucci F, Pugliatti M, Casetta I, Capone JG, Diozzi E, Sensi M, Tugnoli V. Idiopathic cervical dystonia and non-motor symptoms: a pilot case-control study on autonomic nervous system. Neurol Sci 2024; 45:629-638. [PMID: 37648939 PMCID: PMC10791952 DOI: 10.1007/s10072-023-07033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Non-motor symptoms, such as sleep disturbances, fatigue, neuropsychiatric manifestations, cognitive impairment, and sensory abnormalities, have been widely reported in patients with idiopathic cervical dystonia (ICD). This study aimed to clarify the autonomic nervous system (ANS) involvement in ICD patients, which is still unclear in the literature. METHODS We conducted a pilot case-control study to investigate ANS in twenty ICD patients and twenty age-sex-matched controls. The Composite Autonomic System Scale 31 was used for ANS clinical assessment. The laser Doppler flowmetry quantitative spectral analysis, applied to the skin and recorded from indices, was used to measure at rest, after a parasympathetic activation (six deep breathing) and two sympathetic stimuli (isometric handgrip and mental calculation), the power of high-frequency and low-frequency oscillations, and the low-frequency/high-frequency ratio. RESULTS ICD patients manifested higher clinical dysautonomic symptoms than controls (p < 0.05). At rest, a lower high-frequency power band was detected among ICD patients than controls, reaching a statistically significant difference in the age group of ≥ 57-year-olds (p < 0.05). In the latter age group, ICD patients showed a lower low-frequency/high-frequency ratio than controls at rest (p < 0.05) and after mental calculation (p < 0.05). Regardless of age, during handgrip, ICD patients showed (i) lower low-frequency/high-frequency ratio (p < 0.05), (ii) similar increase of the low-frequency oscillatory component compared to controls, and (iii) stable high-frequency oscillatory component, which conversely decreased in controls. No differences between the two groups were detected during deep breathing. CONCLUSION ICD patients showed ANS dysfunction at clinical and neurophysiological levels, reflecting an abnormal parasympathetic-sympathetic interaction likely related to abnormal neck posture and neurotransmitter alterations.
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Affiliation(s)
- Fabiana Colucci
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy.
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy
| | - Jay Guido Capone
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Enrica Diozzi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
| | - Valeria Tugnoli
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria S, Anna, Ferrara, Italy
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Xia K, Han Y, Zhou L, Hu S, Rao R, Shan S, Hua L. Attention impairment in patients with cervical dystonia: An attention network test study. Front Psychol 2022; 13:952567. [PMID: 35992456 PMCID: PMC9386253 DOI: 10.3389/fpsyg.2022.952567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to investigate attentional network functional characteristics in patients with cervical dystonia (CD). Methods A total of 29 patients with CD and 26 healthy controls (HCs) were recruited. All subjects participated in the study and underwent the Attention Network Test (ANT), which evaluated the efficiencies of three independent attention networks (alerting, orienting, and executive control), as well as reaction time (RT) and accuracy. Results Significant differences between CD patients (9.86 ± 27.95 ms) and HCs (33.62 ± 23.41 ms) were observed in the alerting network (t = −3.40, p < 0.05). In contrast, the orienting network (t = 0.26, p = 0.79), executive control network (Z = −0.55, p = 0.58), total mean reaction time (t = −2.6, p = 0.79), and total accuracy rate (Z = −1.67, p = 0.09) showed no significant differences between the two groups. Conclusion Patients with CD showed a significant deficit in the alerting network. However, they did not show any deficits in the orienting or executive control network. In addition, the alerting, orienting, and executive control network functions of CD patients were all affected by the severity of torticollis, especially the alerting network function.
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Affiliation(s)
- Kun Xia
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Yongsheng Han
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
- Department of Neurology, Anhui Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, China
- *Correspondence: Yongsheng Han,
| | - Lanlan Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Sheng Hu
- School of Medical Information Engineering, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Rao Rao
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Shu Shan
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Lei Hua
- Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
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da Silva-Júnior FP, Dos Santos Alves CO, Silva SMCA, Borges V, Ferraz HB, Rocha MSG, Limongi JCP, Barbosa ER, de Carvalho Aguiar P. High prevalence of self-reported non-motor symptoms and lack of correlation with motor severity in adult patients with idiopathic isolated dystonia. Neurol Sci 2021; 43:1061-1065. [PMID: 34297264 DOI: 10.1007/s10072-021-05452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although abnormal movements and postures are the hallmark of dystonia, non-motor symptoms (NMS) are common and negatively affect quality of life. OBJECTIVES The aim of this study was to screen dystonia patients for NMS and analyze their association with clinical parameters, including motor disability. METHODS Adult patients with idiopathic isolated dystonia were interviewed and examined. Dystonia severity was evaluated with the Fahn-Marsden Dystonia Rating Scale and the presence of NMS was assessed using a list of 29 complaints. RESULTS A hundred and two patients (63.7% female) were enrolled. Dystonia began after 20 years of age in 61.8% and was focal or segmental in 82.8% of patients. Only eight patients (7.8%) had no NMS and 59.8% reported more than five. The most prevalent NMS were pain (72.5%) and anxiety (63.7%), followed by difficulty recalling information (44.1%), sadness/anhedonia (41.2%), and difficulty falling asleep (38.2%). No correlation was found between the total number of NMS and dystonia severity (p = 0.18) or regular botulinum toxin use (p = 0.66). The majority of NMS domains correlated with each other. CONCLUSIONS Our results confirm a high prevalence of NMS among dystonia patients, even in those with mild motor disability. The pathophysiology of NMS in dystonia remains to be completely understood.
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Affiliation(s)
- Francisco Pereira da Silva-Júnior
- Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil. .,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Sônia Maria Cesar Azevedo Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Do Servidor Público Estadual, São Paulo, SP, Brazil
| | - Vanderci Borges
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Henrique Ballalai Ferraz
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Patrícia de Carvalho Aguiar
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Vilaseca I, Hidalgo J, Cámara A, Compta Y, Martí MJ. Non-motor symptoms in spasmodic dysphonia: A case control-study. Auris Nasus Larynx 2021; 49:100-105. [PMID: 34092434 DOI: 10.1016/j.anl.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Non-motor symptoms (NMS) have been identified in some focal adult-onset dystonia. In the present study we aimed to evaluate the presence of NMS in patients with spasmodic dysphonia (SD), a focal action-induced dystonia that affects intrinsic laryngeal muscle control. METHODS Seventeen SD patients and 17 control subjects not significantly different in age and sex were evaluated for the presence of NMS. Additionally, voice handicap index (VHI-10), reflux symptom index, neuropsychiatric symptoms and QoL were assessed by validated scales and questionnaires. RESULTS Patients' group significantly differed from control group in mild depressive symptoms (4.35 ± 3.9 vs. 1.47 ± 2; p=0.01), insomnia (35.3% vs. 14.7%; p=0.016), smell and taste loss (11.8% vs. 0%; p=0.033), swallowing difficulties (17.6% vs. 0%; p=0.007) and throat pain (17.6% vs. 0%; p=0.007). In the group of SD, there was no correlation between voice perception evaluated by VHI-10, number of NMS or QoL. CONCLUSION Patients with SD have a greater burden of depressive, smell, taste, and sleep NMS than control subjects.
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Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain.
| | - Judit Hidalgo
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Cámara
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
| | - Yaroslau Compta
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
| | - María José Martí
- Institut d'Investigació Biomèdica Agustí Pi Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED: CB06/05/0018-ISCIII, ERN-RND (ID No 739510), Barcelona, Spain; Parkinson's disease and Movement Disorders Unit, Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona
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Ray S, Pal PK, Yadav R. Non-Motor Symptoms in Cervical Dystonia: A Review. Ann Indian Acad Neurol 2020; 23:449-457. [PMID: 33223660 PMCID: PMC7657286 DOI: 10.4103/aian.aian_27_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 11/04/2022] Open
Abstract
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both. Dystonic movements are typically patterned, associated with twisting of body parts, and may have tremulousness. Dystonia is usually initiated or worsened by voluntary action and associated with overflow muscle activation. Cervical dystonia (CD) is the most prevalent form of dystonia. CD is a condition characterized by cranial muscle overactivity leading to abnormal intermittent or continuous posturing of the head. Non-motor symptoms are comorbidity of dystonia, which significantly hampers the quality of life among these patients. The symptoms can be as a result of the dystonia itself. However, studies have highlighted the involvement of cortical-striatal-thalamocortical circuits in primary dystonia that could be the pathophysiological basis for the non-motor symptoms. The non-motor symptoms that are commonly associated with dystonia are anxiety, depression, restless leg syndrome, excessive daytime sleepiness, cognitive disturbances, and poor sleep. This review attempts to summarize the literature on non-motor symptoms in patients with CD.
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Affiliation(s)
- Somdattaa Ray
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Yadav R, Ray S, Pal P. Nonmotor symptoms and sleep disturbances in patients with blepharospasm. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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