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Asya O, Kavak ÖT, Özden HÖ, Günal D, Enver N. Demographic and clinical characteristics of our patients diagnosed with laryngeal dystonia. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08688-9. [PMID: 38710818 DOI: 10.1007/s00405-024-08688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/14/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Laryngeal dystonia (LD) is a focal dystonia affecting laryngeal musculature with no known etiology or cure. The present study evaluated the sociodemographic and clinical features of patients diagnosed with LD. MATERIALS AND METHODS All patients diagnosed with LD at our University Hospital's Ear, Nose, and Throat Department between January 2017 and July 2023 were retrospectively analyzed. The study included 43 patients. RESULTS Out of the 43 patients, 19 (44%) were male. At the time of diagnosis, the mean age of the patients was 35.1 years (ranging from 17 to 65 years). The mean elapsed time between the first symptom onset and the first diagnosis was 49.2 months (min. 4 months, max. 240 months). Of the participants, 94% had adductor-type LD. None of the patients had a family history of LD. Of the patients, 9 (20%) experienced a life-altering event or trauma just before the onset of symptoms. All patients who consumed alcohol reported symptom relief with alcohol intake. A total of 67.6% of patients stated that their symptoms were triggered by stress. All of our patients received at least one Botulinum toxin injection, with an average of 2.75 dosages per patient. CONCLUSION The gender distribution was approximately equitable between males and females. There was a tendency for men to receive a diagnosis earlier than women following the manifestation of symptoms. A significant number of patients associate the emergence of their symptoms with a stressful event or traumatic experience. This study represents the initial investigation into the sociodemographic characteristics of patients within the Turkish population.
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Affiliation(s)
- Orhan Asya
- Department of Otorhinolaryngology, Pendik Training and Research Hospital, Marmara University Faculty of Medicine, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, 34899, Istanbul, Turkey
| | - Ömer Tarık Kavak
- Department of Otorhinolaryngology, Pendik Training and Research Hospital, Marmara University Faculty of Medicine, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, 34899, Istanbul, Turkey.
| | - Hatice Ömercikoğlu Özden
- Department of Neurology, Pendik Training and Research Hospital, Marmara University Faculty of Medicine, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, 34899, Istanbul, Turkey
| | - Dilek Günal
- Department of Neurology, Pendik Training and Research Hospital, Marmara University Faculty of Medicine, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, 34899, Istanbul, Turkey
| | - Necati Enver
- Department of Otorhinolaryngology, Pendik Training and Research Hospital, Marmara University Faculty of Medicine, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, 34899, Istanbul, Turkey
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Ghanouni A, Jona N, Jinnah HA, Kilic-Berkmen G, Shelly S, Klein AM. Demographics and Clinical Characteristics Associated with the Spread of New-Onset Laryngeal Dystonia. Laryngoscope 2024; 134:2295-2299. [PMID: 37909788 DOI: 10.1002/lary.31146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Adult-onset idiopathic laryngeal dystonia (LD) can be associated with the risk of spread to muscles in the body. Subjects with extralaryngeal onset of dystonia have exhibited spread to the larynx. Previous studies analyze the spread of other dystonias but emphasis has not been placed on LD. The objective was to identify demographic and clinical factors contributing to the spread of dystonia to and from the larynx. METHODS Data were obtained from the Dystonia Coalition (DC)-patients from 49 international clinical centers. Clinical and demographic data was taken from 143 out of 409 patients with diagnosed LD. Patient criteria included adult-onset LD diagnosed on exam with no co-morbid neurologic conditions and no dystonia in other locations. RESULTS Among the 143 patients, 94 (65.7%) patients were diagnosed with focal laryngeal onset, with the remainder having extralaryngeal onset. Family history and age at study were statistically significant indicators of a patient developing laryngeal versus extralaryngeal onset of dystonia. Among the laryngeal onset group, 21 cases (22.3%) had an average time of 5.81 ± 5.79 years to spread from diagnosis, most commonly to neck (61.9%). Among extralaryngeal onset patients, mean time of larynx spread was 7.92 ± 7.737 years, most commonly to neck (22.7%). CONCLUSIONS Our data indicates approximately a quarter of patients with laryngeal-onset dystonia will exhibit spread. There were no demographic or clinical factors that were statistically predictive of the likelihood of spread from larynx. Patients with dystonia elsewhere in the body should be counseled on the possibility of spread to larynx, and vice versa. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2295-2299, 2024.
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Affiliation(s)
- Arian Ghanouni
- Division of Plastic & Reconstructive Surgery, Montefiore Medical Center, Bronx, NY, U.S.A
| | - Nikitha Jona
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Hyder A Jinnah
- Department of Neurology, Emory Brain Health Center, Atlanta, Georgia, U.S.A
| | | | - Sandeep Shelly
- Division of Laryngology, Emory Voice Center, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Division of Laryngology, Emory Voice Center, Atlanta, Georgia, U.S.A
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Younce JR, Cascella RH, Berman BD, Jinnah HA, Bellows S, Feuerstein J, Wagle Shukla A, Mahajan A, Chang FCF, Duque KR, Reich S, Richardson SP, Deik A, Stover N, Luna JM, Norris SA. Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach. Dystonia 2023; 2:11305. [PMID: 37920445 PMCID: PMC10621194 DOI: 10.3389/dyst.2023.11305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.
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Affiliation(s)
- J. R. Younce
- Department of Neurology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R. H. Cascella
- School of Medicine, Washington University, St. Louis, MO, United States
| | - B. D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - S Bellows
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - J. Feuerstein
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A. Wagle Shukla
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - A. Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, United States
| | - F. C. F. Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - K. R. Duque
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - S. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, United States
| | - S. Pirio Richardson
- Department of Neurology, University of New Mexico and New Mexico VA Healthcare System, Albuquerque, NM, United States
| | - A. Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - N. Stover
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. M. Luna
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
| | - S. A. Norris
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
- Department of Neurology, School of Medicine, Washington University, St. Louis, MO, United States
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Lenka A, Pandey S. Dystonia and tremor: Do they have a shared biology? Int Rev Neurobiol 2023; 169:413-439. [PMID: 37482399 DOI: 10.1016/bs.irn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Dystonia and tremor are the two most commonly encountered hyperkinetic movement disorders encountered in clinical practice. While there has been substantial progress in the research on these two disorders, there also exists a lot of gray areas. Entities such as dystonic tremor and tremor associated with dystonia occupy a major portion of the "gray zone". In addition, there is a marked clinical heterogeneity and overlap of several clinical and epidemiological features among dystonia and tremor. These facts raise the possibility that dystonia and tremor could be having shared biology. In this chapter, we revisit critical aspects of this possibility that may have important clinical and research implications in the future. We comprehensively review the points in favor and against the theory that dystonia and tremor have shared biology from clinical, epidemiological, genetic and neuroimaging studies.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
| | - Sanjay Pandey
- Department of Neurology, Amrita Hospital, Faridabad, Delhi National Capital Region, India.
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Jinnah HA, DeFazio G. Adult-onset focal dystonias: To lump or split. Int Rev Neurobiol 2023; 169:317-327. [PMID: 37482396 DOI: 10.1016/bs.irn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The adult-onset focal dystonias are a group of clinically heterogeneous disorders that affect different regions of the body. Although they affect different regions with different clinical manifestations, there is evidence that etiopathogenesis is shared at the anatomical, physiological, and genetic levels. However, there is also evidence that etiopathogenesis varies. This chapter summarizes the evidence for lumping or splitting these apparently different clinical phenotypes. It also includes some potential explanations to explain the similarities and differences.
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Affiliation(s)
- H A Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Atlanta, GA, United States.
| | - Giovanni DeFazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Kilic-Berkmen G, Defazio G, Hallett M, Berardelli A, Ferrazzano G, Belvisi D, Klein C, Bäumer T, Weissbach A, Perlmutter JS, Feuerstein J, Jinnah HA. Diagnosis and classification of blepharospasm: Recommendations based on empirical evidence. J Neurol Sci 2022; 439:120319. [PMID: 35716653 PMCID: PMC9357089 DOI: 10.1016/j.jns.2022.120319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blepharospasm is one of the most common subtypes of dystonia, and often spreads to other body regions. Despite published guidelines, the approach to diagnosis and classification of affected body regions varies among clinicians. OBJECTIVE To delineate the clinical features used by movement disorder specialists in the diagnosis and classification of blepharospasm according to body regions affected, and to develop recommendations for a more consistent approach. METHODS Cross-sectional data for subjects diagnosed with all types of isolated dystonia were acquired from the Dystonia Coalition, an international, multicenter collaborative research network. Data were evaluated to determine how examinations recorded by movement disorder specialists were used to classify blepharospasm as focal, segmental, or multifocal. RESULTS Among all 3222 participants with isolated dystonia, 210 (6.5%) had a diagnosis of focal blepharospasm. Among these 210 participants, 34 (16.2%) had dystonia outside of upper face region. Factors such as dystonia severity across different body regions and number of body regions affected influenced the classification of blepharospasm as focal, segmental, or multifocal. CONCLUSIONS Although focal blepharospasm is the second most common type of dystonia, a high percentage of individuals given this diagnosis had dystonia outside of the eye/upper face region. These findings are not consistent with existing guidelines for the diagnosis and classification of focal blepharospasm, and point to the need for more specific guidelines for more consistent application of existing recommendations for diagnosis and classification.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Daniele Belvisi
- Department of Human Neuroscience, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS NEUROMED, Via Atinense 18, 86077 Pozzilli, Italy
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Anne Weissbach
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany; Institute of System Motor Science, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Joel S Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | | | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
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7
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Scorr LM, Cho HJ, Kilic-Berkmen G, McKay JL, Hallett M, Klein C, Baumer T, Berman BD, Feuerstein JS, Perlmutter JS, Berardelli A, Ferrazzano G, Wagle-Shukla A, Malaty IA, Jankovic J, Bellows ST, Barbano RL, Vidailhet M, Roze E, Bonnet C, Mahajan A, LeDoux MS, Fung VS, Chang FC, Defazio G, Ercoli T, Factor S, Wojno T, Jinnah HA. Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review. Dyst 2022; 1. [PMID: 36248010 PMCID: PMC9557246 DOI: 10.3389/dyst.2022.10359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: Blepharospasm is a type of dystonia where the diagnosis is often delayed because its varied clinical manifestations are not well recognized. The purpose of this study was to provide a comprehensive picture of its clinical features including presenting features, motor features, and non-motor features. Methods: This was a two-part study. The first part involved a systematic literature review that summarized clinical features for 10,324 cases taken from 41 prior reports. The second part involved a summary of clinical features for 884 cases enrolled in a large multicenter cohort collected by the Dystonia Coalition investigators, along with an analysis of the factors that contribute to the spread of dystonia beyond the periocular region. Results: For cases in the literature and the Dystonia Coalition, blepharospasm emerged in the 50s and was more frequent in women. Many presented with non-specific motor symptoms such as increased blinking (51.9%) or non-motor sensory features such as eye soreness or pain (38.7%), photophobia (35.5%), or dry eyes (10.7%). Non-motor psychiatric features were also common including anxiety disorders (34–40%) and depression (21–24%). Among cases presenting with blepharospasm in the Dystonia Coalition cohort, 61% experienced spread of dystonia to other regions, most commonly the oromandibular region and neck. Features associated with spread included severity of blepharospasm, family history of dystonia, depression, and anxiety. Conclusions: This study provides a comprehensive summary of motor and non-motor features of blepharospasm, along with novel insights into factors that may be responsible for its poor diagnostic recognition and natural history.
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Affiliation(s)
- Laura M. Scorr
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Gamze Kilic-Berkmen
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - J. Lucas McKay
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck and University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Tobias Baumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck and University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Joel S. Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO, United States
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Aparna Wagle-Shukla
- Fixel Institute for Neurological Disease, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Irene A. Malaty
- Fixel Institute for Neurological Disease, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Steven T. Bellows
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Richard L. Barbano
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Marie Vidailhet
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Emmanuel Roze
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Cecilia Bonnet
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Abhimanyu Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Mark S. LeDoux
- Department of Psychology, Veracity Neuroscience LLC, University of Memphis, Memphis, TN, United States
| | - Victor S.C. Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Florence C.F. Chang
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Tomaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Stewart Factor
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ted Wojno
- Emory Eye Center, Emory University, Atlanta, GA, United States
| | - H. A. Jinnah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, United States
- Correspondence: H. A. Jinnah,
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8
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Wang M, Sajobi T, Morgante F, Adler C, Agarwal P, Bäumer T, Berardelli A, Berman BD, Blumin J, Borsche M, Brashear A, Deik A, Duque K, Espay AJ, Ferrazzano G, Feuerstein J, Fox S, Frank S, Hallett M, Jankovic J, LeDoux MS, Leegwater-Kim J, Mahajan A, Malaty IA, Ondo W, Pantelyat A, Pirio-Richardson S, Roze E, Saunders-Pullman R, Suchowersky O, Truong D, Vidailhet M, Shukla AW, Perlmutter JS, Jinnah HA, Martino D. Predictive modeling of spread in adult-onset isolated dystonia: Key properties and effect of tremor inclusion. Eur J Neurol 2021; 28:3999-4009. [PMID: 34296504 PMCID: PMC9100858 DOI: 10.1111/ene.15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Several clinical and demographic factors relate to anatomic spread of adult-onset isolated dystonia, but a predictive model is still lacking. The aims of this study were: (i) to develop and validate a predictive model of anatomic spread of adult-onset isolated dystonia; and (ii) to evaluate whether presence of tremor associated with dystonia influences model predictions of spread. METHODS Adult-onset isolated dystonia participants with focal onset from the Dystonia Coalition Natural History Project database were included. We developed two prediction models, one with dystonia as sole disease manifestation ("dystonia-only") and one accepting dystonia OR tremor in any body part as disease manifestations ("dystonia OR tremor"). Demographic and clinical predictors were selected based on previous evidence, clinical plausibility of association with spread, or both. We used logistic regressions and evaluated model discrimination and calibration. Internal validation was carried out based on bootstrapping. RESULTS Both predictive models showed an area under the curve of 0.65 (95% confidence intervals 0.62-0.70 and 0.62-0.69, respectively) and good calibration after internal validation. In both models, onset of dystonia in body regions other than the neck, older age, depression and history of neck trauma were predictors of spread. CONCLUSIONS This predictive modeling of spread in adult-onset isolated dystonia based on accessible predictors (demographic and clinical) can be easily implemented to inform individuals' risk of spread. Because tremor did not influence prediction of spread, our results support the argument that tremor is a part of the dystonia syndrome, and not an independent or coincidental disorder.
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Affiliation(s)
- Meng Wang
- Department of Community Health Sciences, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Charles Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Pinky Agarwal
- Booth Gardner Parkinson’s Center, Evergreen Health, Kirkland, Washington, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center for Rare Diseases, University Medical Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Alfredo Berardelli
- Department of Human Neurosciences, University of Rome “La Sapienza”, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joel Blumin
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Allison Brashear
- Department of Neurology, University of California, Davis, Sacramento, California, USA
| | - Andres Deik
- Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Duque
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gina Ferrazzano
- Department of Human Neurosciences, University of Rome “La Sapienza”, Rome, Italy
| | - Jeanne Feuerstein
- Department of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Susan Fox
- Movement Disorder Clinic, Edmond J Safra Program in Parkinson Disease, Toronto Western Hospital, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Frank
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark S. LeDoux
- Department of Psychology and School of Health Sciences, University of Memphis, and Veracity Neuroscience, Memphis, Tennessee, USA
| | - Julie Leegwater-Kim
- Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Abhimanyu Mahajan
- Rush Parkinson’s disease and movement disorders program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Irene A. Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - William Ondo
- Houston Methodist Hospital, Houston, Texas, USA
- Weill Cornell Medical School, New York, New York, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Pirio-Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Emmanuel Roze
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, Paris, France
| | - Rachel Saunders-Pullman
- Department of Neurology, Icahn School of Medicine at Mount Sinai and Mount Sinai Beth Israel, New York, New York, USA
| | - Oksana Suchowersky
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Truong
- Department of Neurosciences, UC Riverside, Riverside, California, USA
- The Parkinson and Movement Disorder Institute, Fountain Valley, California, USA
| | - Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, Paris, France
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Joel S. Perlmutter
- Departments of Neurology, Psychiatry, Radiology, Neurobiology, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A. Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Davide Martino
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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9
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Chang J, Chen L, Li X, Li J. Tiger face: characteristic manifestations of Meige syndrome. Brain Science Advances 2021. [DOI: 10.26599/bsa.2021.9050020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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10
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Ercoli T, Erro R, Fabbrini G, Pellicciari R, Girlanda P, Terranova C, Avanzino L, Di Biasio F, Barone P, Esposito M, De Joanna G, Eleopra R, Bono F, Manzo L, Bentivoglio AR, Petracca M, Mascia MM, Albanese A, Castagna A, Ceravolo R, Altavista MC, Scaglione C, Magistrelli L, Zibetti M, Bertolasi L, Coletti Moja M, Cotelli MS, Cossu G, Minafra B, Pisani A, Misceo S, Modugno N, Romano M, Cassano D, Berardelli A, Defazio G; Italian Dystonia Registry Participants. Spread of segmental/multifocal idiopathic adult-onset dystonia to a third body site. Parkinsonism Relat Disord 2021; 87:70-4. [PMID: 33991781 DOI: 10.1016/j.parkreldis.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adult-onset focal dystonia can spread to involve one, or less frequently, two additional body regions. Spread of focal dystonia to a third body site is not fully characterized. MATERIALS AND METHODS We retrospectively analyzed data from the Italian Dystonia Registry, enrolling patients with segmental/multifocal dystonia involving at least two parts of the body or more. Survival analysis estimated the relationship between dystonia features and spread to a third body part. RESULTS We identified 340 patients with segmental/multifocal dystonia involving at least two body parts. Spread of dystonia to a third body site occurred in 42/241 patients (17.4%) with focal onset and 10/99 patients (10.1%) with segmental/multifocal dystonia at onset. The former had a greater tendency to spread than patients with segmental/multifocal dystonia at onset. Gender, years of schooling, comorbidity, family history of dystonia/tremor, age at dystonia onset, and disease duration could not predict spread to a third body site. Among patients with focal onset in different body parts (cranial, cervical, and upper limb regions), there was no association between site of focal dystonia onset and risk of spread to a third body site. DISCUSSION AND CONCLUSION Spread to a third body site occurs in a relative low percentage of patients with idiopathic adult-onset dystonia affecting two body parts. Regardless of the site of dystonia onset and of other demographic/clinical variables, focal onset seems to confer a greater risk of spread to a third body site in comparison to patients with segmental/multifocal dystonia at onset.
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11
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Norris SA, Jinnah HA, Klein C, Jankovic J, Berman BD, Roze E, Mahajan A, Espay AJ, Murthy AV, Fung VSC, LeDoux MS, Chang FCF, Vidailhet M, Testa C, Barbano R, Malaty IA, Bäumer T, Loens S, Wright LJ, Perlmutter JS. Clinical and Demographic Characteristics of Upper Limb Dystonia. Mov Disord 2020; 35:2086-2090. [PMID: 32845549 DOI: 10.1002/mds.28223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Knowledge of characteristics in upper limb dystonia remains limited, derived primarily from small, single-site studies. OBJECTIVE The objective of this study was to characterize demographic and clinical characteristics of upper limb dystonia from the Dystonia Coalition data set, a large, international, multicenter resource. METHODS We evaluated clinical and demographic characteristics of 367 participants with upper limb dystonia from onset, comparing across subcategories of focal (with and without dystonia spread) versus nonfocal onset. RESULTS Focal onset occurred in 80%; 67% remained focal without spread. Task specificity was most frequent in this subgroup, most often writer's cramp and affecting the dominant limb (83%). Focal onset with spread was more frequent in young onset (<21 years). Focal onset occurred equally in women and men; nonfocal onset affected women disproportionately. CONCLUSIONS Upper limb dystonia distribution, focality, and task specificity relate to onset age and likelihood of regional spread. Observations may inform clinical counseling and design, execution, and interpretation of future studies. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Scott A Norris
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emmanuel Roze
- Sorbonne University, Inserm U 1127, National Centre for Scientific Research, Joint Research Units 7225, Institut du Cerveau et de la Moelle épinière and Assistance Public Hôpitaux de Paris, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark S LeDoux
- Department of Psychology and School of Health Studies, University of Memphis, Memphis, Tennessee, USA.,Veracity Neurosciences LLC, Memphis, Tennessee, USA
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, AP-HP, Paris, France.,Department of Neurology, Sorbonne Université, Paris, France.,Brain & Spine Institute, Joint Research Units 1127, INSERM 1127, Center National De Recherche Scientific 7235, Paris, France
| | - Claudia Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Irene A Malaty
- University of Florida Department of Neurology, Fixel Institute for Neurologic Diseases, Gainesville, Florida, USA
| | - Tobias Bäumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Laura J Wright
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Abstract
The dystonias are a large and heterogenous group of disorders characterized by excessive muscle contractions leading to abnormal postures and/or repetitive movements. Their clinical manifestations vary widely, and there are many potential causes. Despite the heterogeneity, helpful treatments are available for the vast majority of patients. Symptom-based therapies include oral medications, botulinum toxins, and surgical interventions. For some subtypes of dystonia, specific mechanism-based treatments are available. Advances in understanding the biological basis for many types of dystonia have led to numerous recent clinical trials, so additional treatments are likely to become available in the very near future.
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13
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Berman BD, Groth CL, Sillau SH, Pirio Richardson S, Norris SA, Junker J, Brüggemann N, Agarwal P, Barbano RL, Espay AJ, Vizcarra JA, Klein C, Bäumer T, Loens S, Reich SG, Vidailhet M, Bonnet C, Roze E, Jinnah HA, Perlmutter JS. Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study. J Neurol Neurosurg Psychiatry 2020; 91:314-320. [PMID: 31848221 PMCID: PMC7024047 DOI: 10.1136/jnnp-2019-321794] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Isolated focal dystonia can spread to muscles beyond the initially affected body region, but risk of spread has not been evaluated in a prospective manner. Furthermore, body regions at risk for spread and the clinical factors associated with spread risk are not well characterised. We sought here to prospectively characterise risk of spread in recently diagnosed adult-onset isolated focal dystonia patients. METHODS Patients enrolled in the Dystonia Coalition with isolated dystonia affecting only the neck, upper face, hand or larynx at onset of symptoms were included. Timing of follow-up visits was based on a sliding scale depending on symptom onset and ranged from 1 to 4 years. Descriptive statistics, Kaplan-Meier survival curves and Cox proportional hazard regression models were used to assess clinical characteristics associated with dystonia spread. RESULTS 487 enrolled participants (68.3% women; mean age: 55.6±12.2 years) met our inclusion/exclusion criteria. Spread was observed in 50% of blepharospasm, 8% of cervical dystonia, 17% of hand dystonia and 16% of laryngeal dystonia cases. Most common regions for first spread were the oromandibular region (42.2%) and neck (22.4%) for blepharospasm, hand (3.5%) for cervical dystonia and neck for hand (12.8%) and laryngeal (15.8%) dystonia. Increased spread risk was associated with a positive family history (HR=2.18, p=0.012) and self-reported alcohol responsiveness (HR=2.59, p=0.009). CONCLUSIONS Initial body region affected in isolated focal dystonia has differential risk and patterns of spread. Genetic factors likely influence the risk of spread. These findings can aid clinical prognostication and inform future investigations into potential disease-modifying treatments.
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Affiliation(s)
- Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Scott A Norris
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Johanna Junker
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Pinky Agarwal
- Booth Gardner Parkinson's Center, Evergreen Health, Kirkland, Washington, USA
| | - Richard L Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joaquin A Vizcarra
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Stephen G Reich
- Department of Neurology, University of Maryland Medical Centre, Baltimore, Maryland, USA
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Cecilia Bonnet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Hyder A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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14
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Esposito M, Fabbrini G, Ferrazzano G, Berardelli A, Peluso S, Cesari U, Gigante AF, Bentivoglio AR, Petracca M, Erro R, Barone P, Schirinzi T, Eleopra R, Avanzino L, Romano M, Scaglione CL, Cossu G, Morgante F, Minafra B, Zibetti M, Coletti Moja M, Turla M, Fadda L, Defazio G. Spread of dystonia in patients with idiopathic adult-onset laryngeal dystonia. Eur J Neurol 2018; 25:1341-1344. [DOI: 10.1111/ene.13731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - G. Fabbrini
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | | | - A. Berardelli
- Department of Human Neurosciences; Sapienza, University of Rome; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | - S. Peluso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - U. Cesari
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; Federico II University of Naples; Naples Italy
| | - A. F. Gigante
- Department of Basic Science, Neuroscience and Sense Organs; Aldo Moro University of Bari; Bari Italy
| | - A. R. Bentivoglio
- Movement Disorders Unit; Center for Parkinson's Disease and Extrapyramidal Disorders; Institute of Neurology; Catholic University; Rome Italy
- Don Carlo Gnocchi Onlus Foundation; Milan Italy
| | - M. Petracca
- Movement Disorders Unit; Center for Parkinson's Disease and Extrapyramidal Disorders; Institute of Neurology; Catholic University; Rome Italy
| | - R. Erro
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; University of Salerno; Salerno Italy
| | - P. Barone
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; University of Salerno; Salerno Italy
| | - T. Schirinzi
- Department of Systems Medicine; University of Rome ‘Tor Vergata’; Rome Italy
| | - R. Eleopra
- IRCCS Foundation C. Besta Neurological Institute; Milan Italy
| | - L. Avanzino
- Section of Human Physiology; Department of Experimental Medicine; University of Genoa; Genoa Italy
| | - M. Romano
- Neurology Unit; Villa Sofia Hospital; Palermo Italy
| | | | - G. Cossu
- Department of Neurology; AOB ‘G. Brotzu’ General Hospital; Cagliari Italy
| | - F. Morgante
- Department of Neuroscience; University of Messina; Messina Italy
| | - B. Minafra
- Parkinson's Disease and Movement Disorders Unit; C. Mondino National Neurological Institute; IRCCS; Pavia Italy
| | - M. Zibetti
- Department of Neuroscience ‘Rita Levi Montalcini’; University of Turin; Turin Italy
| | | | - M. Turla
- Neurology Unit; Valle Camonica Hospital; Brescia Italy
| | - L. Fadda
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - G. Defazio
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
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15
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Pandey S, Sharma S. Meige's syndrome: History, epidemiology, clinical features, pathogenesis and treatment. J Neurol Sci 2017; 372:162-170. [DOI: 10.1016/j.jns.2016.11.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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16
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Ham JH, Kim SJ, Song SK, Lyoo CH, Lee PH, Sohn YH, Kang SY. A prognostic factor in focal hand dystonia: typist's cramp cases and literature review. J Neurol Sci 2016; 371:85-87. [PMID: 27871456 DOI: 10.1016/j.jns.2016.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/15/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
The prognosis of focal hand dystonia (FHD) remains unclear. We retrospectively studied six patients with typist's cramp in our hospitals, and five cases in the PubMed database. All of them were right-handed. We compared clinical features between simple (dystonia in only one specific task), and dystonic/progressive groups (dystonia in several and/or new tasks). The initially affected right hand ratio was significantly higher in dystonic/progressive groups than in simple group (p=0.015). Initially affected hand may be a predictor for the progression, implying that the progression may be associated with the amount of daily routine hand movements.
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Affiliation(s)
- Jee Hyun Ham
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea
| | - Sook Keun Song
- Department of Neurology, Jeju National University School of Medicine, 1 Ara 1-dong, Jeju-si, Jeju 690-756, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-Do, Republic of Korea.
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17
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Norris SA, Jinnah HA, Espay AJ, Klein C, Brüggemann N, Barbano RL, Malaty IAC, Rodriguez RL, Vidailhet M, Roze E, Reich SG, Berman BD, LeDoux MS, Richardson SP, Agarwal P, Mari Z, Ondo WG, Shih LC, Fox SH, Berardelli A, Testa CM, Cheng FCF, Truong D, Nahab FB, Xie T, Hallett M, Rosen AR, Wright LJ, Perlmutter JS. Clinical and demographic characteristics related to onset site and spread of cervical dystonia. Mov Disord 2016; 31:1874-1882. [PMID: 27753188 DOI: 10.1002/mds.26817] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/09/2016] [Accepted: 08/12/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Clinical characteristics of isolated idiopathic cervical dystonia such as onset site and spread to and from additional body regions have been addressed in single-site studies with limited data and incomplete or variable dissociation of focal and segmental subtypes. The objectives of this study were to characterize the clinical characteristics and demographics of isolated idiopathic cervical dystonia in the largest standardized multicenter cohort. METHODS The Dystonia Coalition, through a consortium of 37 recruiting sites in North America, Europe, and Australia, recruited 1477 participants with focal (60.7%) or segmental (39.3%) cervical dystonia on examination. Clinical and demographic characteristics were evaluated in terms of the body region of dystonia onset and spread. RESULTS Site of dystonia onset was: (1) focal neck only (78.5%), (2) focal onset elsewhere with later segmental spread to neck (13.3%), and (3) segmental onset with initial neck involvement (8.2%). Frequency of spread from focal cervical to segmental dystonia (22.8%) was consistent with prior reports, but frequency of segmental onset with initial neck involvement was substantially higher than the 3% previously reported. Cervical dystonia with focal neck onset, more than other subtypes, was associated with spread and tremor of any type. Sensory tricks were less frequent in cervical dystonia with segmental components, and segmental cervical onset occurred at an older age. CONCLUSIONS Subgroups had modest but significant differences in the clinical characteristics that may represent different clinical entities or pathophysiologic subtypes. These findings are critical for design and implementation of studies to describe, treat, or modify disease progression in idiopathic isolated cervical dystonia. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Scott A Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - H A Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Richard L Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | | | - Ramon L Rodriguez
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Marie Vidailhet
- Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Universités, Paris, France
| | - Emmanuel Roze
- Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Universités, Paris, France
| | - Stephen G Reich
- Department of Neurology, University of Maryland, Baltimore, Maryland, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Mark S LeDoux
- Departments of Neurology and Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, Kirkland, Washington, USA
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - William G Ondo
- Department of Neurology, Houston Methodist, Houston Texas, USA
| | - Ludy C Shih
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Susan H Fox
- Division of Neurology, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome and IRCCS Neuromed, Italy
| | - Claudia M Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Daniel Truong
- The Parkinson and Movement Disorder Institute, Fountain Valley, California, USA
| | - Fatta B Nahab
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Tao Xie
- Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Mark Hallett
- Human Motor Control Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Ami R Rosen
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Laura J Wright
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Psychiatry, Radiology, Neurobiology, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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18
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Williams L, McGovern E, Kimmich O, Molloy A, Beiser I, Butler JS, Molloy F, Logan P, Healy DG, Lynch T, Walsh R, Cassidy L, Moriarty P, Moore H, McSwiney T, Walsh C, O'Riordan S, Hutchinson M. Epidemiological, clinical and genetic aspects of adult onset isolated focal dystonia in Ireland. Eur J Neurol 2016; 24:73-81. [DOI: 10.1111/ene.13133] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
- L. Williams
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - E. McGovern
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - O. Kimmich
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - A. Molloy
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - I. Beiser
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - J. S. Butler
- Trinity Centre for Bioengineering; Dublin and School of Mathematical Sciences; Dublin Institute of Technology; Dublin Ireland
| | | | - P. Logan
- Beaumont Hospital; Dublin Ireland
| | | | - T. Lynch
- Mater Misericordiae University Hospital; Dublin Ireland
| | - R. Walsh
- Adelaide and Meath Hospital; Dublin Ireland
| | - L. Cassidy
- Royal Victoria Eye and Ear Hospital; Dublin Ireland
| | - P. Moriarty
- Royal Victoria Eye and Ear Hospital; Dublin Ireland
| | - H. Moore
- Cork University Hospital; Cork Ireland
| | | | - C. Walsh
- Departments of Statistics; Trinity College Dublin; University of Limerick; Limerick Ireland
| | - S. O'Riordan
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - M. Hutchinson
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
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Jinnah HA, Goodmann E, Rosen AR, Evatt M, Freeman A, Factor S. Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes. J Neurol 2016; 263:1188-94. [PMID: 27113604 DOI: 10.1007/s00415-016-8136-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
Botulinum toxin (BoNT) is highly effective in the treatment of cervical dystonia (CD), yet a significant proportion of patients report low levels of satisfaction following treatment and fail to follow up for repeated treatments. The goal of this study was to determine the reasons that some patients have unsatisfactory responses. A total of 35 subjects who came to our center requesting alternative treatments due to unsatisfactory responses following BoNT treatment for CD were evaluated. Included were 26 women and 9 men with an average age of 57.1 years (range 25-82 years), and an average duration of illness of 12.5 years (range 1-55 years). Details of unsatisfactory BoNT treatments were methodically collected by a movement specialist using a standardized intake form, including provider subspecialty, product used, the number of satisfactory or unsatisfactory trials, doses given, specific muscles treated, the use of electromyographic guidance, side effects, and tests of resistance. The specialist then provided repeat treatments if indicated, and followed each case until the reasons for unsatisfactory outcomes could be determined. Multiple reasons for unsatisfactory outcomes were found. They included suboptimal BoNT doses, suboptimal muscle targeting, intolerable side effects, complex movement patterns, discordant perceptions, and incorrect diagnoses. Only one patient was functionally resistant to BoNT. Of 32 subjects who received repeat BoNT treatments, 25 (78 %) achieved satisfactory responses after revision of the original treatment plan. These results indicate that the majority of unsatisfactory responses to BoNT treatment of CD were caused by correctible factors and imply a need for improved education regarding optimal treatment methods.
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Albanese A, Sorbo FD. Dystonia and Tremor: The Clinical Syndromes with Isolated Tremor. Tremor Other Hyperkinet Mov (N Y) 2016; 6:319. [PMID: 27152246 PMCID: PMC4850743 DOI: 10.7916/d8x34xbm] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dystonia and tremor share many commonalities. Isolated tremor is part of the phenomenological spectrum of isolated dystonia and of essential tremor. The occurrence of subtle features of dystonia may allow one to differentiate dystonic tremor from essential tremor. Diagnostic uncertainty is enhanced when no features of dystonia are found in patients with a tremor syndrome, raising the question whether the observed phenomenology is an incomplete form of dystonia. METHODS Known forms of syndromes with isolated tremor are reviewed. Diagnostic uncertainties between tremor and dystonia are put into perspective. RESULTS The following isolated tremor syndromes are reviewed: essential tremor, head tremor, voice tremor, jaw tremor, and upper-limb tremor. Their varied phenomenology is analyzed and appraised in the light of a possible relationship with dystonia. DISCUSSION Clinicians making a diagnosis of isolated tremor should remain vigilant for the detection of features of dystonia. This is in keeping with the recent view that isolated tremor may be an incomplete phenomenology of dystonia.
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Affiliation(s)
- Alberto Albanese
- Istituto Clinico Humanitas, Rozzano, Italy; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milan, Italy
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Chung M, Huh R. Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia. Acta Neurochir (Wien) 2016; 158:171-80; discussion 180. [PMID: 26611690 DOI: 10.1007/s00701-015-2646-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between phasic-type and tonic-type cervical dystonia have not been reported. METHODS This study included a retrospective cohort of 30 patients with primary cervical dystonia who underwent GPi DBS. Age, disease duration, dystonia direction, movement types, employment status, relevant life events, and neuropsychological examinations were analyzed with respect to clinical outcomes following GPi DBS. RESULTS The only significant factor affecting clinical outcomes was movement type (phasic or tonic). Sequential changes in clinical outcomes showed significant differences between phasic- and tonic-type cervical dystonia. A delayed benefit was found in both phasic- and tonic-type dystonia. CONCLUSIONS The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.
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Svetel M, Pekmezovic T, Tomic A, Kresojevic N, Kostic VS. The spread of primary late-onset focal dystonia in a long-term follow up study. Clin Neurol Neurosurg 2015; 132:41-3. [DOI: 10.1016/j.clineuro.2015.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/09/2015] [Accepted: 02/21/2015] [Indexed: 11/21/2022]
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Aquino CC, Felício AC, Castro PCFD, Oliveira RA, Silva SMCA, Borges V, Ferraz HB. Clinical features and treatment with botulinum toxin in blepharospasm: a 17-year experience. Arq Neuropsiquiatr 2013; 70:662-6. [PMID: 22990720 DOI: 10.1590/s0004-282x2012000900003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/30/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE It was to analyze clinical aspects of patients with blepharospasm, including outcomes of botulinum toxin treatment. Additionally, clinical characteristics of isolated blepharospasm were compared to those of blepharospasm plus other movement disorders. METHODS Clinical data recorded during 17 years were reviewed. The variables included age, gender, age of onset, past medical history, head trauma, smoking history, family history of dystonia, severity, duration of botulinum toxin relief and adverse effects. RESULTS A total of 125 patients were included and 75.2% were female. The mean age of onset was 54.3 years; 89.6% of the individuals started with contractions in eye region, and 39.2% of them spread to lower face or neck. Isolated blepharospasm group was compared with blepharospasm-plus group for demographic and clinical features, and therapeutic outcomes, without significant differences. Botulinum toxin treatment improved the severity of contractions (p=0.01) with low rate of side effects (14%). CONCLUSIONS Both groups - isolated blepharospasm and blepharospasm-plus - shared similar results concerning epidemiology, clinical features and therapeutic response to botulinum toxin.
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Affiliation(s)
- Camila Catherine Aquino
- Movement Disorder Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo SP, Brazil.
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Martino D, Berardelli A, Abbruzzese G, Bentivoglio AR, Esposito M, Fabbrini G, Guidubaldi A, Girlanda P, Liguori R, Marinelli L, Morgante F, Santoro L, Defazio G. Age at onset and symptom spread in primary adult-onset blepharospasm and cervical dystonia. Mov Disord 2012; 27:1447-50. [DOI: 10.1002/mds.25088] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 05/15/2012] [Accepted: 05/21/2012] [Indexed: 11/11/2022] Open
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White LJ, Klein AM, Hapner ER, Delgaudio JM, Hanfelt JJ, Jinnah HA, Johns MM. Coprevalence of tremor with spasmodic dysphonia: a case-control study. Laryngoscope 2011; 121:1752-5. [PMID: 21792965 DOI: 10.1002/lary.21872] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to define the coprevalence of tremor with spasmodic dysphonia (SD). STUDY DESIGN A single-institution, prospective, case-control study was performed from May 2010 to July 2010. METHODS Consecutive patients with SD (cases) and other voice disorders (controls) were enrolled prospectively. Each participant underwent a voice evaluation and an evaluation for tremor. RESULTS There were 146 voice disorder controls and 128 patients with SD enrolled. Of patients with SD 26% had vocal tremor, 21% had nonvocal tremor. Patients with SD were 2.8 times more likely to have coprevalent tremor than the control group (odds ratio = 2.81; 95% confidence interval, 1.55-5.08), and only 35% of patients with SD had been seen by a neurologist for the evaluation of dystonia and tremor. CONCLUSIONS Tremor is highly prevalent in patients with SD. It is important for each patient diagnosed with SD to undergo an evaluation for tremor, and this is especially important in patients diagnosed with vocal tremor.
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Affiliation(s)
- Laura J White
- Emory University School of Medicine, Atlanta, Georgia, USA
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Godeiro-Junior C, Felício AC, Aguiar PMDC, Borges V, Silva SMA, Ferraz HB. Retrocollis, anterocollis or head tremor may predict the spreading of dystonic movements in primary cervical dystonia. Arq Neuro-Psiquiatr 2009; 67:402-6. [DOI: 10.1590/s0004-282x2009000300006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 04/18/2009] [Indexed: 11/22/2022]
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.
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Abstract
Frequently, blepharospasm is associated with involuntary movements of the platysma, lower face and masticatory muscles. Similarly, masticatory dystonia may occur in isolation or in combination with dystonia of other cranial and cervical muscles. The non-possessive and possessive forms of Meige and Brueghel syndromes have been variably and imprecisely ascribed to various anatomical variations of craniocervical dystonia. Herein, the origin of eponymic terms as applied to craniocervical dystonia is reviewed as support for proposed elimination of these eponyms from clinical usage. Although the term "segmental craniocervical dystonia" more accurately captures the combination of blepharospasm and dystonia of other head and neck muscles, delineation of craniocervical subphenotypes is essential for etiological/genetic and treatment studies. To conclude, the clinical features, epidemiology, pathophysiology and therapeutic management of segmental craniocervical dystonia are examined with a particular focus on "blepharospasm-plus" subphenotypes.
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Affiliation(s)
- Mark S LeDoux
- Departments of Neurology and Anatomy & Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Abstract
This review updates understanding and research on blepharospasm, a subtype of focal dystonia. Topics covered include clinical aspects, pathology, pathophysiology, animal models, dry eye, photophobia, epidemiology, genetics, and treatment. Blepharospasm should be differentiated from apraxia of eyelid opening. New insights into pathology and pathophysiology are derived from different types of imaging, including magnetic resonance studies. Physiologic studies indicate increased plasticity and trigeminal sensitization. While botulinum neurotoxin injections are the mainstay of therapy, other therapies are on the horizon.
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Affiliation(s)
- Mark Hallett
- Human Motor Control Section, NINDS, NIH, 10 Center Drive MSC 1428, Bethesda, MD 20892-1428, USA.
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