Objective: To evaluate the prevalence of non-motor symptoms associated to idiopathic cervical dystonia (CD) in a sample of patients followed in a Brazilian Movement Disorders Clinic.

Background: Dystonia is the third most common movement disorders in specialized clinics, and focal forms are the most common presentation. Some studies have already reported an increased prevalence of psychiatric disorders, pain, impaired quality of sleep and impaired life quality in patients with focal dystonia, especially in CD and blepharospasm. However, few studies were dedicated to explore the clinical significance of different psychiatric disorders and other non-motor symptoms in patients with focal dystonia (Fabbrini et al. 2010; Lehn et al. 2014).

Methods: We evaluated 20 consecutive patients with CD followed at Ribeirão Preto School of Medicine outpatient clinic, that were in treatment with injections of botulinum toxin, and that received their last injection at least 4 months before. They were compared to 20 healthy subjects (HS) matched for age, sex, education, geographical, and social origin. Clinical and demographic information were collected by interview and non-motor symptoms were evaluated using self-report questionnaires: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Apathy Scale (AS), Social Phobia Inventory Test (SPIN), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), WOQHOL brief and a Pain Scale. The local ethical committee approved the study and all patients gave their informed consent.

Results: Both groups had similar age, gender distribution and level of education.

[Table1] Demographic aspects of patients with idiopathic cervical dystonia and healthy subjects.

	Patients with idiopathic Cervical dystonia	Heathy subjects	Statistical analysis
Number	20	20	–
Number of women (%)	15 (75%)	15 (75%)	–
Stopped working because of dystonia (%)	6 (30%)	–	–
	Mean (SD)	Mean (SD)
Age first symptoms (years)	42.7 (11.8)	–	–
Disease duration (years)	16.7 (13.9)	–	–
Tsui score (modified version)	8.3 (4.2)	–	–
Age (years) $	59.5 (13.2)	54.0 (10.9)	p=0.152
Years of education*	8.7 (4.8)	8.6 (4.4)	p=0.973
Mini-mental state examination*	25.4 (3.0)	25.6 (2.8)	p=0.832

*Test t-student; $Mann–Whitney U test; **p<0.05. Patients with CD had significantly more symptoms of anxiety and social phobia than HS. 30% of CD patients presented moderate or serious symptoms of anxiety (BAI>15) and 25% of them presented moderate or serious symptoms of social phobia (SPIN>30). Pain was more prevalent in patients with CD. There were no differences between groups for symptoms of depression, apathy, sleepiness, quality of sleep or for quality of life.

[Table2] Clinical aspects of patients with idiopathic cervical dystonia and healthy subjects.

	Patients with idiopathic Cervical dystonia Mean (SD)	Heathy subjects Mean (SD)	Statistical analysis
BDI$	11.8 (9.7)	9.1 (7.6)	p=0,309
BAI$	11.5 (8.4)	6.0 (7.1)	p=0,021**
AS$	21.6 (6.5)	22.8 (6.6)	p=0,654
SPIN*	21.4 (13.3)	11.7 (8.0)	p=0.009**
ESS*	6.0 (3.9)	7.5 (4.6)	p=0.280
PSQI*	7.7 (4.9)	5.9 (4.4)	p=0.222
WHOQOL*	91.4 (11.0)	91.5 (11.4)	p=0.989
Pain# (%)	85%	35%	p=0.004**

*Test t-student; $Mann–Whitney U test; #Chi-squared test; **p<0.05. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Apathy Scale (AS), Social Phobia Inventory Test (SPIN), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), WHOQOL brief“

Conclusions: Patients with CD may have high prevalence of pain, anxiety symptoms, and social phobia symptoms. The finding of a high prevalence of social phobia and anxiety coping behaviour as the main predictor of psychiatric comorbidity may make a subgroup of patients with CD particularly amenable to specific psychotherapeutic interventions. Pain treatment is very important in these patients.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-evaluation-in-idiopathic-cervical-dystonia/