Objective: To evaluate if dystonia patients without axial phenotype have spontaneous electric activity in back muscles.

Background: Patients with cervical dystonia (CD) often complain of back symptoms even without obvious axial dystonic postures. We examined the spontaneous activity of back muscles in dystonia patients.

Method: The adult patients with CD were included in this study. MiniEMG device was used to evaluate qualitatively electric activity in erector spinae, trapezius, rhomboideus minor, rhomboideus major and latissimus dorsi muscles. The patients were divided into two groups based on back muscle activity. 

The dystonia severity was evaluated with UDRS and TWSRS. The patients evaluated subjectively the dystonic and pain symptoms in different body regions with visual analogue scale. Depression and anxiety were evaluated with BDI-21 and BAI questionnaires. The patients evaluated subjectively the presence of other symptoms.

Results: 89 patients with CD were evaluated. 68 of patients were woman and the average age of patients was 61,9±12,8 years.  Of these patients, 55 had spontaneous back muscle activity. The current age or age of onset did not differ significantly between groups. 

The back activity group patients had more dystonia symptoms as measured with UDRS (median (IQR): 6,5(4,5) vs 4,5(2,4), p = 0,04). The self-evaluated dystonia symptoms differed in upper face, lower face, back, upper limb and lower limb regions. The CD symptoms did not differ as evaluated with TWSTRS torticollis severity scale. In TWSTRS disability score, the back activity group had significantly more points (4(9) vs 2(5), p = 0,04) as well as in TWSTRS pain score (10(9,4) vs 6,4(6,7), p = 0,003).  

Patients in the back activity group reported higher pain levels in the neck, lower back, and upper and lower limbs. The back activity group also reported significantly more walking difficulties, dyspnea and dexterity problems. The groups did not differ with anxiety or depression.

Conclusion: Of studied CD patients, 62% had spontaneous back activity. The nature of detected activity could not be determined. Besides being a dystonic phenomenon, the observation could be related to overflow or compensatory activity. The patients with back activity experienced more back and limb pain and walking difficulties and had more dystonia symptoms. Addressing the observed activity of back muscles may help reduce these symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/back-muscle-activity-is-associated-with-pain-with-cervical-dystonia-patients/