Objective: We describe a case of cervical dystonia in a 36 year-old, secundigravid, Caucasian woman at 8 weeks gestation.

Background: Though uncommon, primary movement disorders can occur in pregnancy, the most common being restless legs syndrome and chorea gravidarum [1]. new onset dystonia in pregnancy or dystonia gravidarum has been reported just 4 times previously [1,2]. Exacerbation of pre-existing movement disorders and onset of de novo movement disorders during pregnancy support the hypothesis that female sex hormones play an important role in regulation of basal ganglia circuitry.

Method: N/A

Results: A 36 year old right handed, secundigravid, Caucasian woman at 8 weeks gestation presented with involuntary movements of the head, neck and  right shoulder. Neurological examination revealed torticollis predominantly to the right, laterocollis to the left, and right shoulder elevation. The left sternocleidomastoid was hypertrophied. Treatment was initiated for presumed dystonia gravidarum with procyclidine and clonazepam. There was some improvement in severity of movements, but symptoms persisted throughout pregnancy. There was complete resolution of dystonia 3 days post-partum. The patient began breast feeding and once mature milk was produced the dystonic movements remerged, albeit less severe than during pregnancy. A 5 day hiatus of breast feeding led to a significant improvement in symptoms but not resolution. At this time botulinum toxin treatment was administered to the left and right SCM with good symptomatic improvement.

Conclusion: This is the 5^th reported case of dystonia with onset during pregnancy and establishes DG as a distinct clinical entity. Based on the cases which have been reported in the literature to date, a distinct clinical phenotype along with a temporal course has emerged.The prompt improvement or resolution of symptoms after delivery strongly supports the hormonal milieu of pregnancy being the key driver of nigrostriatal dysfunction.

References: 1. Ba F, Miyasaki JM. Movement disorders in pregnancy. In: Handbook of Clinical Neurology. ; 2020. doi:10.1016/B978-0-444-64240-0.00013-1 2. Lim ECH, Seet RCS, Wilder-Smith E, Ong BKC. Dystonia gravidarum: A new entity? Mov Disord. 2006. doi:10.1002/mds.20648 3. Fasano A, Elia AE, Guidubaldi A, Tonali PA, Bentivoglio AR. Dystonia gravidarum: A new case with a long follow-up. Mov Disord. 2007. doi:10.1002/mds.21310

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