Objective: This study aimed to evaluate the clinical spectrum of patients with dystonia seen at Cleveland Clinic Abu Dhabi Hospital (CCAD), a tertiary care center in the United Arab Emirates (UAE).

Background: Dystonia is a movement disorder with an estimated prevalence of 0.06%. There are no published data on a large sample size from the middle east region due to a lack of awareness and expertise. The CCAD is a tertiary care hospital catering to the seven emirates of the UAE and neighbouring countries due to the lack of movement disorders centres.

Method:

This is a retrospective chart review from March 2018 until March 2023. We included subjects 14 years and above,  evaluated at least twice at the neurological institute of CCAD (n=106).  Dystonia was classified according to Albanese et al.

Results:

79/106 (75%) of the patients are local Emirati population, and 27 (25%) are expats. Age of onset was adulthood-onset (either early or late) in 60% of subjects, with a mean age at evaluation being 42 years. There was no gender disparity (M 54:F 52), even in the subgroup of cervical dystonia patients. 85/106 (80%) patients had isolated dystonia and the rest had combined dystonia (20%).  66 of the 106 patients (62%) were identified as focal dystonia, with the most common being cervical dystonia (60%), followed by cranial dystonia (including oromandibular with or without lingual dystonia and blepharospasm) and limb dystonia (mostly upper limb). Hemidystonia was seen in 9/106 patients (8.5%). 5 had MRI evidence of vascular events such as stroke, 3 had post-traumatic injury. Medical treatment included trihexyphenidyl, baclofen, benzodiazepines, levodopa and tetrabenazine. 60/106 (56%) patients received botulinum toxin injections, out of which 7 patients have generalized dystonia, 43 with focal dystonia, 5 with segmental and hemidystonia each. Out of 53/60, where the outcome was noted, there was good improvement in 65%, mild improvement in 15% and no improvement in 20%. Deep Brain Stimulation surgery was done in 8 patients, mostly with generalized dystonia.

Conclusion:

This is the first report on the demographics and clinical features of dystonia patients from a tertiary hospital in the Middle East. Isolated dystonia is fairly common, with the majority being focal dystonia, such as cervical dystonia. This study opens up huge potential for further research and collaboration with other tertiary centers in Asian-Oceanic regions including Middle East.

References: 1. Dressler, D., Altenmüller, E., Giess, R. et al. The epidemiology of dystonia: the Hannover epidemiology study. J Neurol 269, 6483–6493 (2022). https://doi.org/10.1007/s00415-022-11310-9
2 Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15;28(7):863-73. doi: 10.1002/mds.25475.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dystonia-in-the-middle-east-the-cleveland-clinic-abu-dhabi-experience/