Objective: The Aim of the study was to assess:1.) if the perception of the visual vertical (VV) is impaired in subjects with cervical dystonia (CDsub), 2.)if there is a correlation between control of head position and the subjective visual vertical and 3.)if treatment with botulinum toxin (BoNTA)has an impact on the perception of the subjective visual vertical (SVV)

Background: Idiopathc cervical dystonia (CD) is characterized by an abnorm head position and visual-spatial processing might be affected in CDsub.

Method: We recruited 30 CDsub and 30 healthy controls (hc). Exclusion criteria: stroke in the past,vestibular disorders. Demographic data recorded:age, gender, onset of dystonia, type of dystonia, start of treatment and medication. First assessment was conducted prior to,2nd assessment 4 weeks after BoNTA treatment. Following tests were performed on both days: TWSTR, the TWSTR- disability scale, the TWSTR-pain scale  and a  self-rating of the  head position. All participants  conducted the line orientation test (LOT) prior to galvanic stimulation (gal.stim) and after gal.stim.

Results: (First data). We recruited 30 CDsub (10 m,20 fem,age 61,7 +/- 6,8 y,12laterocollis/laterocaput;8 torticollis/torticaput;4 combined) and 30 hc (12m,18fem,age:59,9 +/- 7,3 y).The TWSTR-Score ranged from 32 to 49, the TWSTR- disability score from 7 to 20, the TWSTR -pain scale from 5-18 prior to and 0-12 after BoNTA .The number of correct answers in the LOT differed  significantly between hc and CDsub prior and after gal.stim. In contrast to hc CDsub performed worse in the LOT after gal.stim. Sub.with marked laterocollis seem to perform worse in the LOT than sub. with mild laterocollis or torticollis. There was a positive correlation between head tilt and performance in the LOT (r = 0.7). Sub. with marked head tilt and poor LOT results showed a higher TWSTR-disability and TWSTR-pain score. Treatment with BoNT A didin`t seem to alter the performance in the LOT in CDsub.

Conclusion: The results indicate a difference in the perception of the VV and spatial orientation between hc and CDsub.The deterioration in the LOTof CDsub after gal.stim suggests that central compensatory mechanisms might be prone to failure. The deviation from a vertical head position seems to influence the perception of the SVV and might influence the visual-spatial processing. BoNT A treatment did not improve the perception of VV despite improvement of head position.

References: [1]De Pauw et al. Is perception of visual verticality intact in patients with idiopathic cervical dystonia? Acta Neurol Belg. 2018 Mar;118(1):77-84. doi: 10.1007/s13760-017-0853-0. Epub 2017 No
[2]De Pauw J et al. The effect of a single botulinum toxin treatment on somatosensory processing in idiopathic isolated cervical dystonia: an observational study.J Neurol. 2018 Nov;265(11):2672-2683. doi: 10.1007/s00415-018-9045-y. Epub 2018 .
[3]Vacherot F et al. Postural control and sensory integration in cervical dystonia. JP.Clin Neurophysiol. 2007 May;118(5):1019-27.
[4]Anastasopoulos D. et al. Perception of spatial orientation in spasmodic torticollis. Part 2: The visual vertical..Mov Disord. 1997 Sep;12(5):709-14. doi: 10.1002/mds.870120514

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MDS Abstracts - https://www.mdsabstracts.org/abstract/perception-of-the-subjective-visual-vertical-in-subjects-with-cervical-dystonia/