Objective: To investigate the prevalence of dystonic tremor and tremor associated with dystonia (TAWD) in patients with cervical dystonia.

Background: The link between dystonia and tremor has been known for decades, but at present the question arises whether they are two separate illnesses or just different manifestations of one disease with the same pathophysiological background. We distinguish two types of tremor in dystonia: dystonic tremor, which appears on body part affected by dystonia, and tremor associated with dystonia (TAWD) in locations where dystonia does not occur, commonly described as coincidental essential tremor. Dystonia has always been considered a basal ganglia disease. However, the theory of neuronal network dysfunction, involving many areas of brain, currently prevails. The role of cerebellum seems especially important, which promotes the theory that TAWD might not be just a coincidence of essential tremor and cervical dystonia, but one of the symptoms of cerebellar dysfunction in dystonia.

Methods: The prevalence of different forms of tremor was determined by a clinical examination in a group of patients with confirmed diagnosis of cervical dystonia, treated with regular local injections of botulinum toxin A in the tertiary movement disorders center.

Results: In total, 123 patients with cervical dystonia were included in the pilot study, 28 men (22.76%) and 95 women (77.24%). The mean age of patients was 59.8 years. Dystonic tremor of the head was present in 70 patients (56.91%), TAWD was present in 14 cases (11.38%). In all cases, TAWD was present on upper limbs in the form of static or intentional tremor.

Conclusions: In this pilot study, we point out the presence of TAWD as one of the clinical signs of cervical dystonia; TAWD occurred in 11.38% patients in the studied group. Dystonic tremor occurred in more than half of the patients and appears to be a relatively common part of the clinical manifestation in patients with cervical dystonia. Supported by the AZV of the Ministry of Health of the Czech Republic No. 16-30210A grant and Institutional Support of the Research Organizations of the Ministry of Health of the Czech Republic RVO FNOL 2017/2018.

References: Comella C. Dystonia: Then and now. Park Relat Disord 2018; 46: S66 – S69. Bares M. et al. Cerebellum and dystonia: The story continues. Will the patients benefit from new discoveries? Clin Neurophysiol 2018; 129: 282 – 283.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-prevalence-of-dystonic-tremor-and-tremor-associated-with-dystonia-tawd-in-patients-with-cervical-dystonia/