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Yilmaz HN, Bilen S. Evaluation of non-motor symptoms in cervical dystonia, hemifacial spasm, and blepharospasm patients and their correlation with motor symptoms. Neurol Sci 2023; 44:4077-4086. [PMID: 37700177 DOI: 10.1007/s10072-023-07055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Awareness of non-motor symptoms has been increasing in recent years, but there are still few studies on this topic. OBJECTIVE Our aim was to evaluate various non-motor symptoms, especially psychiatric disorders, cognitive status, and sleep, in cervical dystonia (CD), hemifacial spasm (HFS), and blepharospasm (BPS) patients and to investigate whether these symptoms are related to the severity of motor symptoms. METHODS This was a single-center cross-sectional, observational, case-control study. Motor severity scales were used to determine disease severity. We evaluated non-motor symptoms with commonly used scales. A total of 73 patients and 73 control groups participated. RESULTS In CD patients, the MoCA total score, 'language', 'abstraction', and 'orientation' scores were statistically significantly lower; PSQI, ESS, and NMSQ scores were statistically significantly higher than controls. In the BPS group, the MoCA total score and the 'language' score were significantly lower, and the NMSQ score was statistically significantly higher than the controls. In the HFS group, MoCA total score, 'executive functions', 'language', and 'abstraction' scores were statistically significantly lower; PSQI scores are statistically significantly higher than controls. There was a positive correlation between the severity score and the PSQI score in the CD group and between the severity score and the NMSQ score in the BPS group. All three groups had significant cognitive impairments. CONCLUSIONS In CD, BPS, and HFS, non-motor symptoms are apparent with undeniable frequency in addition to common motor symptoms. Importantly, these NMS may cause significant deterioration in the quality of life of the patients.
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Affiliation(s)
- Hanife Nihan Yilmaz
- Neurology Clinic of Ankara City Hospital, Üniversiteler Mahallesi 1604, Cadde No: 9, Çankaya/Ankara, Turkey, 06800
| | - Sule Bilen
- Neurology Clinic of Ankara City Hospital, Üniversiteler Mahallesi 1604, Cadde No: 9, Çankaya/Ankara, Turkey, 06800.
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Mahady L, White J, Rafee S, Yap SM, O'Riordan S, Hutchinson M, Gough P, O'Keeffe F. Social cognition in cervical dystonia. Clin Park Relat Disord 2023; 9:100217. [PMID: 37711968 PMCID: PMC10497798 DOI: 10.1016/j.prdoa.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Whilst traditionally considered a movement disorder, it is now generally accepted that cervical dystonia (CD) presents with additional non-motor symptoms which significantly impact quality of life. Our study primarily aimed to explore social cognition and levels of psychological distress in individuals with CD, in comparison to age- and sex-matched healthy controls. Methods 20 participants with CD attending a specialist movement disorders clinic were recruited. 20 age and sex matched neurologically healthy controls were recruited in parallel. Participants completed the Hospital Anxiety and Depression Scale, and two novel social cognition tasks: The Cambridge Mindreading Face-Voice Battery (CAFMB) and the Edinburgh Social Cognition Test (ESCoT). Results Participants with CD exhibited poorer complex emotion recognition abilities for visual and auditory stimuli, compared to controls on the CAFMB task. Participants with CD did not differ significantly from controls on performance on cognitive or affective Theory of Mind tasks, or interpersonal or intrapersonal understanding of social norms, as measured by the ESCoT. The proportion of depressive symptoms was significantly higher for participants with CD than controls. 40% of participants with CD reported clinically elevated depressive symptoms, and 60% reported clinically elevated anxiety. Poorer understanding of emotional facial expressions was associated with higher levels of depression in the CD group. Conclusions Significant between-group differences between participants with CD and controls suggests socio-cognitive dysfunction is an important aspect of the non-motor syndrome of CD. Findings highlight the need for assessment of and intervention for both social cognitive difficulties and psychological distress in individuals with CD.
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Affiliation(s)
- Laura Mahady
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jessica White
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Shameer Rafee
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Siew-Mei Yap
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sean O'Riordan
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Patricia Gough
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Fiadhnait O'Keeffe
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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3
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Sugar D, Patel R, Comella C, González DA, Gray G, Stebbins GT, Mahajan A. The effect of botulinum toxin on anxiety in cervical dystonia: A prospective, observational study. Parkinsonism Relat Disord 2023; 114:105792. [PMID: 37540934 DOI: 10.1016/j.parkreldis.2023.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Anxiety is present in 30-40% of patients with cervical dystonia (CD). It has been ascribed to a direct effect of the state of motor symptoms on related pain, disability, and disfigurement. Accordingly, any reported benefit of botulinum toxin (BoNT) on anxiety is thought to be secondary to its effect on the same. We sought to evaluate the distinctive impact of botulinum toxin (BoNT) on anxiety in cervical dystonia (CD). METHODS In this prospective observational study, 60 participants with idiopathic isolated CD were recruited from clinic. We assessed motor and anxiety burden using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) parts I-III and State-Trait Anxiety Inventory (STAI). Assessments were done at time of BoNT (baseline) and at 6 weeks post-injection. RESULTS STAI and motor severity TWSTRS scores poorly correlated at the baseline visit (rho = -0.30, p = 0.411). Both, motor TWSTRS (Mdifference = -1.46, p < 0.024) and STAI (Mdifference = -10.37, p = 0.007) improved from baseline to 6 weeks (peak effect). The change in motor TWSTRS poorly correlated with change in anxiety scores from baseline visit to 6 weeks (rho = -0.14, p > 0.999). Of these measures of anxiety, improvement in STAI-T had the largest effect size (rank biserial = 0.52). CONCLUSION BoNT improves both motor severity and anxiety in CD. Poor correlation between motor severity and anxiety at both the time of injection and during the time of peak effect, and improvement in trait anxiety suggests that BoNT has a direct beneficial effect on anxiety.
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Affiliation(s)
- Dana Sugar
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Roshni Patel
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia Comella
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - David A González
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Gabrielle Gray
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA.
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Martino D. What can epidemiological studies teach on the pathophysiology of adult-onset isolated dystonia? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:21-60. [PMID: 37482393 DOI: 10.1016/bs.irn.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Several demographic and environmental factors may play an important role in determining the risk of developing adult-onset isolated dystonia (AOID) and/or modifying its course. However, epidemiologic studies have provided to date only partial insight on the disease mechanisms that are actively influenced by these factors. The age-related increase in female predominance in both patients diagnosed with AOID and subjects carrying its putative mediational phenotype suggests sexual dimorphism that has been demonstrated for mechanisms related to blepharospasm and cervical dystonia. The opposite relationship that spread and spontaneous remission of AOID have with age suggests age-related decline of compensatory mechanisms that protect from the progression of AOID. Epidemiological studies focusing on environmental risk factors yielded associations only with specific forms of AOID, even for those factors that are not likely to predispose exclusively to specific focal forms (for example, only writing dystonia was found associated with head trauma, and only blepharospasm with coffee intake). Other factors show biological plausibility of their mechanistic role for specific forms, e.g., dry eye syndrome or sunlight exposure for blepharospasm, scoliosis for cervical dystonia, repetitive writing for writing dystonia. Overall, the relationship between environment and AOID remains complex and incompletely defined. Both hypothesis-driven preclinical studies and well-designed cross-sectional or prospective clinical studies are still necessary to decipher this intricate relationship.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Hospital Drive NW, Calgary, AB, Canada; The Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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5
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Zito GA, Tarrano C, Ouarab S, Jegatheesan P, Ekmen A, Béranger B, Valabregue R, Hubsch C, Sangla S, Bonnet C, Delorme C, Méneret A, Degos B, Bouquet F, Apoil Brissard M, Vidailhet M, Hasboun D, Worbe Y, Roze E, Gallea C. Fixel-Based Analysis Reveals Whole-Brain White Matter Abnormalities in Cervical Dystonia. Mov Disord 2023. [PMID: 37148555 DOI: 10.1002/mds.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Cervical dystonia (CD) is a form of isolated focal dystonia typically associated to abnormal head, neck, and shoulder movements and postures. The complexity of the clinical presentation limits the investigation of its pathophysiological mechanisms, and the neural networks associated to specific motor manifestations are still the object of debate. OBJECTIVES We investigated the morphometric properties of white matter fibers in CD and explored the networks associated with motor symptoms, while regressing out nonmotor scores. METHODS Nineteen patients affected by CD and 21 healthy controls underwent diffusion-weighted magnetic resonance imaging. We performed fixel-based analysis, a novel method evaluating fiber orientation within specific fiber bundles, and compared fiber morphometric properties between groups. Moreover, we correlated fiber morphometry with the severity of motor symptoms in patients. RESULTS Compared to controls, patients exhibited decreased white matter fibers in the right striatum. Motor symptom severity negatively correlated with white matter fibers passing through inferior parietal areas and the head representation area of the motor cortex. CONCLUSIONS Abnormal white matter integrity at the basal ganglia level may affect several functional networks involved, for instance, in motor preparation and execution, visuomotor coordination, and multimodal integration. This may result in progressive maladaptive plasticity, culminating in overt symptoms of dystonia. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Clément Tarrano
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Salim Ouarab
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Prasanthi Jegatheesan
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Asya Ekmen
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Benoît Béranger
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR 7225, Paris, France
| | - Romain Valabregue
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR 7225, Paris, France
| | - Cécile Hubsch
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Sophie Sangla
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Cécilia Bonnet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Cécile Delorme
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | - Aurélie Méneret
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Degos
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Neurology Unit, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
| | - Floriane Bouquet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
| | | | - Marie Vidailhet
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Hasboun
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Yulia Worbe
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Roze
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
- DMU Neurosciences, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Gallea
- Movement Investigation and Therapeutics Team, Paris Brain Institute, Sorbonne University, Inserm U1127, CNRS UMR7225, Paris, France
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Zheng H, Wu L, Tian S, Liu M, Zhan Q, Yu X, Xie Y, Zhong X, Wu W. Effect of botulinum toxin type A on non-motor symptoms and quality of life in Meige syndrome. Front Neurol 2023; 14:1115482. [PMID: 36846150 PMCID: PMC9947842 DOI: 10.3389/fneur.2023.1115482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Background It has been shown in previous studies that botulinum toxin type A (BTX-A) can effectively relieve the motor symptoms of Meige syndrome. However, its effect on non-motor symptoms (NMS) and quality of life (QoL) has not been comprehensively studied. This study aimed to explore the effects of BTX-A on NMS and QoL and to clarify the relationship between changes in motor symptoms, NMS, and QoL after BTX-A. Methods Seventy-five patients were recruited for the study. All patients were assessed by a series of clinical assessments before, one, and 3 months after BTX-A treatment. Dystonic symptoms, psychiatric disturbances, sleep disorders, and QoL were evaluated. Results After 1 and 3 months of BTX-A treatment, the scores of motor symptoms, anxiety, and depression were significantly decreased (P < 0.05). Except for general health, the scores of the other 36-item short-form health survey QoL subitems were significantly improved after BTX-A (P < 0.05). After 1 month of treatment, the changes in anxiety and depression were not correlated with changes in motor symptoms (P > 0.05). Still, they were negatively correlated with changes in physical functioning, role-physical and mental component summary QoL (P < 0.05). Conclusions BTX-A effectively improved motor symptoms, anxiety, depression, and QoL. Anxiety and depression improvement did not correlate with motor symptom changes after BTX-A, and QoL improvements were strongly associated with psychiatric disturbances.
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Affiliation(s)
- Heqing Zheng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lanxiang Wu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Sheng Tian
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mingxu Liu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingqing Zhan
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinping Yu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yonggang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianhui Zhong
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Wu
- *Correspondence: Wei Wu ✉
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7
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Rafee S, Al-Hinai M, Douglas G, Ndukwe I, Hutchinson M. Mood symptoms in cervical dystonia: Relationship with motor symptoms and quality of life. Clin Park Relat Disord 2023; 8:100186. [PMID: 36747896 PMCID: PMC9898436 DOI: 10.1016/j.prdoa.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
Background Cervical dystonia (CD) has a high prevalence of anxiety and depression. The relationship between motor severity, mood symptoms and QoL is unclear and how to adequately assess these is also unknown. Instruments like the BAI, BDI and HADS are often used but items within these relating to somatic symptoms might influence the results. Methods Patients with idiopathic cervical dystonia (CD) were included. The BAI, BDI, HADS, CIDP58 and TWSTRS2- severity score were used for assessment of motor, mood and QoL symptoms. Pearson's correlations between motor and non-motor symptom scores were assessed. The psychometric properties of the psychiatric tools were measured and principal component analysis performed after identifying items that could correspond to somatic symptoms. Results 201 participants were included. 42% of participants had either significant depression or anxiety symptoms or both when measured by BAI and BDI and 51% of patients met criteria on HADS. HADS-A and HADS-D, BAI and BDI were poorly correlated with TWSTRS2-S. The HADS-A and HADS-D both showed strong correlation with the sleep subdomain of CDIP58. Psychometric and principal component analysis on 149/201 participants did not reveal factor loadings consistent with the a priori somatic groupings. However mean scores were higher for somatic items. Conclusion A good score on the CDIP58, a commonly used tool, does not indicate mild disease severity or minimal mood symptoms. Minimal motor symptoms, similarly, also does not imply a positive QoL. Clinicians should be mindful on ideal methods for performing a holistic assessment of CD patients. This likely warrants a combination of motor, QoL and mood assessment tools.
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Affiliation(s)
- Shameer Rafee
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Corresponding author at: Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland.
| | - Mahmood Al-Hinai
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Gillian Douglas
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Ihedinachi Ndukwe
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent’s University Hospital, Merrion Road, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
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8
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Bailey GA, Matthews C, Szewczyk-krolikowski K, Moore P, Komarzynski S, Davies EH, Peall KJ. Use of remote monitoring and integrated platform for the evaluation of sleep quality in adult-onset idiopathic cervical dystonia. J Neurol 2023; 270:1759-1769. [PMID: 36414751 PMCID: PMC9971061 DOI: 10.1007/s00415-022-11490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Up to 70% of individuals diagnosed with adult-onset idiopathic focal cervical dystonia (AOIFCD) report difficulties with sleep. Larger cohort studies using wrist-worn accelerometer devices have emerged as an alternative to smaller polysomnography studies, in order to evaluate sleep architecture. METHODS To measure activity during the sleep/wake cycle, individuals wore a consumer-grade wrist device (Garmin vivosmart 4) continuously over 7 days on their non-dominant wrist, while completing a daily sleep diary and standardised sleep and non-motor questionnaires via a dedicated app. Sleep measures were derived from the captured raw triaxial acceleration and heart rate values using previously published validated algorithms. RESULTS Data were collected from 50 individuals diagnosed with AOIFCD and 47 age- and sex-matched controls. Those with AOIFCD self-reported significantly higher levels of excessive daytime sleepiness (p = 0.04) and impaired sleep quality (p = 0.03), while accelerometer measurements found the AOIFCD cohort to have significantly longer total sleep times (p = 0.004) and time spent in NREM sleep (p = 0.009), compared to controls. Overall, there was limited agreement between wearable-derived sleep parameters, and self-reported sleep diary and visual analogue scale records. DISCUSSION This study shows the potential feasibility of using consumer-grade wearable devices in estimating sleep measures at scale in dystonia cohorts. Those diagnosed with AOIFCD were observed to have altered sleep architecture, notably longer total sleep time and NREM sleep, compared to controls. These findings suggest that previously reported disruptions to brainstem circuitry and serotonin neurotransmission may contribute to both motor and sleep pathophysiology.
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Affiliation(s)
- Grace A. Bailey
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | | | | | - Peter Moore
- grid.416928.00000 0004 0496 3293The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Kathryn J. Peall
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
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9
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Bailey GA, Martin E, Peall KJ. Cognitive and Neuropsychiatric Impairment in Dystonia. Curr Neurol Neurosci Rep 2022; 22:699-708. [PMID: 36201146 PMCID: PMC9633506 DOI: 10.1007/s11910-022-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review recent literature evaluating psychiatric and cognitive symptoms in dystonia, the two non-motor symptom groups most frequently evaluated in dystonia research and recognised in clinical practice. RECENT FINDINGS Recent work has embedded clinical recognition of psychiatric symptoms in dystonia, with depressive and anxiety-related symptoms routinely observed to be the most common. Less explored symptoms, such as self-harm, suicidal ideation, and substance abuse, represent newer areas of investigation, with initial work suggesting higher rates than the background population. Investigation of cognitive function has provided less consistent results, both within individual dystonia subtypes and across the spectrum of dystonias, partly reflecting the heterogeneity in approaches to assessment. However, recent work indicates impairments of higher cognitive function, e.g. social cognition, and disrupted visual and auditory sensory processing. Dystonia demonstrates psychiatric and cognitive symptom heterogeneity, with further work needed to recognise endophenotypes and improve diagnostic accuracy, symptom recognition, and management.
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Affiliation(s)
- Grace A Bailey
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Eva Martin
- School of Medicine, Cardiff University, Cardiff, UK
| | - Kathryn J Peall
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
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10
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Liu K, Hou Y, Ou R, Yang T, Yang J, Song W, Zhao B, Shang H. Cognitive impairment in Chinese patients with cervical dystonia. Front Neurol 2022; 13:961563. [PMID: 36188384 PMCID: PMC9523424 DOI: 10.3389/fneur.2022.961563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Cognitive impairment (CI) in patients with cervical dystonia (CD) has been reported in many studies but with inconsistent findings. We investigated the prevalence, characteristics, and clinical factors related to CI in Chinese patients with CD. Methods Sixty-eight patients with CD and 68 healthy controls (HCs) were included in the study. Demographic and clinical data were investigated. A logistic regression analysis was conducted to discriminate the clinical factors associated with CI in patients with CD. A cluster analysis was performed to explore the different characteristics within the group of CD patients with CI. Results We found that 42 (61.76%) patients with CD had CI. The most frequent CI domain was visuospatial function (39.71%), followed by memory (38.24%), attention/working memory (29.41%), language (25.00%), and executive function (23.53%). CD patients with CI were older, less educated, had an older age of onset, more severe motor symptoms and disability, and experienced more pain than CD patients without CI. The presence of CI in patients with CD was associated with less education (OR = 0.802, p = 0.034) and a higher Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscore (OR = 1.305, p = 0.001). The cluster analysis identified two different subgroups of patients, one with relatively mild cognitive impairment and the other with relatively severe cognitive impairment. Conclusion CI is relatively common in Chinese patients with CD, with the most common CI domain of the visuospatial function. In the present study, CI in patients with CD was associated with less education and more severe motor symptoms, and patients with CI may be further divided into two subgroups based on different extent and domain of cognitive decline.
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Costanzo M, Belvisi D, Berardelli I, Maraone A, Baione V, Ferrazzano G, Cutrona C, Leodori G, Pasquini M, Conte A, Fabbrini G, Defazio G, Berardelli A. Effect of Botulinum Toxin on Non-Motor Symptoms in Cervical Dystonia. Toxins (Basel) 2021; 13:toxins13090647. [PMID: 34564651 PMCID: PMC8472845 DOI: 10.3390/toxins13090647] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with cervical dystonia (CD) may display non-motor symptoms, including psychiatric disturbances, pain, and sleep disorders. Intramuscular injection of botulinum toxin type A (BoNT-A) is the most efficacious treatment for motor symptoms in CD, but little is known about its effects on non-motor manifestations. The aim of the present study was to longitudinally assess BoNT-A’s effects on CD non-motor symptoms and to investigate the relationship between BoNT-A-induced motor and non-motor changes. Forty-five patients with CD participated in the study. Patients underwent a clinical assessment that included the administration of standardized clinical scales assessing dystonic symptoms, psychiatric disturbances, pain, sleep disturbances, and disability. Clinical assessment was performed before and one and three months after BoNT-A injection. BoNT-A induced a significant improvement in dystonic symptoms, as well as in psychiatric disturbances, pain, and disability. Conversely, sleep disorders were unaffected by BoNT-A treatment. Motor and non-motor BoNT-A-induced changes showed a similar time course, but motor improvement did not correlate with non-motor changes after BoNT-A. Non-motor symptom changes after BoNT-A treatment are a complex phenomenon and are at least partially independent from motor symptom improvement.
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Affiliation(s)
- Matteo Costanzo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00185 Rome, Italy;
| | - Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Carolina Cutrona
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, SS 554 Bivio Sestu, 09042 Monserrato, Italy;
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (M.C.); (D.B.); (A.M.); (V.B.); (G.F.); (C.C.); (G.L.); (M.P.); (A.C.); (G.F.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence:
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