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Gandhi SE, Anderson DG, Newman EJ. A Clinical Approach to Focal Dystonias. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2022. [DOI: 10.47795/ufdf2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dystonia is a hyperkinetic movement disorder (HMD), characterised by sustained or intermittent involuntary muscle contractions resulting in abnormal postures and/or movements [1]. Although primary dystonia has an estimated prevalence of 16 per 100,000 [2], the diagnosis may be delayed, due to its clinical heterogeneity, the lack of objective biomarkers and the potential for pseudodystonic conditions to mimic it [1,3]. We provide an overview of the classification and common subtypes of focal dystonia, focusing on the clinical phenomenology and diagnosis.
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Norris SA, Jinnah HA, Klein C, Jankovic J, Berman BD, Roze E, Mahajan A, Espay AJ, Murthy AV, Fung VSC, LeDoux MS, Chang FCF, Vidailhet M, Testa C, Barbano R, Malaty IA, Bäumer T, Loens S, Wright LJ, Perlmutter JS. Clinical and Demographic Characteristics of Upper Limb Dystonia. Mov Disord 2020; 35:2086-2090. [PMID: 32845549 DOI: 10.1002/mds.28223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Knowledge of characteristics in upper limb dystonia remains limited, derived primarily from small, single-site studies. OBJECTIVE The objective of this study was to characterize demographic and clinical characteristics of upper limb dystonia from the Dystonia Coalition data set, a large, international, multicenter resource. METHODS We evaluated clinical and demographic characteristics of 367 participants with upper limb dystonia from onset, comparing across subcategories of focal (with and without dystonia spread) versus nonfocal onset. RESULTS Focal onset occurred in 80%; 67% remained focal without spread. Task specificity was most frequent in this subgroup, most often writer's cramp and affecting the dominant limb (83%). Focal onset with spread was more frequent in young onset (<21 years). Focal onset occurred equally in women and men; nonfocal onset affected women disproportionately. CONCLUSIONS Upper limb dystonia distribution, focality, and task specificity relate to onset age and likelihood of regional spread. Observations may inform clinical counseling and design, execution, and interpretation of future studies. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Scott A Norris
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyder A Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emmanuel Roze
- Sorbonne University, Inserm U 1127, National Centre for Scientific Research, Joint Research Units 7225, Institut du Cerveau et de la Moelle épinière and Assistance Public Hôpitaux de Paris, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Abhimanyu Mahajan
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark S LeDoux
- Department of Psychology and School of Health Studies, University of Memphis, Memphis, Tennessee, USA.,Veracity Neurosciences LLC, Memphis, Tennessee, USA
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, AP-HP, Paris, France.,Department of Neurology, Sorbonne Université, Paris, France.,Brain & Spine Institute, Joint Research Units 1127, INSERM 1127, Center National De Recherche Scientific 7235, Paris, France
| | - Claudia Testa
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Irene A Malaty
- University of Florida Department of Neurology, Fixel Institute for Neurologic Diseases, Gainesville, Florida, USA
| | - Tobias Bäumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics and Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Laura J Wright
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Departments of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Neuroscience, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Lee SY, Lee HD, Cho YS, Han SH. Treatment of focal dystonia involving multiple muscles with a single injection of botulinum toxin A to 1 muscle: A case report. Medicine (Baltimore) 2018; 97:e12785. [PMID: 30334967 PMCID: PMC6211890 DOI: 10.1097/md.0000000000012785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Botulinum toxin A (BTX-A) injection is effective in treating focal dystonia. However, there are no prior reports regarding the treatment of progressive focal dystonia by a single BTX-A injection that affect a distant muscle. PATIENT CONCERNS A 19-year-old male was referred to the rehabilitation clinic with a complaint of involuntary movement in his left big toe. The involuntary movement pattern was initially observed in the abduction direction only; however, it progressed to irregular mixed patterns in the flexion and abduction directions. DIAGNOSES In needle electromyography, abnormal dystonic patterns were observed in the left abductor hallucis (AH), flexor hallucis longus, and flexor hallucis brevis muscles. INTERVENTIONS AND OUTCOMES These symptoms resolved with a single BTX-A injection to the AH muscle. LESSONS In this case, a single BTX-A injection to 1 muscle for treating progressive focal dystonia was effective on a distant noninjected muscle.
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Payo Froiz I, Descals Moll C, Montalà Reig J, Usón Martín M, Espino Ibáñez A. Focal gradual-onset variant of stiff-person syndrome. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Payo Froiz I, Descals Moll C, Montalà Reig J, Usón Martín M, Espino Ibáñez A. Forma focal y de larga evolución del síndrome de la persona rígida. Neurologia 2016; 31:643-644. [DOI: 10.1016/j.nrl.2014.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022] Open
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We Are Able, We Intend, We Act—But We Do Not Succeed: A Theoretical Framework for a Better Understanding of Paradoxical Performance in Sports. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2014. [DOI: 10.1123/jcsp.2014-0047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Paradoxical performance can be described simply as a sudden decrease in a top athlete’s performance despite the athlete’s having striven for superior performance, such as the lost-skill syndrome in trampolining or “the yips” in golf. There is a growing amount of research on these phenomena, which resemble movement disorders. What appears to be missing, however, is a clear phenomenology of the affected movement characteristics leading to a classification of the underlying cause. This understanding may enable specific diagnostic methods and appropriate interventions. We first review the different phenomena, providing an overview of their characteristics and their occurrence in sports and describing the affected sports and movements. We then analyze explanations for the yips, the most prominent phenomenon, and review the methodological approaches for diagnosing and treating it. Finally, we present and elaborate an action theoretical approach for diagnosing paradoxical performance and applying appropriate interventions.
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Gonzalez-Alegre P, Schneider RL, Hoffman H. Clinical, Etiological, and Therapeutic Features of Jaw-opening and Jaw-closing Oromandibular Dystonias: A Decade of Experience at a Single Treatment Center. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:231. [PMID: 24847442 PMCID: PMC4011122 DOI: 10.7916/d8th8jsm] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/02/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dystonia is a heterogeneous hyperkinetic disorder. The anatomical location of the dystonia helps clinicians guide their evaluation and treatment plan. When dystonia involves masticatory, lingual, and pharyngeal muscles, it is referred to as oromandibular dystonia (OMD). METHODS We identified patients diagnosed with OMD in a Movement Disorders Clinic and Laryngeal Movement Disorders Clinic from a single institution. Demographic, etiological, clinical, and therapeutic information was retrospectively reviewed for patients with jaw-opening (O-OMD) and jaw-closing (C-OMD) OMD. RESULTS Twenty-seven patients were included. Their average age of onset was in the sixth decade of life and there was a female predominance. Etiological factors linked in this study to OMD included a family history of dystonia or essential tremor, occupation, cerebellar disease, a dental disorder, and tardive syndrome. Clinically, patients with C-OMD presented with more prominent feeding difficulties, but seemed to respond better to therapy than those with O-OMD. In addition to the known benefits of botulinum toxin therapy, patients who described sensory tricks obtained benefit from the use of customized dental prosthesis. DISCUSSION This works provides useful information on potential etiological factors for OMD and its response to therapy, and highlights the potential benefit of dental prosthesis for the treatment of OMD.
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Affiliation(s)
- Pedro Gonzalez-Alegre
- Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Robert L Schneider
- Department of Oral & Maxillofacial Surgery, College of Dentistry, The University of Iowa, Iowa City, Iowa, United States of America
| | - Henry Hoffman
- Department of Otolaryngology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
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Abstract
The yips is a multi-etiological phenomenon consisting of involuntary movements during the execution of a skill (e.g., a golf putt). Reinvestment, the conscious control of a movement that detrimentally affects automated movements, is thought to be a potential mechanism leading to the yips. Preventing yips-affected golfers from consciously controlling their movement, therefore, should be beneficial. The aim of the study was to be the first to empirically test in a laboratory whether reinvestment causes the yips and to explore if the tendency to reinvest can explain yips behavior. Nineteen yips-affected golfers participated in a lab experiment. They putted with the dominant arm in a skill-focus and an extraneous condition, in which they had to perform different dual tasks designed either to direct their focus on their own skill or to distract them from it. The tendency to reinvest was estimated via the Movement-Specific Reinvestment Scale. Yips behavior was assessed by putting performance and movement variability. Although the dual-task performance showed that the attentional manipulation worked, the tendency to reinvest did not predict the behavior of the yips-affected golfers in either putting condition. The yips-affected golfers also showed no difference in yips behavior between the skill-focus and the extraneous condition. In other words, the attentional manipulation did not change yips behavior. The data do not support the assumption that there is a link between the yips and reinvestment, likely because of the multi-etiological nature of the yips. Other psychological or neurological mechanisms such as conditioned reactions may better explain the yips and should be investigated.
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Go SA, Coleman-Wood K, Kaufman KR. Frequency analysis of lower extremity electromyography signals for the quantitative diagnosis of dystonia. J Electromyogr Kinesiol 2013; 24:31-6. [PMID: 24295542 DOI: 10.1016/j.jelekin.2013.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/15/2013] [Accepted: 11/06/2013] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to develop an objective, quantitative tool for the diagnosis of lower extremity dystonia. Frequency domain analysis was performed on surface and fine-wire electromyography (EMG) signals collected from the lower extremity musculature of ten patients with suspected dystonia while performing walking trials at self-selected speeds. The median power frequency (MdPF) and percentage of total power contained in the low frequency range (%AUCTotal) were determined for each muscle studied. Muscles exhibiting clinical signs of dystonia were found to have a shift of the MdPF to lower frequencies and a simultaneous increase in the %AUCTotal. A threshold frequency of 70Hz identified dystonic muscles with 73% sensitivity and 63% specificity. These results indicate that frequency analysis can accurately distinguish dystonic from non-dystonic muscles.
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Affiliation(s)
- Shanette A Go
- Mayo Graduate School, Mayo Medical School and the Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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How to detect the yips in golf. Hum Mov Sci 2013; 32:1270-87. [PMID: 24016710 DOI: 10.1016/j.humov.2013.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 11/21/2022]
Abstract
The yips is a multi-aetiological phenomenon that is characterized by an involuntary movement that can affect a golfer's putting performance. Diagnostics are crucial for a better understanding of what causes the yips but are still lacking. The purpose of the present study was therefore to identify sensitive methods for detecting the yips and evaluating its aetiology. Forty participants, 20 yips-affected golfers and 20 nonaffected golfers, completed a psychometric testing battery and performed a putting session in the laboratory. They answered questions about their golfing and yips experience and filled in standardized questionnaires measuring trait anxiety, perfectionism, stress-coping strategies, somatic complaints, and movement and decision reinvestment. In the laboratory, they had to putt in five different conditions that might elicit the yips: as usual with both arms, under pressure, with one (the dominant) arm, with a unihockey racket, and with latex gloves. Measures included putting performance, situational anxiety, kinematic parameters of the putter, electromyography of the arm muscles, and electrocardiography. The groups were separated only by putting performance and kinematic parameters when putting with the dominant arm. Future research should use kinematics to investigate the aetiology of the yips and possible interventions.
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Takada LT, Pimentel MLV, Dejesus-Hernandez M, Fong JC, Yokoyama JS, Karydas A, Thibodeau MP, Rutherford NJ, Baker MC, Lomen-Hoerth C, Rademakers R, Miller BL. Frontotemporal dementia in a Brazilian kindred with the c9orf72 mutation. ACTA ACUST UNITED AC 2012; 69:1149-53. [PMID: 22964910 DOI: 10.1001/archneurol.2012.650] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe the clinical features of a Brazilian kindred with C9orf72 frontotemporal dementia-amyotrophic lateral sclerosis and compare them with other described families with C9orf72 and frontotemporal dementia-amyotrophic lateral sclerosis-causing mutations. DESIGN Report of a kindred. SETTING Dementia center at a university hospital. PATIENTS One kindred encompassing 3 generations. RESULTS The presence of a hexanucleotide (GGGGCC) expansion in C9orf72 was confirmed by repeat-primed polymerase chain reaction and Southern blot. The observed phenotypes were behavioral variant frontotemporal dementia and amyotrophic lateral sclerosis with dementia, with significant variability in age at onset and duration of disease. Parkinsonian features with focal dystonia, visual hallucinations, and more posterior atrophy on neuroimaging than is typical for frontotemporal dementia were seen. CONCLUSIONS Behavioral variant frontotemporal dementia due to C9orf72 expansion displays some phenotypic heterogeneity and may be associated with hallucinations, parkinsonism, focal dystonia, and posterior brain atrophy. Personality changes may precede the diagnosis of dementia by many years and may be a distinguishing feature of this mutation.
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Affiliation(s)
- Leonel T Takada
- Memory and AgingCenter, University of California, San Francisco, 350 Parnassus Ave, Ste 905, San Francisco, CA 94143-1207, USA.
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Delnooz CCS, van de Warrenburg BPC. Current and future medical treatment in primary dystonia. Ther Adv Neurol Disord 2012; 5:221-40. [PMID: 22783371 PMCID: PMC3388529 DOI: 10.1177/1756285612447261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dystonia is a hyperkinetic movement disorder, characterized by involuntary and sustained contractions of opposing muscles causing twisting movements and abnormal postures. It is often a disabling disorder that has a significant impact on physical and psychosocial wellbeing. The medical therapeutic armamentarium used in practice is quite extensive, but for many of these interventions formal proof of efficacy is lacking. Exceptions are the use of botulinum toxin in patients with cervical dystonia, some forms of cranial dystonia (in particular, blepharospasm) and writer's cramp; deep brain stimulation of the pallidum in generalized and segmental dystonia; and high-dose trihexyphenidyl in young patients with segmental and generalized dystonia. In order to move this field forward, we not only need better trials that examine the effect of current treatment interventions, but also a further understanding of the pathophysiology of dystonia as a first step to design and test new therapies that are targeted at the underlying biologic and neurophysiologic mechanisms.
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Affiliation(s)
- Cathérine C S Delnooz
- Radboud University Nijmegen Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, the Netherlands
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Schapira AHV, Hillbom M. Publishing changes and information delivery in the clinical neurosciences. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.2011.03594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Phukan J, Albanese A, Gasser T, Warner T. Primary dystonia and dystonia-plus syndromes: clinical characteristics, diagnosis, and pathogenesis. Lancet Neurol 2011; 10:1074-85. [PMID: 22030388 DOI: 10.1016/s1474-4422(11)70232-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The dystonias are a heterogeneous group of hyperkinetic movement disorders characterised by involuntary sustained muscle contractions that lead to abnormal postures and repetitive movements. Dystonia syndromes represent common movement disorders and yet are often misdiagnosed or unrecognised. In recent years, there have been substantial advances in the understanding of the spectrum of clinical features that encompass dystonia syndromes, from severe generalised childhood dystonia that is often genetic in origin, to adult-onset focal dystonias and rarer forms of secondary dystonias, to dystonia as a feature of other types of CNS dysfunction. There has also been a rationalisation of the classification of dystonia and a greater understanding of the causes of dystonic movements from the study of genetics, neurophysiology, and functional imaging in the most prevalent form of dystonia syndrome, primary dystonia.
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Affiliation(s)
- Julie Phukan
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
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Strader S, Rodnitzky RL, Gonzalez-Alegre P. Secondary dystonia in a botulinum toxin clinic: clinical characteristics, neuroanatomical substrate and comparison with idiopathic dystonia. Parkinsonism Relat Disord 2011; 17:749-52. [PMID: 21852177 DOI: 10.1016/j.parkreldis.2011.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/22/2011] [Accepted: 07/31/2011] [Indexed: 11/24/2022]
Abstract
The analysis of patients with secondary dystonia has been valuable to explore the anatomical, pharmacological and physiological bases of this disorder. The goal of this study is to compare the clinical characteristics of patients with primary and secondary dystonia and analyze the neuroanatomical bases of a subgroup of patients with lesion-induced dystonia. We identified patients evaluated in our Botulinum Toxin Clinic from 1/2000 to 7/2009 with an ICD code for "dystonia". Medical records of all subjects were reviewed, recording demographic, clinical, therapeutic and neuroimaging data. A total of 230 patients were included in the study. Idiopathic/primary dystonia was diagnosed in 162 and secondary dystonia in 58, while in 10 the etiology was uncertain. We found a female predominance (2.4:1 and 1.9:1 for primary and secondary dystonia, respectively). The cervical region was most commonly affected in primary dystonia and the limbs in secondary cases. The age at presentation was higher in primary (54.4 ± 14.1) than secondary (49 ± 17.9) dystonia. Among patients with secondary dystonia, a focal lesion was the presumed etiology in 32, with localizing diagnostic studies available in 16. The most common lesions were strokes involving the corticospinal pathway. All of those patients exhibited limb dystonia, except one with cervical dystonia following a thalamic infarct. In conclusion, primary and secondary dystonias are more prevalent in women, suggesting a sex-related predisposition to the development of this movement disorder. Lesion-induced dystonia most frequently involves the limbs and is caused by lesions in the cerebral cortex and subcortical white matter.
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Affiliation(s)
- Scott Strader
- Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1101, USA
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Ha AD, Jankovic J. An introduction to dyskinesia--the clinical spectrum. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 98:1-29. [PMID: 21907081 DOI: 10.1016/b978-0-12-381328-2.00001-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The term movement disorder is used to describe a variety of abnormal movements, and may involve an excess or paucity of movement. Careful characterization of phenomenology is an essential component of diagnosis. Factors such as speed, amplitude, duration, distribution, rhythmicity, suppressibility and pattern of movement provide valuable information to guide the clinician in their assessment of the movement disorder. In this chapter, the clinical spectrum and phenomenology of dyskinesias will be reviewed.
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Affiliation(s)
- Ainhi D Ha
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, 77030, USA
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