Tremor in Idiopathic Cervical Dystonia – Possible Implications for Botulinum Toxin Treatment Considering the Col-Cap Classification

Tremor and Other Hyperkinetic Movements

article

Sanjay Pandey¹  Alexandre Kreisler²  Artur Drużdż³  Bo Biering-Sørensen⁴  Jaroslaw Sławek⁵  Laurent Tatu⁷  Wolfgang H. Jost⁸ 

[1] Department of Neurology, Govind Ballabh Pant Institute of Postgraduate medical education and research;Service de Neurologie et Pathologie du Mouvement, CHRU de Lille;Department of Neurology, Municipal Hospital;Movement Disorder Clinic, Department of Neurology, Rigshospitalet;Department of Neurological‑Psychiatric Nursing, Medical University of Gdańsk;Department of Neurology, St. Adalbert Hospital;Department of Neuromuscular diseases and Department of Anatomy, University of Franche-Comté;Parkinson-Klinik Ortenau

关键词: Cervical dystonia;    Tremor;    Torticaput;    Botulinum toxin;    Ultrasonography;   

DOI  :  10.5334/tohm.63

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

Background: Tremor is an important phenotypic feature of dystonia. Using the new concept (Col-Cap) of classification we examined the frequency of tremor in cervical dystonia (CD) patients, their main subtypes and muscles injected. Methods: In this large study conducted at multiple movement disorder centres in Europe and India, between January and June 2019, we examined 293 patients with idiopathic CD who were all treated with botulinum toxin (BTX). Results: The dystonic head tremor (DHT+) was present in 57.6 % of CD patients and they had a significantly longer duration of symptoms than patients without head tremor (DHT–). In DHT+ patients torticaput was the most common subtype and the majority (63.3%) had one or two subtypes only. There was no significant difference between the number of unilateral injections for any of the muscles in the DHT+ and DHT– groups, while the number of patients receiving bilateral injections in splenius capitis (78 vs 25; p = 0.00001), sternocleidomastoid (31 vs 6; p = 0.0005), trapezius (28 vs 9; p = 0.01), and obliquus capitis inferior (15 vs 2; p = 0.008) were significantly more in the DHT+ group. The mean doses of all three types of BTX/A were not significantly different between the two groups. Conclusions: The frequency of head tremor was 57.6% in our CD patients and torticaput was the most common dystonic subtype associated with tremor. Simple forms of CD seemed more likely associated with head tremor, than complex forms of CD. Most of the DHT+ patients received bilateral injections. The use of ‘Col-Cap’ classification was helpful in the identification of muscles likely to be involved in tremor in CD patients.

【 授权许可】

CC BY