Assessment of Non-Motor Symptoms in Cervical Dystonia

INTRODUCTION: Cervical dystonia (CD) is a movement disorder characterized by cranial muscle overactivity, leading to an abnormal head posture. CD patients often experience mood disorders and sleep disorders due to the disturbing body image associated with deformities, and these symptoms can be at least as disabling as motor symptoms. This study investigated the frequency of non-motor symptoms and their relation to CD severity.
METHODS: The study comprises 26 clients with CD and 26 healthy volunteers. The clinical severity of CD was assessed by the Toronto Western Spasmodic Torticollis Rating Scale. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Standardized Mini-Mental State Examination (SMMSE), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale were used to evaluate non-motor symptoms in patients with CD and healthy controls. All dystonia patients we included were receiving botulinum toxin therapy.
RESULTS: The mean BDI and BAI scores were significantly higher in the patient group (p=0.006 and p=0.001, respectively). The mean score of SMMSE was considerably lower in the patient group than that in HCs (p=0.014). The frequency of excessive daytime sleepiness did not differ between groups. The patients with CD had worse sleep quality than HCs (p=0.001). According to the subgroup analysis of PSQI, sleep onset latency and sleep disturbance were significantly higher in the patient group (p=0.001 and p=0.012, respectively). Furthermore, sleep duration and sleep efficiency were significantly lower in the patient group (p=0.001 and p=0.001, respectively). No significant correlation was found between non-motor symptoms and disease severity, age, and duration of disease in the CD (p>0.05).
DISCUSSION AND CONCLUSION: CD causes functional impairment in many patients and leads to difficulties such as lack of self-confidence, timidity, avoidance of social movements, and depressive mood. Therefore, a comprehensive assessment of the non-motor symptoms of patients diagnosed with CD can also increase treatment success.