Abstract
Patients with dystonia experience unusual postures and disfigurement. The aim of the study was to examine changes in the body concept in relation to quality of life and severity of dystonia. Our cohort consisted of 20 patients with idiopathic dystonia resistant to medical therapy who were planned for pallidal deep brain stimulation. The results were compared to 25 healthy controls. The patients were assessed with Frankfurt Body Concept Scale, Short Form 36 (SF-36) Health Survey, Hamilton Depression Scale, Beck Depression Inventory, Social Phobia Inventory and Social Interaction Anxiety Scale. The disease severity was evaluated with Burke–Fahn–Marsden Dystonia Rating Scale and Toronto Western Spasmodic Torticollis Rating Scale. Patients with dystonia had a significantly impaired body concept in eight out of nine subscales in comparison to healthy controls. The differences were most pronounced for the subscales general health, body care, physical efficacy, sexuality and physical appearance (p < 0.001). Furthermore, all eight subscales of SF-36 exhibited significantly lower values in patients with dystonia compared to controls. We also found significant positive correlations between SF-36 and body concept subscales. Impairment of body concept was not associated with disease severity or levels of social anxiety symptoms. However, there was a significant association between self-rated depression and disease severity. Our patients suffered from increased depression and social anxiety symptoms except social interaction anxiety. We conclude that patients with dystonia have significant body concept impairment that interferes with quality of life in both physical and emotional domains. Future studies should focus on assessing these symptoms after adequate therapeutic management of motor symptoms.
Highlights
All dystonias are classified along two axes: clinical characteristics and etiology [1,2]
In addition to previous studies that showed patients with dystonia may have depression, anxiety and reduced quality of life [5,7], our study indicates that aspects of body concept correlate both with depression and quality of life
In accordance with previous studies [10,33], we found a significantly reduced quality of life in patients with dystonia compared to healthy controls concerning both physical as well as mental aspects
Summary
All dystonias are classified along two axes: clinical characteristics and etiology [1,2]. Clinical characteristics represent the phenomenology of dystonia in a patient. It includes age of onset, body distribution (e.g., generalized, segmental, focal), temporal pattern and association with other disorders. The second axis outlines the etiology of dystonia covering anatomical changes (degeneration, structural change or neither) and pathogenic disease patterns (inherited, acquired and idiopathic). Brain Sci. 2020, 10, 488; doi:10.3390/brainsci10080488 www.mdpi.com/journal/brainsci. Primary dystonias include inherited and idiopathic dystonias. Secondary dystonias manifest from other disease states or brain injury
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