Comorbidity in focal dystonia and effect of botulinum toxin treatment

Abstract

Objectives : (1) To evaluate prevalence and risk factors of sleep disorders, sexual dysfunction and autonomic failure in idiopathic cervical dystonia (CD) and blepharospasm (BL). (2) To analyze the impact of botulinum toxin (BoNT) treatment on comorbidity in focal dystonia (FD). Background : The approach to movement disorder change, and non-motor comorbidity was shown to considerably impair quality of life in degenerative diseases. In contrast, there are no data on the prevalence of sleep disorders, sexual dysfunction or autonomic failure in non-degenerative movement disorders such as CD and BL, although depression and pain are well-known complications in FD. Methods : Standardized interviews, clinical examinations, autonomic testing, and self-rating forms in 221 patients with idiopathic FD (111 CD, 110 BL). Results : Impaired sleep quality was found in 45% of CD and in 46% of BL patients. Of 80 CD patients tested, 46% had autonomic failure. Sexual dysfunction became apparent in 35% of 82 patients. Depression was found in 25% of CD and 30% of BL patients. Conclusions : Beyond pain and depression, patients with FD frequently suffer from non-motor symptoms. Interestingly, results in CD and BL patients are similar, pointing to intrinsic mechanisms of sleep and sexual disturbances. In our series, BoNT treatment ameliorated non-motor symptoms only marginally, underlining the necessity of a multimodal treatment concept in FD.