Abstract
<strong>Background:</strong> Although abnormal head and neck postures are defining features of cervical dystonia (CD), head tremor (HT) is also common. However, little is known about the relationship between abnormal postures and HT in CD. <strong>Methods:</strong> We analyzed clinical data and video recordings from 185 patients enrolled by the Dystonia Coalition. We calculated the likelihood of their HT and HT type (“regular” vs. “jerky”) given directionality of abnormal head postures, disease duration, sex, and age. <strong>Results:</strong> Patients with retrocollis were more likely to have HT than patients with anterocollis (X<sup>2</sup> (1, N = 121) = 7.98, p = 0.005). There was no difference in HT likelihood given left or right turning in laterocollis and rotation. Patients with HT had longer disease duration (<em>t</em>(183) = 2.27, p = 0.024). There was no difference in age between patients with and without HT. In a logistic regression model, anterocollis/retrocollis direction (X<sup>2</sup> (1, N = 121) = 6.04, p = 0.014), disease duration (X<sup>2</sup> (1, N = 121) = 7.28, p = 0.007), and the interaction term between age and disease duration (X<sup>2</sup> (1, N = 121) = 7.77, p = 0.005) collectively contributed to HT likelihood. None of the postural directionality or demographic variables were associated with differential likelihood of having regular versus jerky HT. <strong>Discussion:</strong> We found that HT is more likely for CD patients with a specific directionality in their predominant posture. Our finding that CD patients with longer disease duration have a higher likelihood of HT also raises the question of whether HT becomes more likely over time in individual patients.
Highlights
Abnormal head posture is a defining feature of cervical dystonia (CD), head tremor (HT) is common,[1] affecting more than half of CD patients.[2,3] Both abnormal posture and HT lead to substantially reduced quality of life
Tremor commonly occurs in CD, and abnormal posture and tremor usually occur in the same body region, the relationship between head posture and HT remains unclear
Given the conventional view that the isolated focal dystonias, including CD, are usually nondegenerative disorders, we further hypothesized that the presence of HT and its type do not depend on disease duration or age
Summary
Abnormal head posture is a defining feature of cervical dystonia (CD), head tremor (HT) is common,[1] affecting more than half of CD patients.[2,3] Both abnormal posture and HT lead to substantially reduced quality of life. A in-depth understanding of how posture and tremor relate in CD may shed light on their pathophysiological mechanisms Delineating this relationship may inform clinical management because chemodenervation strategies for dystonic posture may differ from treatment for tremor. Given the conventional view that the isolated focal dystonias, including CD, are usually nondegenerative disorders, we further hypothesized that the presence of HT and its type do not depend on disease duration or age. We calculated the likelihood of their HT and HT type (“regular” vs “jerky”) given directionality of abnormal head postures, disease duration, sex, and age. Our finding that CD patients with longer disease duration have a higher likelihood of HT raises the question of whether HT becomes more likely over time in individual patients
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