Abstract
Background: Mood disorder is common in cervical dystonia and can impact on quality of life. It often precedes the onset of cervical dystonia and does not improve with botulinum toxin therapy.Objective: To assess health-related quality of life in relation to mood disorder and measures of severity, disability and pain, in cervical dystonia patients receiving botulinum toxin therapy.Methods: In a single-center, University Hospital movement disorders clinic, we conducted a comprehensive, cross-sectional study of disease severity, non-motor symptoms, mood and health-related quality of life in patients with cervical dystonia receiving botulinum toxin therapy using TWSTRS-2 for pain, severity and disability; Beck Anxiety Inventory and Beck Depression Inventory. We assessed all variables in relation to health-related quality of life assessed by Cervical Dystonia Impact Profile-58 and the Euro-QoL Utility Index.Results: In 201 patients (136 women), mean age 61.5 years, significant determinants of impaired health related quality of life were: being a woman, reporting a history of anxiety or depression, prevalent pain, disability, anxiety and/or depression but not physician-assessed disease severity.Conclusion: Patient-reported measures of pain, disability and, most markedly, mood disorder, are significant factors affecting quality of life; these were totally unrelated to the neurologist-rated measure of disease severity. Mood disorders, the predominant predictor of quality of life, were not addressed in the botulinum toxin clinic.
Highlights
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both [1].Adult-onset idiopathic focal dystonia (AOIFD) is the most common form of dystonia; the most common phenotype is cervical dystonia [2]
Sex Differences There were no significant differences between men and women in age, duration of cervical dystonia (CD) or years of formal education (Table 1)
We found that health related quality of life (HrQoL) in cervical dystonia, assessed by both a generic measure (EuroQoL Utility Index) and a disease specific instrument, the Cervical Dystonia Impact Profile−58 (CDIP-58), is overwhelmingly determined by a combination of factors: anxiety, depression and the patient’s report of pain and disability (TWSTRS-2 Pain and TWSTRS-2 Disability)
Summary
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both [1].Adult-onset idiopathic focal dystonia (AOIFD) is the most common form of dystonia; the most common phenotype is cervical dystonia [2]. Mood disorders may precede the Quality of Life in Cervical Dystonia onset of the motor symptoms of dystonia [8], and do not improve with botulinum toxin therapy [3, 5]; they are considered a primary feature of AOIFD, not secondary. Disease impact is commonly measured by the validated Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS-2) scales of Disability, Severity and Pain [19]. Mood disorder is common in cervical dystonia and can impact on quality of life It often precedes the onset of cervical dystonia and does not improve with botulinum toxin therapy
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