title: Head tremor in cervical dystonia.
abstract: OBJECTIVE
  To compare the clinical characteristics, natural history, and therapeutic outcome of patients with cervical dystonia (CD) with head tremor (HT+) and without head tremor (HT-).
  
  
  METHODS
  We prospectively evaluated 114 consecutive patients of CD over a 9-month period with a detailed questionnaire. Chi-square and t-tests were employed for statistical analysis.
  
  
  RESULTS
  Seventy-eight (68.4%) patients had head tremor and 27 of them (34.6%) had tremor as one of the first symptoms. Age at onset of symptoms were similar in HT+ and HT- groups; however there was a higher prevalence in women in the former group (66.7% vs. 41.7%; p=0.01). HT+ patients had more frequent positive family history of essential-like hand/head tremor (21.8% vs. 5.5%; p<0.05), associated neck pain (92.3% vs. 77.8%: p<0.05), and essential-like hand tremor (40% vs. 8.3%; p<0.001). They also appeared to have more frequent history of preceding head/neck trauma (14.1% vs. 8.3%), frequent head rotation (88.5% vs. 69.4%) and antecollis (12.8% vs. 5.5%) but less often head tilt (37.2% vs. 47.2%) and gestes antagonistes (60.2% vs. 75%) than the HT- patients; however these differences were not statistically significant. The frequency of prior psychiatric illnesses, the incidence of dystonias in other parts of the body, frequency of retrocollis and shoulder elevation, and spontaneous remission were similar in the two groups.
  
  
  CONCLUSIONS
  Head tremor is common in CD and is more commonly associated with hand tremor and family history of tremor or other movement disorders. This supports a possible genetic association between CD and essential tremor (ET). Linkage studies are required to evaluate the genetic association between CD and ET.
authors.affiliation: Neurodegenerative Disorders Centre, Vancouver Hospital & Health Sciences Centre, University of British Columbia, Canada.
authors.forename: P K
authors.initials: PK
authors.lastname: Pal
authors.forename: A
authors.initials: A
authors.lastname: Samii
authors.forename: M
authors.initials: M
authors.lastname: Schulzer
authors.forename: E
authors.initials: E
authors.lastname: Mak
authors.forename: J K
authors.initials: JK
authors.lastname: Tsui
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000453:epidemiology; D004421:Dystonia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000453:epidemiology; D019547:Neck Pain / Q000453:epidemiology; D011187:Posture; D015995:Prevalence; D011446:Prospective Studies; D014103:Torticollis / Q000453:epidemiology; D016896:Treatment Outcome; D014202:Tremor / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins