Cervical dystonia following peripheral trauma--a case-control study.
Post-traumatic cervical dystonia as a diagnostic entity remains a subject of debate. Patients with cervical dystonia (CD) were asked to identify any significant illness prior to the onset of their CD. Sixteen patients of 95 respondents reported a history of injury in the four-week period prior to onset of their dystonia. A retrospective study of the clinical characteristics of the 16 patients with early post-traumatic CD (CD-PT) in comparison with the 52 patients reporting no antecedent trauma (CD-NT) was performed. In this comparison the CD-PT group had a significantly increased frequency of laterocollis, significantly more reported pain and more reported depression. Non-significant trends were noted for less responsiveness to botulinum toxin and less use of gestes antagonistes in the CD-PT group. There were no group differences in the presence of a family history of dystonia. Eleven of the CD-PT group had been or were currently involved in litigation. A sub-group of seven CD-PT patients had laterocollis, six of whom conformed to a clinical pattern of persistent non-spasmodic laterocollis with marked pain; all seven had been involved in litigation. This form of CD-PT is a distinct clinical entity and has an onset within hours or a few days of the trauma. In contrast, no significant differences were noted between patients with CD-NT and the eight patients with later onset of CD between 4 weeks and one year after peripheral trauma.
Research Registrar, Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. seanorior1@eircom.net
Sean
S
O'Riordan
Michael
M
Hutchinson
D000293:Adolescent; D000328:Adult; D001134:Arm Injuries / Q000453:epidemiology / Q000503:physiopathology*; D001905:Botulinum Toxins / Q000627:therapeutic use; D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007603:Jurisprudence; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000453:epidemiology / Q000503:physiopathology*; D009334:Neck Muscles / Q000293:injuries* / Q000503:physiopathology*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D010147:Pain Measurement; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014103:Torticollis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*
D001905:Botulinum Toxins