title: Head trauma in primary cranial dystonias: a multicentre case-control study.
abstract: BACKGROUND
  The relationship between prior trauma and primary adult-onset dystonia is not well understood. Previous uncontrolled observations and exploratory case-control studies have yielded contradictory results.
  
  
  OBJECTIVE
  To analyse the association between cranial dystonia and prior head trauma.
  
  
  METHODS
  An ad hoc multicentre case-control study was performed using a semistructured interview to collect detailed information on the history of head trauma before disease onset in five Italian tertiary referral centres for movement disorders. The presence of a history of head trauma and of post-traumatic sequelae (loss of consciousness, bone fractures, scalp/facial wounds) before disease onset was recorded from 177 patients with primary adult-onset cranial dystonia and from 217 controls with primary hemifacial spasm matched by age strata and sex. Differences between groups were assessed by Mann-Whitney U test and Fisher's exact test, and the relationship between prior head trauma and case/control status was analysed by multivariate logistic regression models.
  
  
  RESULTS
  No association was found between vault/maxillofacial trauma and cranial dystonia. Most reported traumas occurred several years before disease onset. None of the main post-traumatic sequelae altered the chance of developing cranial dystonia compared with patients with primary hemifacial spasm, nor did head trauma modify the age at onset of cranial dystonia.
  
  
  CONCLUSIONS
  These results do not support prior head trauma as a possible environmental factor modifying the risk of developing late-onset cranial dystonia. The lack of association may have pathogenetic and medical-forensic implications.
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare, 11 70124 Bari, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Martino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Defazio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Abbruzzese
authors.forename: Paolo
authors.initials: P
authors.lastname: Girlanda
authors.forename: Michele
authors.initials: M
authors.lastname: Tinazzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fabbrini
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Aniello
authors.forename: Laura
authors.initials: L
authors.lastname: Avanzino
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Majorana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Majorana
authors.forename: Carlo
authors.initials: C
authors.lastname: Trompetto
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berardelli
mesh_terms: D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D006259:Craniocerebral Trauma / Q000150:complications*; D020821:Dystonic Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors