title: Head tremor in patients with cervical dystonia: different outcome?
abstract: OBJECTIVE
  The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters.
  
  
  METHODS
  We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups.
  
  
  RESULTS
  The occurrence of head tremor in our sample was of 38.2%. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT- one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT- group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07.
  
  
  CONCLUSIONS
  According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.
authors.affiliation: Movement Disorders Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo SP, Brazil. cleciojunior@yahoo.com.br
authors.forename: Clecio
authors.initials: C
authors.lastname: Godeiro-Junior
authors.forename: Andre C
authors.initials: AC
authors.lastname: Felicio
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Aguiar
authors.forename: Vanderci
authors.initials: V
authors.lastname: Borges
authors.forename: Sonia M A
authors.initials: SM
authors.lastname: Silva
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ferraz
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006225:Hand; D019416:Head Movements; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D014103:Torticollis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014202:Tremor / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A