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. 2020 Mar;35(3):450-456.
doi: 10.1002/mds.27927. Epub 2019 Nov 27.

Cervical dystonia incidence and diagnostic delay in a multiethnic population

Sara C LaHue  1   2 , Kathleen Albers  3 , Samuel Goldman  1   4   5 , Raymond Y Lo  6 , Zhuqin Gu  7 , Amethyst Leimpeter  3 , Robin Fross  8 , Kathleen Comyns  1 , Connie Marras  9 , Annelie de Kleijn  10 , Robin Smit  10 , Maya Katz  1   2   4 , Laurie J Ozelius  11 , Susan Bressman  12   13 , Rachel Saunders-Pullman  12   13 , Cynthia Comella  14 , Jeffrey Klingman  15 , Lorene M Nelson  16 , Stephen K Van Den Eeden  3 , Caroline M Tanner  1   2   4
Affiliations

Cervical dystonia incidence and diagnostic delay in a multiethnic population

Sara C LaHue et al. Mov Disord. 2020 Mar.

Abstract

Background: Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized.

Objectives: To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization.

Methods: We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration.

Results: CD incidence was 1.18/100,000 person-years (95% confidence interval [CI], 0.35-2.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person-years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2-164.5), cervical disc disease (OR 3.83; 95% CI, 2.8-5.2), neck sprain/strain (OR 2.77; 95% CI, 1.99-3.62), anxiety (OR 2.24; 95% CI, 1.63-3.11) and depression (OR 1.94; 95% CI, 1.4-2.68).

Conclusions: CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects. © 2019 International Parkinson and Movement Disorder Society.

Keywords: cervical dystonia; diagnostic delay; incidence.

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Conflict of interest statement

Relevant conflicts of interests/financial disclosures: Nothing to report.

Figures

FIG. 1.
FIG. 1.
Case identification process for patients with cervical dystonia (CD) obtained from a multiethnic membership of a health maintenance organization in Northern California.
FIG. 2.
FIG. 2.
Incidence of cervical dystonia by decade standardized to the U.S. population during the year 2000. P-Y, person-years.
See this image and copyright information in PMC

Comment in

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