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. 2020 Jan 20:10.
doi: 10.7916/tohm.v0.745. eCollection 2020.

Postural Directionality and Head Tremor in Cervical Dystonia

Qiyu Chen  1 , Jeanne P Vu  1 , Elizabeth Cisneros  1 , Casey N Benadof  1 , Zheng Zhang  1 , Richard L Barbano  2 , Christopher G Goetz  3 , Joseph Jankovic  4 , Hyder A Jinnah  5 , Joel S Perlmutter  6   7 , Mark I Appelbaum  8 , Glenn T Stebbins  3 , Cynthia L Comella  3 , David A Peterson  1   9
Affiliations

Postural Directionality and Head Tremor in Cervical Dystonia

Qiyu Chen et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Background: Although abnormal head and neck postures are defining features of cervical dystonia (CD), head tremor (HT) is also common. However, little is known about the relationship between abnormal postures and HT in CD.

Methods: We analyzed clinical data and video recordings from 185 patients enrolled by the Dystonia Coalition. We calculated the likelihood of their HT and HT type ("regular" vs. "jerky") given directionality of abnormal head postures, disease duration, sex, and age.

Results: Patients with retrocollis were more likely to have HT than patients with anterocollis (X2 (1, N = 121) = 7.98, p = 0.005). There was no difference in HT likelihood given left or right turning in laterocollis and rotation. Patients with HT had longer disease duration (t(183) = 2.27, p = 0.024). There was no difference in age between patients with and without HT. In a logistic regression model, anterocollis/retrocollis direction (X2 (1, N = 121) = 6.04, p = 0.014), disease duration (X2 (1, N = 121) = 7.28, p = 0.007), and the interaction term between age and disease duration (X2 (1, N = 121) = 7.77, p = 0.005) collectively contributed to HT likelihood. None of the postural directionality or demographic variables were associated with differential likelihood of having regular versus jerky HT.

Discussion: We found that HT is more likely for CD patients with a specific directionality in their predominant posture. Our finding that CD patients with longer disease duration have a higher likelihood of HT also raises the question of whether HT becomes more likely over time in individual patients.

Keywords: Cervical dystonia; disease duration; head tremor; posture; tremor type.

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Conflict of interest statement

Funding: This research was conducted by the Dystonia Coalition, which is part of the Rare Diseases Clinical Research Network, an initiative funded by the Office of Rare Diseases Research at the National Center for Advancing Translational Sciences (U54 TR001456) in collaboration with the National Institute of Neurological Disorders and Stroke (U54 NS065701) at the National Institutes of Health (NIH). This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer-Reviewed Medical Research Program under Award No. W81XWH-17-1-0393. Opinions, interpretations, conclusions, and recommendations made in this article are those of the author and are not necessarily endorsed by the Department of Defense. Conflicts of Interest: The authors report no conflicts of interest. Ethics Statement: This study was performed in accordance with the ethical standards detailed in the Declaration of Helsinki. The authors’ institutional ethics committee has approved this study and all patients have provided written informed consent.

Figures

Figure 1
Figure 1
Mosaic Plot Depicting Likelihood of Head Tremor in Regard to Pitch. The area of each rectangle is proportional to the number of patients.
Figure 2
Figure 2
Distribution of Age of Onset, Disease Duration, and Age for Patients without versus with Head Tremor (Upper), and for Head Tremor Patients Whose Head Tremor Type Was Regular versus Jerky. Each data point represents one patient.
Figure 3
Figure 3
Summary Schematic of the Interaction between Pitch, Head Tremor, and Time. Arrows indicate significant associations.
See this image and copyright information in PMC

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