Longitudinal Follow-Up of Mood in Cervical Dystonia and Influence on Age at Onset

Abstract

Background: Anxiety and depression are highly prevalent conditions in cervical dystonia and considered intrinsic to the disease mechanism. Psychiatric symptoms do not appear to be influenced by botulinum toxin therapy. Studies focusing on changes in mood disorder during the course of the disease are limited in this chronic, lifelong disorder.

Objective: To assess the longitudinal prevalence of mood disorder, pain, and quality of life in patients with cervical dystonia attending a botulinum toxin clinic.

Methods: Patients involved in phase I of our study were invited to be involved in reassessment using the Beck Depression Inventory, Second Revision; Beck Anxiety Index; Cervical Dystonia Impact Profile-58 (CDIP-58); and the Toronto Western Spasmodic Torticollis Rating Scale-2 Pain Scale (TWSTRS2-Pain).

Results: A total of 53 participants took part after a mean study interval duration of 24 months. There were no significant differences between the 2 study time points in the prevalence of anxiety (P = 0.2919) and depressive symptoms (P = 0.5). Self-reported quality of life by CDIP-58 (P = 0.96) and pain by TWSTRS2-Pain (P = 0.9321) were unchanged. Men and women with significant symptoms of mood disorder had an earlier age of onset of cervical dystonia (P = 0.008).

Conclusion: Anxiety and depressive symptoms persist in cervical dystonia, seem to be unrelated to pain severity, and need to be specifically targeted to improve quality of life. The relationship between mood disorder and age of onset suggest that mood disorder may be part of the disease pathophysiology.

Keywords: anxiety; cervical dystonia; depression; longitudinal; quality of life.

FIG. 1

The 53 patients with cervical dystonia were assessed at 2 time points (phase I [P1] and phase II [P2]), 2 years apart, in relation to Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Cervical Dystonia Impact Profile–58 (CDIP58), and the Toronto Western Spasmodic Torticollis Rating Scale–2 Pain scale (TWSTRS). This figure demonstrates the overall stability of reported measures during the 2‐year period. The vertical bars indicate mean (± standard deviation) values at the plot showing the P1 and P2 results of all measures used.