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. 2025 May 27:19:1599951.
doi: 10.3389/fnins.2025.1599951. eCollection 2025.

Neck and mind: exploring emotion processing in cervical dystonia

Federico Carbone #  1 , Marina Peball #  1 , Philipp Ellmerer  1 , Beatrice Heim  1 , Wolfgang Nachbauer  1 , Elisabetta Indelicato  1 , Matthias Amprosi  1 , Philipp Mahlknecht  1 , Anna Hussl  1 , Anna Hotter  1 , Roberta Granata  1 , Klaus Seppi  1   2 , Atbin Djamshidian  1 , Sylvia Boesch  1
Affiliations

Neck and mind: exploring emotion processing in cervical dystonia

Federico Carbone et al. Front Neurosci. .

Abstract

Objective: A wide range of non-motor symptoms such as pain, mood disorders, insomnia, and executive dysfunction may occur in focal dystonia. Little is known, however, about emotional processing. We aim to assess emotion recognition and alexithymia in patients with cervical dystonia (CD) compared to healthy age-, sex- and education-matched controls (HC).

Methods: Emotion processing was assessed with an eye-tracking paradigm using a validated dataset of facial expressions and the Toronto Alexithymia Scale (TAS-20). Dystonia severity and disability, cognition, and comorbid depression and anxiety were also assessed.

Results: We recruited 35 CD patients and 17 matched HC. In the eye-tracking task, CD patients recognized emotions less accurately than HCs (77.0% vs. 84.4%; p = 0.001), primarily based on difficulties in identification of fear (p = 0.003) and surprise (p = 0.037). Moreover, patients had longer fixations within the mouth region (p = 0.027) and left eye (p = 0.037) than HC. CD patients also had significantly higher total TAS-20 scores (p = 0.002) and subscores (difficulty identifying and describing feelings; all p ≤ 0.026). Five patients (14.3%) reached the threshold for alexithymia and 6 (17.1%) for possible alexithymia. No HC scored positive for alexithymia and only 2 (11.8%) did for possible alexithymia. TAS-20 score correlated inversely with emotion recognition task performance (r = -0.411; p = 0.014).

Interpretation: We found poorer performance in emotion recognition in CD patients compared to HC. Together with a different gaze pattern and higher scores for alexithymia our results highlight deficits in emotion processing in CD.

Keywords: cervical dystonia; emotions; eye-tracking technology; facial recognition; neuropsychological test.

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Conflict of interest statement

MP received speaking honoraria (lectures) by Candoro ethics Austria. BH reports honoraria from Novartis AG, AbbVie, Bial and grants from the Austrian science fund (FWF) outside the submitted work. AHu reports speaking honoraria from Merz and AbbVie. KS reports honoraria from the International Parkinson and Movement Disorders Society, grants from the FWF Austrian Science Fund, the Michael J. Fox Foundation, and the International Parkinson and Movement Disorder Society, as well as personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, AbbVie, Bial, Roche, and Grünenthal outside the submitted work. SB reports honoraria from the grants from the ERN RND, and FWF Austrian Science Fund, the Friedreich Ataxia Research Alliance, and the International Parkinson and Movement Disorder Society, as well as personal fees from Biogen, AbbVie, Biohaven, Merz, VICO Pharmaceuticals and Ipsen outside the submitted work. AD reports honoraria from Novo Nordisk, Roche, Bial, and AbbVie. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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