The Prevalence and Correlation of Non-motor Symptoms in Adult Patients with Idiopathic Focal or Segmental Dystonia

Background: Idiopathic focal dystonia is a motor syndrome associated with dysfunction of basal ganglia circuits. Observations have suggested that many other non-motor symptoms may also be part of the clinical picture. The aim was to assess the prevalence and correlation of non-motor symptoms in patients with common idiopathic focal or segmental dystonia. Methods: In a single-center cross-sectional case–control study, we evaluated the presence of pain, neuropsychiatric symptoms, and sleep alterations in 28 patients with blepharospasm, 28 patients with cervical dystonia, 24 patients with writer’s cramp, and 80 control subjects matched for sex, age, and schooling. We obtained clinical and demographic data, and evaluated patients using the Fahn–Marsden Dystonia Rating Scale and other specific scales for dystonia. All subjects completed the following questionnaires: Beck Depression Inventory, Beck Anxiety Inventory, Social Phobia Inventory, Apathy Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Brief Pain Scale, and the World Health Organization Quality of Life brief scale. Results: The patients presented more symptoms of depression, anxiety, and apathy than the control subjects. They also reported worse quality of sleep and more pain complaints. Patients with blepharospasm were the most symptomatic subgroup. The patients had worse quality of life, and the presence of pain and symptoms of apathy and depression were the main influences for these findings, but not the severity of motor symptoms. Discussion: Patients with dystonia, especially those with blepharospasm, showed higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep, and pain. These symptoms had a negative impact on their quality of life

The prevalence of non-motor symptoms in patients with idiopathic focal and segmental dystonia

Distonia é o terceiro distúrbio do movimento mais comum. Caracteriza-se por contrações musculares sustentadas ou intermitentes que podem gerar posturas anormais. Nos últimos anos, muitos estudos tentaram relacionar a presença de sintomas não motores como parte da manifestação clínica dessa patologia; no entanto, os resultados ainda são controversos. Objetivo: Avaliar a prevalência de sintomas não motores em pacientes com distonia focal ou segmentar idiopática e seu impacto na qualidade de vida. Métodos: Foram avaliados 80 pacientes e 80 controles sem patologias neurológicas pareados para sexo, idade e anos de estudo. Os pacientes foram questionados quanto ao tempo e gravidade de doença. Dados demográficos, comorbidades e medicações em uso foram coletados de ambos os grupos. Os sintomas não motores foram avaliados por meio de escalas validadas para a população brasileira. Foram avaliados sintomas de depressão, ansiedade, fobia social, apatia, sonolência diurna, qualidade do sono, cognição e dor, assim como qualidade de vida. Resultados: 80 pacientes foram avaliados: 28 com diagnóstico de blefaroespasmo ou distonia de Meige, 28 com distonia cervical ou orocervical e 24 com distonia de membro, em sua maioria, distonia tarefa-específica da escrita (cãibra do escrivão). Os pacientes apresentaram mais sintomas de depressão, ansiedade e apatia do que os controles, assim como uma pior qualidade do sono e mais queixas de dor. Ao avaliarmos pelo tipo de distonia, os pacientes com blefaroespasmo foram os mais sintomáticos com relação a esses sintomas. Qualidade de vida foi pior nos pacientes que nos controles. Conclusões: Pacientes com distonia, principalmente com blefaroespasmo, apresentaram maior prevalência de sintomas de depressão, de ansiedade, de apatia, pior qualidade do sono e dor. Esses sintomas causaram impacto negativo na qualidade de vida desses pacientesDystonia is the third most common movement disorder. It´s characterized by sustained or intermittent muscle contractions causing abnormal postures. In recent years many studies have sought to relate the presence of non-motor symptoms as part of clinical manifestation of this disease, however, results are still controversial. Objective: To assess prevalence of non-motor symptoms in patients with idiopathic focal or segmental dystonia and its impact in life quality. Methods: We evaluated 80 patients and 80 healthy controls matched for sex, age and years of schooling. Questions about the time at onset and severity of illness were asked to patients. Clinical and demographic data were noted in both groups. Non-motor symptoms were assessed using validated scales for Brazilian population. We assessed symptoms of depression, anxiety, social phobia, apathy, daytime sleepiness, sleep quality, cognition and pain, as well as quality of life. Results: We evaluated 80 patients: 28 with blepharospasm or Meige syndrome, 28 with cervical or orocervical dystonia and 24 with limb dystonia, mostly with specific writing task dystonia (writer´s cramp). Patients had more symptoms of depression, anxiety and apathy than controls, as well as worse quality of sleep and more pain complaints. Analysing by type of dystonia, patients with blepharospasm were the most symptomatic group in relation to these symptoms. Quality of life was worse in dystonic patients. Conclusions: Patients with dystonia, mainly those with blepharospasm, had a higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep and pain. These symptoms had a negative impact on these patients\' quality of lif

Bipolar disorder, a precursor of Parkinson's disease?

ABSTRACT Parkinson's disease is a neurodegenerative disorder predominantly resulting from dopamine depletion in the substantia nigra pars compacta. Some psychiatric disorders may have dopaminergic dysfunction as their substrate. We describe a well-documented case of Parkinson's disease associated with Bipolar Disorder. Although there is some knowledge about the association between these diseases, little is known about its pathophysiology and correlation. We believe that among various hypotheses, many neurotransmitters are linked to this pathophysiology

Epidemiological and clinical aspects of a sample of Brazilian patients with primary dystonia and the impact of the new classification on their clinical evaluation

ABSTRACT Dystonia is a relatively common movement disorder but some of its epidemiological and clinical aspects have not been well characterized in Brazilian patients. Also, a new clinical classification for the disorder has been proposed and its impact on clinical practice is unclear. We aimed to describe the clinical and demographic characteristics of a Brazilian series of patients with primary dystonia, to estimate its local prevalence, and to explore the impact of using a new classification for dystonia. We identified 289 patients with primary dystonia over a 12-month period, of whom235 underwent a detailed evaluation. Patients with primary dystoniamade up one-sixth of all patients evaluated at the service where the study was conducted, with an estimated local prevalence of 19.8/100,000 inhabitants. The clinical and demographic characteristics of the patients were similar to those described elsewhere, with blepharospasm as the most common focal dystonia and most patients using sensory tricks that they judged useful on a day-to-day basis. The application of the new classification was easy and simple, and the systematic approach allowed for a better clinical characterization of our patients. We recognized two dystonic syndromes that were not described in the original article that proposed the classification, and suspected that the arbitrary distinction between generalized and multifocal dystonia seems not to be useful for patients with primary dystonia. In conclusion, the prevalence and clinical characteristics of our patients were not distinct from other studies and the new classification was shown to be practical and useful to characterize patients with dystonia