Objective: Objective:We aimed to characterise the demographic and clinical aspects of cervical dystonia (CD) patients with symptomatic anxiety and depression. We hypothesised that these patients have a particularly severe form of CD.

Background: Background: Anxiety and depression are important non-motor symptoms which affect 40–60% of CD patients; they may precede the onset of the motor symptoms by many years; they are poorly recognised. CD patients with symptomatic mood disorder may form a particularly severe phenotype of this otherwise relatively benign disorder.

Method: Participants and methods: CD patients attending a botulinum toxin clinic were asked about a past history of a medical diagnosis of, or treatment for, depression or anxiety. All patients were surveyed & assessed by demographic measures and instruments including Utility Values derived from EuroQol 5-Dimension, 5-Level instrument (EQoL-UV), the CD Impact Profile–58 (CDIP-58); Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI-II) and physician-rated measures from the Comprehensive CD Rating Scale, the Toronto Western Spasmodic Torticollis Scale-2 (TWSTRS-2). Non-parametric statistical methods were used to compare those with and without a history of anxiety or depression).

Results: Results: Of the 189 CD patients, 64 (34%) patients had a history of a medical diagnosis & treatment for anxiety and/or depression; 37/64 (58%) were symptomatic prior to the onset of the dystonia; 125/189 CD patients (66%) had no history of mood disorder. The 64 symptomatic patients were significantly more affected than the 125 in: pain levels by TWSTRS-2 pain scores (p <0.019); TWSTRS disability score (p = 0.0002); current anxiety by the BAI-II (p < 0.0001); current depression by BDI (p < 0.0001); HrQoL by EQoL-UV (p = 0.0015); HrQoL by the CDIP-58 (p = 0.009). There were no differences between the two groups in the physician-assessed TWSTRS-2 severity scores (p = 0.68), in the age of onset (p = 0.0961), sex ratios (ns), or years of education (ns).

Conclusion: Conclusion: CD patients with a clinical history of anxiety and/or depression form a distinct group and exhibit more distress in relation to pain, disability, anxiety, depression with more impaired health-related quality of life. They require special attention in the clinic; they may represent a more severe phenotype and are worthy of more intense research and therapeutic scrutiny.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-phenotyping-adult-onset-isolated-cervical-dystonia-the-importance-of-symptomatic-anxiety-and-depression/