Quality of life in patients with focal dystonia

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Abstract

Objectives

The aims of this study were to identify the clinical and demographic factors influencing health-related quality of life (HR-QoL) and to compare HR-QoL measures between various types of focal dystonia (cervical dystonia, blepharospasm, and writer’s cramp).

Methods

We examined 157 consecutive patients with adult-onset primary focal dystonia, and HR-QoL was assessed by using the SF-36 questionnaire. Univariate and multivariate regression analyses were performed.

Results

Patients with writer’s cramp scored better in all SF-36 domains, except role functioning physical (RP), while these differences were statistically significant for physical functioning (PF) (p = 0.020), bodily pain (BP) (p = 0.001), and general health (GH) (p = 0.004). Patients with writer’s cramp and blepharospasm scored significantly better for BP (p = 0.001) than patients with cervical dystonia. We found that each of the eight dimensions of SF-36 proved to be significantly correlated to the Hamilton depression rating scale score in patients with torticollis and blepharospsm, while vitality (VT), social functioning (SF), and mental health (MH) scales showed statistically significant correlations in patients with hand dystonia. Similar relationships were observed between anxiety and SF-36 domains.

Conclusion

Depression and anxiety are the most important predictors of poorer HR-QoL in patients with all three types of focal dystonia.

Introduction

Dystonia is characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures. When classified by distribution, patients are categorized as having focal, segmental, multifocal, generalized, or hemidystonia [1]. In focal dystonia, a single body region is affected; for example, blepharospasm (eyes), laryngeal dystonia, cervical dystonia or torticollis (neck), or writer’s cramp (arm), etc. [2]. In a cross-sectional study of primary dystonia in eight European countries, the prevalence was 152 per million, with focal dystonia having the highest value of 117 per million (77%) [3].

Despite several reports involving cervical dystonia and blepharospasm [4], [5], [6], [7], little is known about the clinical and demographic factors associated with poor health-related quality of life (HR-QoL) in patients with primary focal dystonia. Besides the clinical problems of involuntary abnormal postures and repetitive movements, frequently associated with pain, dystonic patients present with a wide range of social disabilities and impairments of HR-QoL (i.e., depression, poor social interaction, and low self-esteem) [8]. Dystonic movements and postures are visible and stigmatizing [6], [9].

The aim of the present study was to identify the clinical and demographic factors influencing HR-QoL in consecutive patients with primary focal dystonia, and to compare HR-QoL measures between various types of focal dystonia (cervical dystonia, blepharospasm, and writer’s cramp). QoL was assessed by using a generic questionnaire, the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) [10].

Section snippets

Patients and methods

The study was comprised of 157 consecutive patients with adult-onset primary focal dystonia (Table 1), in whom if focal dystonia was the only sign of neurologic disease other than tremor [1]. The exclusion criteria comprised neurologic abnormalities in addition to dystonia, a robust response to levodopa (i.e., dopa-responsive dystonia), a history of exposure to dopamine receptor blocking agents within 6 months before the onset of dystonia, severe head trauma with a loss of consciousness, and

Results

Considering demographic and clinical data, statistically significant differences among the groups with cervical dystonia, blepharospasm, and writer’s cramp were found with age at onset (i.e., patients with blepharospasm were older than patients with cervical dystonia or writer’s cramp), education, and employment status (Table 1). Tremor and pain were more common in patients with cervical dystonia (p = 0.001).

Botulinum toxin injections were most frequently (79% of patients) used in patients with

Discussion

The results obtained in this study are in agreement with the findings of several other studies that reported reduced HR-QoL in patients with cervical dystonia and blepharospasm [5], [6], [15], [16], [17], [18]. However, the HR-QoL scores for patients with hand dystonia have not been previously published.

A comparison of SF-36 scores with the norms for the general population of a similar age showed that people with dystonia had scores indicative of a worse HR-QoL in all domains, particularly

Acknowledgement

This work was supported by grants from the Ministry of Science and Technology of the Republic of Serbia (grants No. 145057 and No. 145045).

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