Background: The relationship between prior trauma and primary adult-onset dystonia is not well understood. Previous uncontrolled observations and exploratory case–control studies have yielded contradictory results.
Objective: To analyse the association between cranial dystonia and prior head trauma.
Methods: An ad hoc multicentre case–control study was performed using a semistructured interview to collect detailed information on the history of head trauma before disease onset in five Italian tertiary referral centres for movement disorders. The presence of a history of head trauma and of post-traumatic sequelae (loss of consciousness, bone fractures, scalp/facial wounds) before disease onset was recorded from 177 patients with primary adult-onset cranial dystonia and from 217 controls with primary hemifacial spasm matched by age strata and sex. Differences between groups were assessed by Mann–Whitney U test and Fisher’s exact test, and the relationship between prior head trauma and case/control status was analysed by multivariate logistic regression models.
Results: No association was found between vault/maxillofacial trauma and cranial dystonia. Most reported traumas occurred several years before disease onset. None of the main post-traumatic sequelae altered the chance of developing cranial dystonia compared with patients with primary hemifacial spasm, nor did head trauma modify the age at onset of cranial dystonia.
Conclusions: These results do not support prior head trauma as a possible environmental factor modifying the risk of developing late-onset cranial dystonia. The lack of association may have pathogenetic and medical–forensic implications.
- BSP, blepharospasm
- HFS, hemifacial spasm
- OMD, oromandibular dystonia
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Published Online First 20 October 2006
Funding: This study was supported by the Italian Ministry for Education, University, and Research (“40% Grant”; Epidemiology, Genetics, and Pathophysiology of Adult-Onset Dystonia).
Competing interests: None declared.