Spontaneously changing muscular activation pattern in patients with cervical dystonia

Authors

  • A. Münchau MD,

    1. MRC Human Movement and Balance Unit and
    2. University Department of Clinical Neurology, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, London, United Kingdom
    Current affiliation:
    1. Department of Neurology, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
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  • S.R. Filipovic MD,

    1. MRC Human Movement and Balance Unit and
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  • A. Oester-Barkey BA,

    1. MRC Human Movement and Balance Unit and
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  • N.P. Quinn MD, FRCP,

    1. University Department of Clinical Neurology, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • J.C. Rothwell PhD,

    1. MRC Human Movement and Balance Unit and
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  • K.P. Bhatia MD, MRCP

    Corresponding author
    1. University Department of Clinical Neurology, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, London, United Kingdom
    • Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
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Abstract

The objective of this study was to determine stability of the neck muscle activation pattern in a given dystonic head position in patients with cervical dystonia (CD). We assessed 26 patients with CD and botulinum toxin (BT) treatment failure before surgical denervation. None of them had received BT injections for at least 4 months. To relate dystonic head position to underlying neck muscle activity, we used synchronised video and poly-electromyographic (EMG) recording over a period of 10 minutes. The muscle activation pattern during constant (“stable”) maximal dystonic excursions was analysed. EMG data of nine patients was excluded from the analysis, as these patients had a constantly changing head position or marked head tremor. In the remaining 17 patients, who had a fairly stable dystonic position, muscular activation patterns during the recording spontaneously changed in nine (Group A) while in eight it remained stable (Group B). There was no significant difference in demographic variables between the two groups other than a male predominance in Group A. However, the retrospectively determined initial response to BT treatment (before BT treatment failure had occurred) was significantly worse in Group A as compared with Group B. Neck muscle activation patterns can spontaneously change in CD patients despite constant dystonic head position, implying an inherent variability of the underlying central motor program in some patients. This should be considered when BT treatment response is unsatisfactory, and should also be taken into account when interpreting results of EMG recordings of neck muscles in these patients. © 2001 Movement Disorder Society.

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