Assessment of health related quality of life in patients with cervical dystonia and writer’s cramp

Pavan Kumar Singh, Reeta Singh


Background: There is paucity of literature regarding data about clinical and demographic factors affecting HRQoL with assessment with validated specific tool in patients with CD and WC especially from India.

Methods: Demographic, clinical details, SF-36 and BDI score were noted in included patients. CD and WC severity scale were assessed by TWSTRS and BFM scale respectively. Disease specific quality of life in patients with CD was assessed by CDQ-24.

Results: All 32 patients with CD scored significantly worse in all the eight domains of the SF-36. Patients with CD had significantly worse (mean BDI 12.14±6.7 versus 5.09±4.8; P<0.001) score. In CD group 15.62% have no depression, while 34.37% had mild and 34.37% had moderate to severe depression. Patients with CD had significantly worse CDQ-24 score (mean 50.96±20.47 versus 6.89±6.33); (P<0.001). TWSTRS score had negative correlation with BDI and CDQ-24. All 60 patients with WC scored significantly worse in all domains of the SF-36 except 3 domain physical functioning (p =0.80), bodily pain (p=0.122) and vitality (p=0.97).Among WC patients 45% have no depression, 21.67% had mild and 23.35% had moderate to severe depression. BFM had significant negative correlation with all SF-36 subscale except role emotional (p=0.059).

Conclusions: Patients with CD and WC suffered from significant impairment in HRQoL with moderate to severe depression .The validated specific scale provides further evidence for profound impact of above mentioned dystonias on physical, psychological and social aspect of quality of life.




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Jankovic J, Tolosa E. Parkinson’s Disease and Movement Disorders: 5th edition, edited by Jankovic J. 2007: 321-47

Nutt JG, Muenter MD, Aronson A. Epidemiology of focal and generalized dystonias in Rochester, Minnesota. Mov Dis. 1988;3:188-94.

Khanh DL, Beate N. The prevalence of primary dystonia in general community. Neurology. 2003;61:1294-6.

The ESDE Colaborative group. A prevalence study of primary dystonia in eight European countries. J Neurol. 2000;247:787-92.

Das SK, Tapas KB. Community survey of primary dystonia in the city of Kolkata, India. Mov Dis. 2007;14:2031-6.

Sheehy MP, Marsden CD. Writers’ cramp-a focal dystonia. Brain. 1982;105(3):461-80.

Sheehy MP, Rothwell JC, Marsden CD. Writer’s cramp. Adv Neurol. 1988;50:457-72.

Thompson PD. Writers’ cramp. Br J Hosp Med. 1993;50:91-4.

Revicki DA, Osoba D, Fairclough D. Recommendation on health related quality of life research to support labeling and promotional claims in United States. Quality Life Res. 2000;9:887-900.

Ware JE Jr, Kosinski M, Gandek. The factor structure of the SF-36 health survey in 10 countries: result from the IQOLA Project. International Study of Life Assessment. J Clin Epidemiol. 1998;51:1159-65.

Jahanshahi M. Psychosocial factors and depression in torticollis. J Psychosom Res. 1991;35:493-507.

Jahanshahi M, Marsden CD. Body concept, disability, and depression in patients with spasmodic torticollis. Behav Neurol. 1990;3:117-31.

Jahanshahi M, Marsden CD. Psychological functioning before and after treatment of torticollis with botulinum toxin. J Neurol Neurosurg Psychiatry. 1992;55:229-31.

Müller J, Kemmler G, Wissel J, Schneider A, Voller B, Grossmann J, et al. The impact of blepharospasm and cervical dystonia on heaith related quality of life and depression. J Neurol. 2002;249(7):842-6.

Nickel T, Heinen F, Scheidt CE, et al. Spasmodic torticollis – a multicenter study on behavioral aspects. III: Psychosocial changes and coping. Behavioural Neurology. 1996;9:89-95.

Ben-Shlomo Y, Camfield L, Warner T, ESDE collaborative group. What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry. 2002;72:608-14.

Slawek J, Friedman A, Potulska A, Pierre Krystkowiak P, Gervais C, Banach M et al. Factors affecting the health related quality of life with cervical dystonia and impact of botulinum toxin type A injections. Funct Neurol. 2007;22(2):95-100.

Pekmezovic T, Svetel M, Ivanovic N .Quality of life in patient with focal dystonia. Clin Neurol Neurosurg. 2009;111(2):161-4.