Pal P K, Samii A, Schulzer M, Mak E, Tsui J K
Neurodegenerative Disorders Centre, Vancouver Hospital & Health Sciences Centre, University of British Columbia, Canada.
Can J Neurol Sci. 2000 May;27(2):137-42.
To compare the clinical characteristics, natural history, and therapeutic outcome of patients with cervical dystonia (CD) with head tremor (HT+) and without head tremor (HT-).
We prospectively evaluated 114 consecutive patients of CD over a 9-month period with a detailed questionnaire. Chi-square and t-tests were employed for statistical analysis.
Seventy-eight (68.4%) patients had head tremor and 27 of them (34.6%) had tremor as one of the first symptoms. Age at onset of symptoms were similar in HT+ and HT- groups; however there was a higher prevalence in women in the former group (66.7% vs. 41.7%; p=0.01). HT+ patients had more frequent positive family history of essential-like hand/head tremor (21.8% vs. 5.5%; p<0.05), associated neck pain (92.3% vs. 77.8%: p<0.05), and essential-like hand tremor (40% vs. 8.3%; p<0.001). They also appeared to have more frequent history of preceding head/neck trauma (14.1% vs. 8.3%), frequent head rotation (88.5% vs. 69.4%) and antecollis (12.8% vs. 5.5%) but less often head tilt (37.2% vs. 47.2%) and gestes antagonistes (60.2% vs. 75%) than the HT- patients; however these differences were not statistically significant. The frequency of prior psychiatric illnesses, the incidence of dystonias in other parts of the body, frequency of retrocollis and shoulder elevation, and spontaneous remission were similar in the two groups.
Head tremor is common in CD and is more commonly associated with hand tremor and family history of tremor or other movement disorders. This supports a possible genetic association between CD and essential tremor (ET). Linkage studies are required to evaluate the genetic association between CD and ET.
比较伴有头部震颤（HT+）和不伴有头部震颤（HT-）的颈部肌张力障碍（CD）患者的临床特征、自然病史和治疗结果。
我们在9个月的时间里对114例连续的CD患者进行了前瞻性评估，并使用详细的问卷。采用卡方检验和t检验进行统计分析。
78例（68.4%）患者有头部震颤，其中27例（34.6%）以震颤作为首发症状之一。HT+组和HT-组症状出现时的年龄相似；然而，前一组女性的患病率更高（66.7%对41.7%；p = 0.01）。HT+患者有更频繁的原发性手部/头部震颤阳性家族史（21.8%对5.5%；p < 0.05）、相关的颈部疼痛（92.3%对77.8%：p < 0.05）和原发性手部震颤（40%对8.3%；p < 0.001）。他们似乎也有更频繁的头部/颈部外伤史（14.1%对8.3%）、频繁的头部旋转（88.5%对69.4%）和前斜颈（12.8%对5.5%），但与HT-患者相比，头部倾斜（37.2%对47.2%）和对抗性动作（60.2%对75%）较少；然而，这些差异无统计学意义。两组先前精神疾病的发生率、身体其他部位肌张力障碍的发生率、后斜颈和肩部抬高的频率以及自发缓解情况相似。
头部震颤在CD中很常见，并且更常与手部震颤以及震颤或其他运动障碍的家族史相关。这支持了CD与特发性震颤（ET）之间可能存在的遗传关联。需要进行连锁研究来评估CD和ET之间的遗传关联。
