Hentschel F, Dressler D, Abele M, Paus S
Department of Anaesthesiology, University of Bonn, Bonn, Germany.
Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany.
J Neural Transm (Vienna). 2017 Feb;124(2):245-251. doi: 10.1007/s00702-016-1639-x. Epub 2016 Nov 5.
Causes of cardiovascular autonomic dysfunction in cervical dystonia (CD) are poorly understood. Studies examining effects of botulinum neurotoxin (BoNT) therapy on heart rate variability (HRV) yielded contradictory results. There is compelling evidence that depression shifts autonomic balance towards sympathetic predominance. As depression is the most frequent non-motor symptom in CD, we sought to determine if it is associated to dysfunction of cardiovascular autonomic regulation. Standardized interviews, clinical examinations, self-rating forms, autonomic symptom questionnaire, and automated autonomic testing in outpatients with idiopathic CD were used. Cardiovascular autonomic screening encompassed five different analyses of HRV, and testing of orthostasis. 85 CD patients participated in the study. 21% of them had HRV impairment, 14% orthostatic hypotension. 30% of CD patients had symptoms of depression. In those, decreased HRV was more frequent than in CD patients without mood disturbance (40 vs. 13%; p = 0.008). CD patients with and without depression had no other significant differences, including demographics, dystonia severity, comorbidity, medication, or BoNT therapy. Cardiovascular autonomic imbalance with sympathetic predominance is a non-motor manifestation of CD, associated to depression. Impaired HRV is a cardiovascular risk factor, moreover, emphasizing the need to identify and treat depression in dystonia.
颈部肌张力障碍（CD）中心血管自主神经功能障碍的病因尚不清楚。研究肉毒杆菌神经毒素（BoNT）治疗对心率变异性（HRV）的影响，结果相互矛盾。有确凿证据表明，抑郁症会使自主神经平衡向交感神经占优势转变。由于抑郁症是CD中最常见的非运动症状，我们试图确定它是否与心血管自主神经调节功能障碍有关。我们对特发性CD门诊患者进行了标准化访谈、临床检查、自评量表、自主神经症状问卷和自动自主神经测试。心血管自主神经筛查包括对HRV的五种不同分析以及直立性低血压测试。85名CD患者参与了该研究。其中21%有HRV损害，14%有直立性低血压。30%的CD患者有抑郁症状。在这些患者中，HRV降低的情况比没有情绪障碍的CD患者更常见（40%对13%；p = 0.008）。有抑郁和无抑郁的CD患者在人口统计学、肌张力障碍严重程度、合并症、用药或BoNT治疗等方面没有其他显著差异。以交感神经占优势的心血管自主神经失衡是CD的一种非运动表现，与抑郁症有关。HRV受损是一种心血管危险因素，此外，这也强调了在肌张力障碍中识别和治疗抑郁症的必要性。
