Department of Neuroscience and Rehabilitation, University of Ferrara, Via Aldo Moro, 8, 44100, Ferrara, Italy.
Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Neurol Sci. 2024 Feb;45(2):629-638. doi: 10.1007/s10072-023-07033-y. Epub 2023 Aug 30.
Non-motor symptoms, such as sleep disturbances, fatigue, neuropsychiatric manifestations, cognitive impairment, and sensory abnormalities, have been widely reported in patients with idiopathic cervical dystonia (ICD). This study aimed to clarify the autonomic nervous system (ANS) involvement in ICD patients, which is still unclear in the literature.
We conducted a pilot case-control study to investigate ANS in twenty ICD patients and twenty age-sex-matched controls. The Composite Autonomic System Scale 31 was used for ANS clinical assessment. The laser Doppler flowmetry quantitative spectral analysis, applied to the skin and recorded from indices, was used to measure at rest, after a parasympathetic activation (six deep breathing) and two sympathetic stimuli (isometric handgrip and mental calculation), the power of high-frequency and low-frequency oscillations, and the low-frequency/high-frequency ratio.
ICD patients manifested higher clinical dysautonomic symptoms than controls (p < 0.05). At rest, a lower high-frequency power band was detected among ICD patients than controls, reaching a statistically significant difference in the age group of ≥ 57-year-olds (p < 0.05). In the latter age group, ICD patients showed a lower low-frequency/high-frequency ratio than controls at rest (p < 0.05) and after mental calculation (p < 0.05). Regardless of age, during handgrip, ICD patients showed (i) lower low-frequency/high-frequency ratio (p < 0.05), (ii) similar increase of the low-frequency oscillatory component compared to controls, and (iii) stable high-frequency oscillatory component, which conversely decreased in controls. No differences between the two groups were detected during deep breathing.
ICD patients showed ANS dysfunction at clinical and neurophysiological levels, reflecting an abnormal parasympathetic-sympathetic interaction likely related to abnormal neck posture and neurotransmitter alterations.
运动障碍以外的症状，如睡眠障碍、疲劳、神经精神表现、认知障碍和感觉异常，在特发性颈肌张力障碍（ICD）患者中已有广泛报道。本研究旨在阐明自主神经系统（ANS）在 ICD 患者中的参与情况，这在文献中尚不清楚。
我们进行了一项初步的病例对照研究，以调查 20 名 ICD 患者和 20 名年龄性别匹配的对照组的 ANS。使用综合自主系统量表 31 进行 ANS 临床评估。激光多谱勒血流定量光谱分析应用于皮肤，并从指数记录，用于测量休息时、副交感神经激活（六次深呼吸）和两个交感神经刺激（等长握力和心算）后，高频和低频振荡的功率，以及低频/高频比。
ICD 患者表现出比对照组更高的临床自主神经症状（p<0.05）。在休息时，ICD 患者的高频功率带低于对照组，在≥57 岁年龄组中达到统计学显著差异（p<0.05）。在后者的年龄组中，ICD 患者在休息时和心算后显示出比对照组更低的低频/高频比（p<0.05）。无论年龄如何，在握力时，ICD 患者表现出（i）更低的低频/高频比（p<0.05），（ii）与对照组相比，低频振荡成分的相似增加，和（iii）稳定的高频振荡成分，而对照组的高频振荡成分则相反下降。在深呼吸时，两组之间没有差异。
ICD 患者在临床和神经生理学水平表现出 ANS 功能障碍，反映了异常的副交感神经-交感神经相互作用，可能与异常的颈部姿势和神经递质改变有关。
