Motor and non-motor symptoms in cervical dystonia

In this thesis, we detected a high frequency of non-motor symptoms (NMS) in patients with cervical dystonia (CD), with a high impact on quality of life (HR-QoL). Psychiatric co-morbidity and fatigue are most likely primary symptoms and part of the phenotype of CD, while excessive daytime sleepiness and impaired sleep quality were highly related to psychiatric co-morbidity and pain. To improve the recognition and treatment of NMS, we proposed and explored a NMS questionnaire as a first step towards a dystonia specific NMS questionnaire. Future studies are warranted to explore the effect of NMS treatment on HR-QoL.

Secondly, we explored the role of serotonin in the pathophysiology of dystonia using PET imaging. It appeared that serotonergic perturbations in the raphe nuclei and in basal ganglia output regions are related to both motor- and NMS in CD.

Currently there are no good (pharmaco)therapeutic options for most forms of dystonia and associated non-motor symptoms. Further research with PET imaging and selective serotonergic drugs in appropriate models for dystonia is required to establish the role of the serotonergic system in dystonia and to guide us to new therapeutic strategies.

Dissertation: http://hdl.handle.net/11370/c33faae9-1e2f-427b-985a-6097a076aeed