Head tremor and pain in cervical dystonia.

BACKGROUND: Although head tremor (HT) and pain are prevalent in cervical dystonia (CD), their joint relationship to phenotypic features of focal dystonia remains unclear. OBJECTIVES: We examined how severity of HT and pain are associated with age of CD onset and duration, and whether HT subtypes ("jerky" or "regular") exhibit distinct relationships between severity of HT and pain. METHODS: The severity of HT and pain were assessed with the Toronto Western Spasmodic Torticollis Rating Scale in retrospective review of 188 CD patients recruited through the Dystonia Coalition. RESULTS: HT severity was associated with longer CD duration (p < 0.0005), whereas pain severity was associated with younger age at onset (p = 0.043). HT severity and pain severity were not correlated for jerky HT (p = 0.996), but positively correlated for regular HT (p = 0.01). CONCLUSIONS: The distinct associations of HT and pain with age at onset, disease duration, and HT subtype further characterize the heterogeneity of CD's clinical presentation and suggest similarly heterogeneous underlying mechanisms.

Postural Directionality and Head Tremor in Cervical Dystonia.

Background: Although abnormal head and neck postures are defining features of cervical dystonia (CD), head tremor (HT) is also common. However, little is known about the relationship between abnormal postures and HT in CD. Methods: We analyzed clinical data and video recordings from 185 patients enrolled by the Dystonia Coalition. We calculated the likelihood of their HT and HT type ("regular" vs. "jerky") given directionality of abnormal head postures, disease duration, sex, and age. Results: Patients with retrocollis were more likely to have HT than patients with anterocollis (X2 (1, N = 121) = 7.98, p = 0.005). There was no difference in HT likelihood given left or right turning in laterocollis and rotation. Patients with HT had longer disease duration (t(183) = 2.27, p = 0.024). There was no difference in age between patients with and without HT. In a logistic regression model, anterocollis/retrocollis direction (X2 (1, N = 121) = 6.04, p = 0.014), disease duration (X2 (1, N = 121) = 7.28, p = 0.007), and the interaction term between age and disease duration (X2 (1, N = 121) = 7.77, p = 0.005) collectively contributed to HT likelihood. None of the postural directionality or demographic variables were associated with differential likelihood of having regular versus jerky HT. Discussion: We found that HT is more likely for CD patients with a specific directionality in their predominant posture. Our finding that CD patients with longer disease duration have a higher likelihood of HT also raises the question of whether HT becomes more likely over time in individual patients.

Sensory Tricks Are Associated with Higher Sleep-Related Quality of Life in Cervical Dystonia.

Background: Sensory tricks are compensatory gestures that cervical dystonia (CD) patients use to reduce abnormal neck posture and movements. Although sensory tricks are common in CD, little is known about whether trick efficacy changes over time or has effect on quality of life. Methods: We analyzed clinical data and video recordings from 188 patients with isolated CD. We calculated the duration of CD and assessed the Toronto Western Spasmodic Torticollis Rating Scales and the Cervical Dystonia Impact Profile (CDIP-58). Results: A longer duration of CD corresponded to a less effective sensory trick (r(187) = 0.1901, p = 0.009). Patients who demonstrated more effective sensory tricks reported higher sleep-related quality of life than patients with less effective sensory tricks (r(187) = 0.1680, p = 0.0212). There were no significant relationships between the effectiveness of a sensory trick and the other aspects of quality of life as measured by the CDIP-58. Discussion: Patients who have had CD longer had less effective sensory tricks consistent with patients' verbal reports of previously having a trick that no longer works. Patients should be apprised of a wide variety of sensory tricks because their previous tricks may lose efficacy over time and because more effective tricks are associated with higher sleep-related quality of life.

Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children.

Home visiting programs for families with young children have been in effect for many years; however, this is the first comprehensive meta-analytic effort to quantify the usefulness of home visits as a strategy for helping families across a range of outcomes. Sixty home visiting programs contributed data to analysis within 5 child and 5 parent outcome groups. Standardized effect sizes were computed for each end-of-treatment outcome measure, for each treatment versus control contrast. Weighted mean standardized effect sizes ranged from -.043 to.318; 6 of the 10 significantly differed from 0. No one program characteristic consistently affected effect sizes across outcome groups. The extent to which these findings have practical use for the field is discussed.

Rohling's Interpretive Method and inherent limitations on the flexibility of "flexible batteries".

Miller and Rohling (2001) proposed a 24-step algorithm, the Rohling Interpretive Method (RIM), for quantitative interpretation of results from flexible neuropsychological test batteries. We believe that the RIM as presented in that paper has several conceptual problems, including (a) a failure to distinguish "statistically significant" from pathological differences, (b) an assumption that declines in specific abilities can be inferred when a particular test score deviates from an estimate of general premorbid ability, and (c) confusion between the standard deviation associated with individual test scores versus that of a composite of those scores. As an alternative, we suggest the value of developing and using co-normed comprehensive neuropsychological test batteries from which test users might select subsets of tests.