Treatment of task-specific dystonia in sports: A systematic review.

Introduction: Task specific dystonia is a movement disorder only affecting a highly practiced skill and is found in a broad set of expert movements including in sports. Despite affecting many sports, there is no comprehensive review of treatment options, which is in contrast to better studied forms of task specific dystonia in musicians and writers. For this reason, studies involving an intervention to treat task specific dystonia in sports were systematically reviewed, with special attention for the quality of outcome measures. Methods: The PICO systematic search strategy was employed on task-specific dystonia, and all synonyms. Inclusion criteria were peer reviewed published studies pertaining to sports, studies with a measurement and/or intervention in TSD, all in English. We excluded abstracts, expert opinions, narrative review articles, unpublished studies, dissertations and studies exclusively relating to choking. We included case reports, case studies and case-control studies. Results: In April 2022 Pubmed, Embase, Web of Science, and Psychinfo were searched. Of the 7000 articles identified, 31 were included that described psychological and invasive and/or pharmacological interventions. There was a lack of formal standardized outcome measures in studies resulting in low quality evidence for the effectiveness of treatment options. A descriptive synthesis showed emotional regulation was effective, but was exclusively tried in golfers. Interventions like botulinum toxin or pharmacology had a similar effectiveness compared to studies in musicians dystonia, however there was almost no formal evidence for these treatments. Conclusion: The quality of studies was low with a lack of standardized outcome measures. Future studies with larger cohorts and quantitative outcome measures are needed to improve understanding of treatments for task specific dystonia in athletes.

[Stroke mimicking acute peripheral vertigo: how to avoid misdiagnosis - importance of alarm symptoms and assessment of eye movements]. / Draaiduizeligheid: gewoon beroerd of een beroerte?

Identifying the occurrence of stroke in patients with isolated vertigo is difficult for general practitioners (GPs) as well as for physicians working in the Emergency Department. Three patients with acute vestibular syndrome are presented in this clinical lesson. The importance of an adequate neuro-otological examination is emphasised. However, many GPs lack knowledge of the nystagmus and the head impulse test. Alternative strategies for GPs are discussed.

[The yips: a movement disorder among golfers]. / De 'yips': een bewegingsstoornis bij golfers.

BACKGROUND: Although the yips occurs commonly in golfers, this neurological movement disorder is a relatively unknown phenomenon among physicians. CASE DESCRIPTION: A 47-year-old golf player developed a disturbing, neurological movement disorder that manifested when playing golf: the yips. These jerks occurred when putting, but not during practice rounds. The patient's father suffered from similar yips. CONCLUSION: The yips is a task-specific dystonia, which can also manifest in players of other sports. Multiple factors, such as genetic predisposition and anxiety seem to be involved in its pathophysiology. The disorder is relatively common among both professional and amateur golfers. The adverse impact can be big and a cure is yet to be found.

Benign paroxysmal positional vertigo in Parkinson's disease.

BACKGROUND: Dizziness is a frequent complaint of patients with Parkinson's disease (PD), and orthostatic hypotension (OH) is often thought to be the cause. We studied whether benign paroxysmal positional vertigo (BPPV) could also be an explanation. AIM: To assess the prevalence of benign paroxysmal positional vertigo in patients with Parkinson's disease, with and without dizziness. METHODS: 305 consecutive outpatients with PD completed the Movement Disorders Society-sponsored revision of the Unified Parkinsons' Disease Rating Scale-motor score, the Dizziness Handicap Inventory, the Dix-Hallpike maneuver and a test for orthostatic hypotension. When positive for benign paroxysmal positional vertigo, a repositioning maneuver was performed. Patients were followed for three months to determine the clinical response. RESULTS: 305 patients responded (186 men (61%), mean age 70.5 years (Standard Deviation 9.5 years)), of whom 151 (49%) complained of dizziness. 57 (38%) of the dizzy patients appeared to have orthostatic hypotension; 12 patients (8%) had a classical but previously unrecognized benign paroxysmal positional vertigo. A further four patients (3%) had a more atypical presentation of benign paroxysmal positional vertigo. Three months after treatment, 11 (92%) of patients with classical benign paroxysmal positional vertigo were almost or completely without complaints. We found no 'hidden' benign paroxysmal positional vertigo among patients without dizziness. The prevalence of benign paroxysmal positional vertigo among all patients with PD was 5.3%. CONCLUSION: Among Parkinson patients with symptoms of dizziness, up to 11% may have benign paroxysmal positional vertigo, which can be treated easily and successfully.