Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Jan;64(1):25–32. doi: 10.1136/jnnp.64.1.25

Possible risk factors for primary adult onset dystonia: a case-control investigation by the Italian Movement Disorders Study Group

G Defazio 1, A Berardelli 1, G Abbruzzese 1, V Lepore 1, V Coviello 1, D Acquistapace 1, L Capus 1, F Carella 1, M T De Berardinis 1, G Galardi 1, P Girlanda 1, S Maurri 1, A Albanese 1, L Bertolasi 1, R Liguori 1, A Rossi 1, L Santoro 1, G Tognoni 1, P Livrea 1
PMCID: PMC2169915  PMID: 9436723

Abstract

OBJECTIVES—Little is known about the aetiology of idiopathic adult onset dystonia. The Italian Movement Disorders Study Group promoted a case-control study on some hypothetical risk factors including past medical events, life events, life habits, occupational hazards, and family hystory of dystonia, parkinsonism, and tremor.
METHODS—Cases affected by idiopathic adult onset dystonia (age at symptom onset >20 years, duration of disease >one year and <five years) were selected among consecutive outpatients attending 14Italian centres. Control outpatients matched for age (±5 years), sex, and referral centre were identified among diagnostic categories thought to be unassociated with study exposures. Information was obtained by a standardised questionnaire administered by medical interviewers. Conditional logistic univariate and multivariate regression analyses were performed by a standard statistical package.
RESULTS—Multivariate analysis on 202 cases and 202 age and sex matched control outpatients indicated that head or facial trauma with loss of consciousness, family history of dystonia, and family history of postural tremor independently increased the risk of developing adult onset dystonia, whereas hypertension and cigarette smoking exerted a protective effect. The findings also suggested a positive association between local body injury—for example, previous ocular diseases and neck or trunk trauma—and dystonia of the same body part.
CONCLUSIONS—The results support the idea that environmental and genetic factors may both be important in the aetiology of adult onset dystonia, and suggest aetiological clues worthy of further analytical investigation.



Full Text

The Full Text of this article is available as a PDF (128.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berardelli A., Rothwell J. C., Day B. L., Marsden C. D. The pathophysiology of cranial dystonia. Adv Neurol. 1988;50:525–535. [PubMed] [Google Scholar]
  2. Burke R. E., Fahn S., Gold A. P. Delayed-onset dystonia in patients with "static" encephalopathy. J Neurol Neurosurg Psychiatry. 1980 Sep;43(9):789–797. doi: 10.1136/jnnp.43.9.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Calne D. B., Lang A. E. Secondary dystonia. Adv Neurol. 1988;50:9–33. [PubMed] [Google Scholar]
  4. Defazio G., Livrea P., Guanti G., Lepore V., Ferrari E. Genetic contribution to idiopathic adult-onset blepharospasm and cranial-cervical dystonia. Eur Neurol. 1993;33(5):345–350. doi: 10.1159/000116969. [DOI] [PubMed] [Google Scholar]
  5. Dubinsky R. M., Gray C. S., Koller W. C. Essential tremor and dystonia. Neurology. 1993 Nov;43(11):2382–2384. doi: 10.1212/wnl.43.11.2382. [DOI] [PubMed] [Google Scholar]
  6. Fahn S., Williams D. T. Psychogenic dystonia. Adv Neurol. 1988;50:431–455. [PubMed] [Google Scholar]
  7. Fletcher N. A., Harding A. E., Marsden C. D. The relationship between trauma and idiopathic torsion dystonia. J Neurol Neurosurg Psychiatry. 1991 Aug;54(8):713–717. doi: 10.1136/jnnp.54.8.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Grandas F., Elston J., Quinn N., Marsden C. D. Blepharospasm: a review of 264 patients. J Neurol Neurosurg Psychiatry. 1988 Jun;51(6):767–772. doi: 10.1136/jnnp.51.6.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hosmer D. W., Taber S., Lemeshow S. The importance of assessing the fit of logistic regression models: a case study. Am J Public Health. 1991 Dec;81(12):1630–1635. doi: 10.2105/ajph.81.12.1630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hubble J. P., Busenbark K. L., Koller W. C. Essential tremor. Clin Neuropharmacol. 1989 Dec;12(6):453–482. doi: 10.1097/00002826-198912000-00001. [DOI] [PubMed] [Google Scholar]
  11. Jankovic J., Ford J. Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol. 1983 Apr;13(4):402–411. doi: 10.1002/ana.410130406. [DOI] [PubMed] [Google Scholar]
  12. Jankovic J., Leder S., Warner D., Schwartz K. Cervical dystonia: clinical findings and associated movement disorders. Neurology. 1991 Jul;41(7):1088–1091. doi: 10.1212/wnl.41.7.1088. [DOI] [PubMed] [Google Scholar]
  13. Jankovic J. Post-traumatic movement disorders: central and peripheral mechanisms. Neurology. 1994 Nov;44(11):2006–2014. doi: 10.1212/wnl.44.11.2006. [DOI] [PubMed] [Google Scholar]
  14. Jedynak C. P., Bonnet A. M., Agid Y. Tremor and idiopathic dystonia. Mov Disord. 1991;6(3):230–236. doi: 10.1002/mds.870060307. [DOI] [PubMed] [Google Scholar]
  15. Klawans H. L. Dystonia and tremor following exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Mov Disord. 1987;2(4):255–261. doi: 10.1002/mds.870020403. [DOI] [PubMed] [Google Scholar]
  16. Lee M. S., Rinne J. O., Ceballos-Baumann A., Thompson P. D., Marsden C. D. Dystonia after head trauma. Neurology. 1994 Aug;44(8):1374–1378. doi: 10.1212/wnl.44.8.1374. [DOI] [PubMed] [Google Scholar]
  17. Lou J. S., Jankovic J. Essential tremor: clinical correlates in 350 patients. Neurology. 1991 Feb;41(2 ):234–238. doi: 10.1212/wnl.41.2_part_1.234. [DOI] [PubMed] [Google Scholar]
  18. Micheli S., Fernández-Pardal M., Quesada P., Brannan T., Obeso J. A. Variable onset of adult inherited focal dystonia: a problem for genetic studies. Mov Disord. 1994 Jan;9(1):64–68. doi: 10.1002/mds.870090110. [DOI] [PubMed] [Google Scholar]
  19. Morens D. M., Grandinetti A., Reed D., White L. R., Ross G. W. Cigarette smoking and protection from Parkinson's disease: false association or etiologic clue? Neurology. 1995 Jun;45(6):1041–1051. doi: 10.1212/wnl.45.6.1041. [DOI] [PubMed] [Google Scholar]
  20. Nutt J. G., Muenter M. D., Aronson A., Kurland L. T., Melton L. J., 3rd Epidemiology of focal and generalized dystonia in Rochester, Minnesota. Mov Disord. 1988;3(3):188–194. doi: 10.1002/mds.870030302. [DOI] [PubMed] [Google Scholar]
  21. Pauletti G., Berardelli A., Cruccu G., Agostino R., Manfredi M. Blink reflex and the masseter inhibitory reflex in patients with dystonia. Mov Disord. 1993 Oct;8(4):495–500. doi: 10.1002/mds.870080414. [DOI] [PubMed] [Google Scholar]
  22. Pita Salorio D., Quintana Conte R. Ophthalmologic causes of blepharospasm. Adv Neurol. 1988;49:91–102. [PubMed] [Google Scholar]
  23. Sackett D. L. Bias in analytic research. J Chronic Dis. 1979;32(1-2):51–63. doi: 10.1016/0021-9681(79)90012-2. [DOI] [PubMed] [Google Scholar]
  24. Scott B. L., Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology. 1996 Jan;46(1):68–74. doi: 10.1212/wnl.46.1.68. [DOI] [PubMed] [Google Scholar]
  25. Suchowersky O., Calne D. B. Non-dystonic causes of torticollis. Adv Neurol. 1988;50:501–508. [PubMed] [Google Scholar]
  26. Wacholder S., McLaughlin J. K., Silverman D. T., Mandel J. S. Selection of controls in case-control studies. I. Principles. Am J Epidemiol. 1992 May 1;135(9):1019–1028. doi: 10.1093/oxfordjournals.aje.a116396. [DOI] [PubMed] [Google Scholar]
  27. Wacholder S., Silverman D. T., McLaughlin J. K., Mandel J. S. Selection of controls in case-control studies. II. Types of controls. Am J Epidemiol. 1992 May 1;135(9):1029–1041. doi: 10.1093/oxfordjournals.aje.a116397. [DOI] [PubMed] [Google Scholar]
  28. Waddy H. M., Fletcher N. A., Harding A. E., Marsden C. D. A genetic study of idiopathic focal dystonias. Ann Neurol. 1991 Mar;29(3):320–324. doi: 10.1002/ana.410290315. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES