Objective: To develop an algorithm for the selection of adults with disabling spasticity for treatme...

Tremor is an important phenotypic feature of dystonia. Using the new concept (Col-Cap) of classification we examined the frequency of tremor in cervical dystonia (CD) patients, their main subtypes and muscles injected. In this large study conducted at multiple movement disorder centres in Europe and India, between January and June 2019, we examined 293 patients with idiopathic CD who were all treated with botulinum toxin (BTX). The dystonic head tremor (DHT+) was present in 57.6 % of CD patients and they had a significantly longer duration of symptoms than patients without head tremor (DHT–). In DHT+ patients torticaput was the most common subtype and the majority (63.3%) had one or two subtypes only. There was no significant difference between the number of unilateral injections for any of the muscles in the DHT+ and DHT– groups, while the number of patients receiving bilateral injections in splenius capitis (78 vs 25; p = 0.00001), sternocleidomastoid (31 vs 6; p = 0.0005), trapezius (28 vs 9; p = 0.01), and obliquus capitis inferior (15 vs 2; p = 0.008) were significantly more in the DHT+ group. The mean doses of all three types of BTX/A were not significantly different between the two groups. The frequency of head tremor was 57.6% in our CD patients and torticaput was the most common dystonic subtype associated with tremor. Simple forms of CD seemed more likely associated with head tremor, than complex forms of CD. Most of the DHT+ patients received bilateral injections. The use of ‘Col-Cap’ classification was helpful in the identification of muscles likely to be involved in tremor in CD patients.

Background and objectives Hyperkinetic movement disorders, characterized by complex and overlapping motor patterns, present significant challenges in classification and treatment. The inconsistency in definitions and descriptors complicates both research and clinical communication. This study aims to provide an overview of current terminology and definitions related to spasticity and other hyperkinetic movement disorders associated with central nervous system lesions. We propose a unified terminology and classification system for spastic movement disorders (SMD). Methods In this scoping review, definitions of spasticity, dystonia, tremor, chorea, hemiballismus, athetosis, myoclonus, and dyssynergia were reviewed, with emphasis on overlaps and diagnostic challenges among these disorders. The goal was to develop a consensus expert opinion on a phenomenological approach to SMD. Results The proposed classification system for spasticity includes clinical characteristics (Axis 1) and etiology (Axis 2). Axis 1 includes: age at onset, body distribution, disease course, phenomenological description, and impact on body function, activity, and participation. The phenomenological description allows sub-classification of SMD into: phasic reflex overactivity, stimulus-induced muscle overactivity, constant muscle overactivity, and lack of muscle selectivity. These categories clarify disabling phenotypes such as clonus, dysregulated co-contraction, muscle spasms, activity-induced muscle hypertonia, associated reactions, and persistent muscle hypertonia. Discussion This framework for classification of SMD aims to establish a common language for describing clinical phenotypes. By adopting a phenomenological approach, we underscore the importance of consistent descriptors and propose a systematic classification method for movement disorders, particularly spasticity. We hope this unified terminology will enhance clinical practice, research, and ultimately, patient care.

The aim of this study is to develop a treatment diary for patients receiving spasticity treatment including botulinum toxin injection and physiotherapy and/or occupational therapy. The diary focuses on problems triggered by skeletal muscle overactivity; agreed goals for treatment and the patient’s self-evaluation of achievement on the Goal Attainment Scale; which skeletal muscles were injected; physiotherapists’ and occupational therapists’ evaluation of the patients’ achievement of objectives on the Goal Attainment Scale; and proposals for optimization of treatment and changing goals. The evaluation included a satisfaction questionnaire and the WHO-QoL BREF and WHO-5 well-being score. Overall, 10 patients were enrolled in the pilot study. The patients were generally satisfied with the diary, found that it involved them more in their treatment and made it easier to set personal goals, and found it worth the time spent using it. However, no clear advantage in relation to their quality of life (WHO-QoL BREF and WHO-5 well-being score) was reported.

Empowerment and implementation of self‐management strategies are vital components in the future care of chronic, neurological patient groups, including people with Parkinson’s disease (PD). This study aimed to evaluate the feasibility and effectiveness of an 8‐week self‐management intervention designed for people with PD (PwP) with follow‐up assessments at 3 and 6 months postintervention. The program focused on developing self‐management skills, coping strategies, disease education, mindfulness, exercise routines, and individual goal‐setting tools. Objective measurements using Parkinson’s KinetiGraph™ (PKG) were employed to monitor motor symptoms, immobility levels, and burden of nonmotor symptoms (self‐reported in the PKG portal). Participants, serving as their own controls, were recruited from movement disorder clinics, private neurologists, and a specialized rehabilitation center. Primary endpoints were change in Health Education Impact Questionnaire (HeiQ) and Health Literacy Questionnaire (HLQ‐14) scores, assessed at baseline and at 3‐ and 6‐month follow‐up. Secondary endpoints included changes in quality of life, self‐efficacy, motor symptoms (PKG data), nonmotor symptoms, contacts to the clinics 6 months before and after the intervention, and time spent with immobility. Eighty PwP completed the program, and 59 caregivers attended the educational sessions. Statistically significant changes were found between baseline and follow‐up in the motor symptom burden, self‐efficacy, and reduced clinical contacts. Although no statistical changes were observed in health literacy, quality of life, and nonmotor symptoms, sustained positive trends were observed. The findings suggest that the program may enhance empowerment and self‐management strategies in PwP, particularly in self‐efficacy level, managing motor symptoms, and less need of contact to the clinics.