Tomic S, et al. J Clin Neurol. 2022 Nov;18(6):628-634. https://doi.org/10.3988/jcn.2022.18.6.628

Background/Objectives: Cervical dystonia (CD) is a condition characterized by involuntary activity of cervical muscles, which is often accompanied by various non-motor symptoms. Recent studies indicate impaired saccadic eye movements in CD. Local administration of botulinum toxin type A (BoNT/A), which causes temporary paralysis of the injected muscle, is the first-line treatment of focal dystonia, including CD. To our knowledge, concurrent observation of the effect of BoNT/A on smooth eye movements, voluntary saccades, memory-guided saccades, and antisaccades in CD has not yet been explored. The aim of this study was to assess the effect of BoNT/A on eye movements and non-motor symptoms in patients with CD, which, when altered, could imply a central effect of BoNT/A. Methods: Thirty patients with CD performed smooth pursuit, prosaccadic expression, memory-guided saccades, and antisaccade tasks; eye movements were recorded by an eye tracker. Motor and non-motor symptoms, including depression, anxiety, pain, disability, and cognitive changes prior to and after BoNT/A administration, were also evaluated. Results: The number of correct onward counts (p < 0.001), overall correct memory-guided saccades count (p = 0.005), motor symptoms (p = 0.001), and non-motor symptoms, i.e., anxiety (p = 0.04), depression (p = 0.02), and cognition (p < 0.001) markedly improved after BoNT/A administration. Conclusions: Memory-guided saccades, depression, and anxiety improve after BoNT/A in CD.

Cervical dystonia (CD), blepharospasm (BSP), and idiopathic hemifacial spasm (HFS) are focal hyperkinetic movement disorders with distinct underlying mechanisms. While CD and BSP involve central network dysfunctions within the basal ganglia-thalamo-cortical and cerebellar circuits, HFS primarily results from peripheral facial nerve hyperexcitability. Still, people living with all three conditions often struggle with mood issues like depression and anxiety, which can originate from both the burden of illness and changes in brain biology. We studied 61 patients (CD, n = 30; BSP, n = 9; HFS, n = 22) and assessed depression and anxiety before and three weeks after botulinum neurotoxin type A (BoNT-A) therapy, considering injection site and dose. BoNT-A significantly reduced depressive and anxiety symptoms across all groups, regardless of disease type, dose, or glabellar injection. These psychiatric improvements were not associated with the degree of motor symptom reduction, suggesting a partially independent mechanism of mood modulation. Our findings indicate that BoNT-A’s mood benefits may extend beyond local motor effects, possibly involving broader sensorimotor-limbic interactions. These results highlight the therapeutic potential of BoNT-A for addressing non-motor symptoms in both dystonic and non-dystonic hyperkinetic disorders. Future studies employing imaging and neurophysiological methods are necessary to explain the neural pathways underlying these effects.

Introduction: Sleep disorders are among the most common non-motor symptoms in patients with cervical dystonia (CD), Parkinson's disease (PD), and depression. The study aimed to assess the prevalence and characteristics of sleep disorders in patients with cervical dystonia compared to healthy controls, patients with Parkinson's disease, and patients with depression.Methods: In this cross-sectional study, we evaluated 122 patients (30 control patients, 30 with cervical dystonia, 32 with Parkinson's disease, and 30 with depression). Demographic data were collected. All of them, except for the depression group, were tested for depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Sleep disorders were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Statistical significance was defined at α=0.05.Results: Patients with cervical dystonia differed from the healthy control group in terms of PSQI score and some subscales. The depression group differed in most PSQI subscales when compared to the patients with Parkinson's disease and cervical dystonia, while the latter two groups of patients differed only in the duration subscale. Patients with Parkinson's disease differed from other groups of patients only in one subscale - daytime sleepiness.Conclusion: Cervical dystonia patients suffer from more sleep disturbances when compared to healthy controls. There are differences in the frequency and extent of sleep disturbances with less pronounced symptoms in patients with cervical dystonia and Parkinson's disease, while patients with depression present the most pronounced symptoms. Symptoms of depression and anxiety correlate with sleep disturbances in patients with Parkinson's disease and cervical dystonia. Patients with cervical dystonia do not experience daytime sleepiness problems.

Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disorder characterized with alpha-synuclein pathology. For the majority of patients, except for some genetic forms, etiology is still unknown. There are some implications that food intake and gut microbiota could contribute to PD. Aim: The aim of this paper is to analyze the influence of protein, fruit and vegetable intake on the clinical presentation of idiopathic Parkinson disease Patients and methods: Patients with idiopathic PD were surveyed for demographic data and nutritional habits in regards to protein, fruit and vegetable intake. Motor symptoms were evaluated using the Unified Parkinson Disease Rating Scale (UPDRS) part III and IV, cognitive impairment using Mini Mental State Examination (MMSE) and depression using Beck Depression Inventory (BDI). Results: We have analyzed data of 96 patients. Patients using fewer dairy products have more often tremor type of PD (p<0.040). We did not find any differences in severity of motor symptoms, disease stage, age when disease start, frequency of motor complications and fluctuation of therapy, depression and cognitive impairment according to protein, fruit and vegetable ingestion. Conclusion: Higher intake of dairy products could influence the appearance of less favorable forms of Parkinson's disease (rigor type). Protein, fruit and vegetable intake do not influence the disease appearance, severity of motor symptoms, motor fluctuation and complication of therapy, disease stage, the appearance of cognitive impairment nor depression in Parkinson's disease patients.