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<div class="editorbox"> '''Original Editor '''- [[User:Harshit Anand|Harshit Anand]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Dystonia ==
== Dystonia ==
Dystonia is a movement condition in which muscles contract involuntarily, resulting in repeated or twisting motions. The disorder can affect one area of your body (focal dystonia), two or more neighbouring sections (segmental dystonia), or your entire body (global dystonia) (general dystonia).<ref>[https://www.mayoclinic.org/diseases-conditions/dystonia/symptoms-causes/syc-20350480]Dystonia definition by  Mayo clinic</ref>
[[File:Dystonia, medically induced.jpeg|thumb|Medically induced dystonia]]
 
[[Dystonia]] is a hyperkinetic movement disorder in which involuntary contractions of muscles occur. It is characterised by sustained [[muscle]] contractions and abnormal trunk, neck, face, arms, and legs postures.<ref>Tarsy D, Simon DK. Dystonia. [https://www.nejm.org/doi/full/10.1056/NEJMra055549 New England Journal of Medicine]. 2006 Aug 24;355(8):818-29.Available: https://www.nejm.org/doi/full/10.1056/NEJMra055549<nowiki/>(accessed 18.3.2023)</ref> Dystonia Rating Scales (DRS) aim to evaluation the severity and distribution of motor symptoms and how they affect an individuals life. and also give a reference point for post-treatment evaluations. These tools provide an [[Outcome Measures|objective outcome]], and need be accurate and of high quality.<ref name=":0">Albanese A, Sorbo FD, Comella C, Jinnah HA, Mink JW, Post B, Vidailhet M, Volkmann J, Warner TT, Leentjens AF, Martinez‐Martin P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207366/ Dystonia rating scales: critique and recommendations.] Movement Disorders. 2013 Jun 15;28(7):874-83.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207366/ (accessed 18.3.2023)</ref>
For more information, see page: [[Dystonia]]


== Dystonia Rating Scale ==
== Dystonia Rating Scale ==
A task force that looked into DRS advocated the use of  seven specific dystonia scales.


==== Background ====
# One scale rating blepharospasm, the Blepharospasm Disability Index (BSDI)
Although several rating systems have been used to measure dystonia, only a few have had their clinimetric features tested. A task group was formed by the Movement Disorders Society to assess existing dystonia grading scales and place them in a clinical and clinimetric framework.
# Two scales rating cervical dystonia , the Cervical Dystonia Impact Scale (CDIP-58) and the Toronto Western Spasmodic torticollis Rating Scale (TWSTRS)
 
# One scale rating blepharospasm and cervical dystonia, the Craniocervical Dystonia Questionnaire (CDQ-24)
=== Types of Dystonia Rating Scale<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207366/bin/NIHMS514282-supplement-Supplementary_Material.docx]Summary of Supplementary data provided by NCBI</ref> ===
# Two scales rating laryngeal dystonia, the Voice Handicap Index (VHI) and the Vocal Performance Questionnaire (VPQ)
Classification of the rating measures applied in studies of dystonia.
# One scale rating generalized dystonia the Fahn-Marsden Dystonia Rating Scale (FMDRS). <ref name=":0" />
{| class="wikitable sortable"
|+
!
= Table 1 =
Classification of the rating measures applied in studies of dystonia.
{| class="wikitable"
! colspan="1" rowspan="2" |Scales
! colspan="1" rowspan="2" |Type
! colspan="3" rowspan="1" |Criteria
! colspan="1" rowspan="2" |Qualification
|-
! colspan="1" rowspan="1" |1
! colspan="1" rowspan="1" |2
! colspan="1" rowspan="1" |3
|-
| rowspan="1" |'''Blepharospasm'''
|
|
|
|
|
|-
| colspan="1" rowspan="1" | •Blepharospasm Disability Index (BSDI)
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="1" rowspan="1" | •Jankovic rating scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Blepharospasm Disability Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="6" rowspan="1" |
----
|-
| rowspan="1" |'''Cervical dystonia'''
|
|
|
|
|
|-
| colspan="1" rowspan="1" | •Cervical Dystonia Impact Scale (CDIP-58)
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="1" rowspan="1" | •Functional Disability Questionnaire
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Toronto Western Spasmodic torticollis Rating Scale (TWSTRS)
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="1" rowspan="1" | •Tsui scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Modified Tsui scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Freiberg Questionnaire for Dystonia torticollis version
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Disability questionnaire for patients with cervical dystonia
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Body Concept Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Ways of Coping Checklist
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Blepharospasm/cervical dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Craniocervical Dystonia Questionnaire (CDQ-24)
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Oromandibular dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Oromandibular dystonia questionnaire
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Suggested
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Laryngeal dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Unified Spasmodic Dysphonia Rating Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Voice Handicap Index (VHI)
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="1" rowspan="1" | •Voice Handicap Index 10
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Pediatric Voice Handicap Index
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Uncertain
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Pediatric Voice-Related Quality of Life
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Uncertain
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Voice-Related Quality of Life
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Vocal Performance Questionnaire (VPQ)
| colspan="1" rowspan="1" |Generic
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Arm dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Arm Dystonia Disability Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Task-specific dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Dystonia Evaluation Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Listed
|-
| colspan="1" rowspan="1" | •Tubiana-Chamagne Score
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Writer’s Cramp Rating Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="6" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Generalized dystonia'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" | •Global Dystonia rating Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|-
| colspan="1" rowspan="1" | •Fahn-Marsden Dystonia Rating Scale (FMDRS)
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Recommended
|-
| colspan="1" rowspan="1" | •Unified Dystonia Rating Scale
| colspan="1" rowspan="1" |Specific
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |Suggested
|}
Notes:
 
a“Specific” indicates a measure developed specifically for dystonia, “generic” indicates a measure applicable across different diseases, including dystonia;
 
bCriteria are as follows: 1 used in dystonia patients, 2 used by researchers beyond original developers, 3 successful clinimetric testing.
|}


==== Abbreviations ====
== Conclusion ==
{| class="wikitable"
Looking forward there is need for refinement of existing rating scales eg to include non motor features, and new outcome measures for dystonia's that currently have no rating scales eg. lower limb and trunk dystonia's. it is important to choose the most appropriate tool for dystonia subtypes, and training is recommended. Scales still need further research and development.<ref name=":0" />
|BoNT
|botulinum neurotoxin
|-
|BSDI
|Blepharospasm Disability Index
|-
|CDIP-58
|Cervical Dystonia Impact Scale
|-
|CDQ-24
|Craniocervical Dystonia Questionnaire
|-
|FMDRS
|Fahn-Marsden Dystonia Rating Scale
|-
|HRQoL
|Health-related quality of life
|-
|TWSTRS
|Toronto Western Spasmodic torticollis Rating Scale
|-
|VHI
|Voice Handicap Index
|-
|VPQ
|Vocal Performance Questionnaire
|}


==== Limitations ====
==== References ====
Although none of the measures evaluated are acceptable or sufficient for diagnosing a specific dystonia type (e.g., certain forms of focal or generalised dystonia, paroxysmal dystonia, etc. ), they can be used to rate severity and compare patient groups. Because most dystonia scales evaluate specific body regions, they should only be used on patients who are well-defined and homogeneous. The CDQ-24, for example, has been used in individuals with segmental and generalised dystonia to assess the impact of craniocervical dystonia on quality of life. However, because this scale is exclusive to craniocervical dystonia, using it in individuals with dystonia affecting other parts of the body could lead to inaccurate results.
<references />
[[Category:Neurology]]
[[Category:Neurological - Outcome Measures]]
[[Category:Neurological - Conditions]]

Latest revision as of 03:34, 18 March 2023

Original Editor - Harshit Anand Top Contributors - Lucinda hampton, Harshit Anand, Kim Jackson, Vidya Acharya and Muskan Rastogi

Dystonia[edit | edit source]

Medically induced dystonia

Dystonia is a hyperkinetic movement disorder in which involuntary contractions of muscles occur. It is characterised by sustained muscle contractions and abnormal trunk, neck, face, arms, and legs postures.[1] Dystonia Rating Scales (DRS) aim to evaluation the severity and distribution of motor symptoms and how they affect an individuals life. and also give a reference point for post-treatment evaluations. These tools provide an objective outcome, and need be accurate and of high quality.[2]

Dystonia Rating Scale[edit | edit source]

A task force that looked into DRS advocated the use of seven specific dystonia scales.

  1. One scale rating blepharospasm, the Blepharospasm Disability Index (BSDI)
  2. Two scales rating cervical dystonia , the Cervical Dystonia Impact Scale (CDIP-58) and the Toronto Western Spasmodic torticollis Rating Scale (TWSTRS)
  3. One scale rating blepharospasm and cervical dystonia, the Craniocervical Dystonia Questionnaire (CDQ-24)
  4. Two scales rating laryngeal dystonia, the Voice Handicap Index (VHI) and the Vocal Performance Questionnaire (VPQ)
  5. One scale rating generalized dystonia the Fahn-Marsden Dystonia Rating Scale (FMDRS). [2]

Conclusion[edit | edit source]

Looking forward there is need for refinement of existing rating scales eg to include non motor features, and new outcome measures for dystonia's that currently have no rating scales eg. lower limb and trunk dystonia's. it is important to choose the most appropriate tool for dystonia subtypes, and training is recommended. Scales still need further research and development.[2]

References[edit | edit source]

  1. ↑ Tarsy D, Simon DK. Dystonia. New England Journal of Medicine. 2006 Aug 24;355(8):818-29.Available: https://www.nejm.org/doi/full/10.1056/NEJMra055549(accessed 18.3.2023)
  2. ↑ 2.0 2.1 2.2 Albanese A, Sorbo FD, Comella C, Jinnah HA, Mink JW, Post B, Vidailhet M, Volkmann J, Warner TT, Leentjens AF, Martinez‐Martin P. Dystonia rating scales: critique and recommendations. Movement Disorders. 2013 Jun 15;28(7):874-83.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207366/ (accessed 18.3.2023)
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