Clinical subtypes of anterocollis in parkinsonian syndromes

• Type of Material: Article
• Authors: Gonzalo J. Revuelta, Medical University of South Carolina; Michael Benatar, University of Miami; Alan Freeman, Emory University; Thomas Wichmann, Emory University; Hyder A Jinnah, Emory University; Mahlon R DeLong, Emory University; Stewart Factor, Emory University
• Language: English
• Date: 2012-04-15
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jns.2011.11.017
• Title of Journal or Parent Work: Journal of the Neurological Sciences
• ISSN: 0022-510X
• Volume: 315
• Issue: 1-2
• Start Page: 100
• End Page: 103
• Grant/Funding Information: This study was supported by a grant from the Bachmann–Strauss Dystonia Parkinson Foundation and the NIH/NCRR (award number UL1RR029882).
• Keywords: Anterocollis; DISEASE; Life Sciences & Biomedicine; Dystonia; Parkinson's disease; DISPROPORTIONATE ANTECOLLIS; Science & Technology; DROPPED HEAD SYNDROME; PROGRESSIVE SUPRANUCLEAR PALSY; Myopathy; Clinical Neurology; NECK EXTENSOR MYOPATHY; DYSTONIA; FOCAL MYOPATHY; DEFORMITIES; MULTIPLE SYSTEM ATROPHY; Head drop syndrome; CAMPTOCORMIA; Neurosciences; Neurosciences & Neurology
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Background: Disproportionate anterocollis is a debilitating condition which occurs in the later stages of parkinsonian syndromes and for which there is no effective therapy. Multiple hypotheses have been proposed to explain its underlying etiology, including myopathy of the cervical extensors, and dystonia of the cervical flexors. Methods: We examined the records of 39 patients (8 prospectively) with anterocollis and parkinsonian syndromes to explore demographics, historical and clinical data, findings from electromyography and response to therapies. We classified our patients based on whether or not they were weak on neck extension and also based on primary diagnosis (PD vs atypical parkinsonian syndrome). Demographic, clinical, historical and EMG features are reported for each group. Results: There were no significant demographic differences between clinical subtypes, or primary diagnosis. Electromyographic (EMG) findings demonstrated myopathic changes in both groups, although they were more prominent in the group which was weak in extension. Historical features were similar between groups except for dopamine agonist use, which was more common in the myopathic subgroup (p = 0.02). There were no other significant clinical differences between clinical subtypes or primary diagnosis with the exception that patients with atypical parkinsonian syndromes had more advanced motor symptoms. Conclusions: We conclude that anterocollis is a heterogeneous condition in which at least two distinct subtypes exist. Recognizing these subtypes may help guide therapy and future research.