Skip to main content

Advertisement

SpringerLink
Log in

Cervical dystonia and substance abuse

  • Short Commentary
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Objective

To investigate the prevalence of substance abuse (SA) in patients with cervical dystonia (CD) and to correlate it with prevalence of psychiatric disorders.

Methods

Data on anxiety, depression, dystonia severity, and substance abuse were collected from ten sites participating in the Dystonia Coalition. Patients were divided into two groups according to the presence of SA, utilizing Structured Clinical Interview for DSM-4 criteria. Wilcoxon Rank-Sum test was used to analyze the difference in median scores on the questionnaires between the groups. Chi-square test was used to analyze association between opiate and benzodiazepine use and SA. Association between TWSTRS severity and SA and medication use was assessed. A two-tailed p value of < 0.05 was considered significant. SAS 9.3 (SAS Institute Inc., Cary, NC, USA) was used for all analyses.

Results

Of 208 CD patients, 23 (11%) were identified with SA; 26.3% of patients with SA were on opiates compared to 7.2% of CD patients without SA (p = 0.006). Compared to non-SA patients, those experiencing SA were more likely male (88.9%; p = 0.0007), younger (median age 55; p = 0.031), and scored worse on questionnaires assessing depression (p = 0.044, p = 0.005), anxiety (p = 0.003), and dystonia psychiatric severity (p = 0.033). The median TWSTRS motor severity scores were higher in SA patients compared to non-SA patients (20 versus 16, p = 0.0339). The median TWSTRS total disability, motor, and pain scores were higher in patients on opiates than patients who were not (12 versus 8, p = 0.0071; 18.5 versus 16, p = 0.0243; 12.4 versus 6.7, p = 0.0052, respectively).

Conclusions

Potential risk factors for SA in CD patients include younger age and male gender with comorbid anxiety, depression and other psychiatric problems. Caution should be exercised when prescribing drugs with potential for abuse in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Albanese A, Bhatia K, Bressman SB et al (2013) Phenomenology and classification of dystonia: a consensus update. Mov Disord 28(7):863–873

    Article  PubMed  PubMed Central  Google Scholar 

  2. Comella C, Bhatia K (2015) An international survey of patients with cervical dystonia. J Neurol 262(4):837–848

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Tomic S, Petkovic I, Pucic T, Resan B, Juric S, Rotim T (2016) Cervical dystonia and quality of life. Acta Neurol Belg 116(4):589–592

    Article  PubMed  Google Scholar 

  4. Gundel H, Wolf A, Xidara V, Busch R, Ceballos-Baumann AO (2001) Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry 71(4):499–504

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Berardelli I, Ferrazzano G, Pasquini M, Biondi M, Berardelli A, Fabbrini G (2015) Clinical course of psychiatric disorders in patients with cervical dystonia. Psychiatry Res 229(1–2):583–585

    Article  PubMed  Google Scholar 

  6. Fabbrini G, Berardelli I, Moretti G et al (2010) Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord 25(4):459–465

    Article  PubMed  Google Scholar 

  7. Zurowski M, McDonald WM, Fox S, Marsh L (2013) Psychiatric comorbidities in dystonia: emerging concepts. Mov Disord 28(7):914–920

    Article  PubMed  Google Scholar 

  8. Thenganatt MA, Jankovic J (2014) Treatment of dystonia. Neurotherapeutics 11(1):139–152

    Article  CAS  PubMed  Google Scholar 

  9. Kalapatapu RK, Sullivan MA (2010) Prescription use disorders in older adults. Am J Addict 19(6):515–522

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pirio Richardson S, Wegele AR, Skipper B, Deligtisch A, Jinnah HA (2017) Dystonia treatment: patterns of medication use in an international cohort. Neurology 88(6):543–550

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hasin DS, O’Brien CP, Auriacombe M et al (2013) DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 170(8):834–851

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kuerbis A, Sacco P, Blazer DG, Moore AA (2014) Substance abuse among older adults. Clin Geriatr Med 30(3):629–654

    Article  PubMed  PubMed Central  Google Scholar 

  13. Swendsen J, Conway KP, Degenhardt L et al (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105(6):1117–1128

    Article  PubMed  PubMed Central  Google Scholar 

  14. Compton WM, Thomas YF, Stinson FS, Grant BF (2007) Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 64(5):566–576

    Article  PubMed  Google Scholar 

  15. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602

    Article  PubMed  Google Scholar 

  16. Quello SB, Brady KT, Sonne SC (2005) Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect 3(1):13–21

    Article  PubMed  PubMed Central  Google Scholar 

  17. Regier DA, Farmer ME, Rae DS et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 264(19):2511–2518

    Article  CAS  PubMed  Google Scholar 

  18. Bruce SE, Yonkers KA, Otto MW et al (2005) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 162(6):1179–1187

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kyllerman M, Forsgren L, Sanner G, Holmgren G, Wahlstrom J, Drugge U (1990) Alcohol-responsive myoclonic dystonia in a large family: dominant inheritance and phenotypic variation. Mov Disord 5(4):270–279

    Article  CAS  PubMed  Google Scholar 

  20. Berman BD, Junker J, Shelton E et al (2017) Psychiatric associations of adult-onset focal dystonia phenotypes. J Neurol Neurosurg Psychiatry 88(7):595–602. https://doi.org/10.1136/jnnp-2016-315461

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hall AJ, Logan JE, Toblin RL et al (2008) Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 300(22):2613–2620

    Article  CAS  PubMed  Google Scholar 

  22. Edlund MJ, Sullivan M, Steffick D, Harris KM, Wells KB (2007) Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers? Pain Med 8(8):647–656

    Article  PubMed  Google Scholar 

  23. Forman RF, Svikis D, Montoya ID, Blaine J (2004) Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 27(1):1–8

    Article  PubMed  PubMed Central  Google Scholar 

  24. van den Dool J, Tijssen MA, Koelman JH, Engelbert RH, Visser B (2016) Determinants of disability in cervical dystonia. Parkinsonism Relat Disord 32:48–53

    Article  PubMed  Google Scholar 

  25. Landsman-Blumberg PB, Katz N, Gajria K, Coutinho AD, Yeung PP, White R (2017) Burden of alcohol abuse or dependence among long-term opioid users with chronic noncancer pain. J Manag Care Spec Pharm 23(7):718–724

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Ms. Lea Kiefer, the study coordinator at Baylor College of Medicine, who recognized the high incidence of substance abuse our patients.

Funding

This study was supported in part by the Dystonia Coalition, which is funded by the National Center for Advancing Translational Sciences (Grant U54 TR001456) and the National institute for Neurological Disorders and Stroke (U54 NS065701) at the National Institutes of Health, USA.

Author information

Authors and Affiliations

  1. Department of Neurology, Henry Ford Health System, Henry Ford Hospital, 2799 W Grand Blvd., K-11, Detroit, MI, 48202, USA

    Abhimanyu Mahajan & Neepa Patel

  2. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Joseph Jankovic

  3. Department of Psychiatry and Neurology, Baylor College of Medicine, Houston, TX, USA

    Laura Marsh

  4. Department of Neurology, University of Arkansas Medical Center, Little Rock, AK, USA

    Achint Patel

  5. Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA

    H. A. Jinnah

  6. Department of Neurology, Rush University, Chicago, IL, USA

    Cynthia Comella

  7. Department of Neurology, University of Rochester, Rochester, NY, USA

    Richard Barbano

  8. Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University at St. Louis, St. Louis, MO, USA

    Joel Perlmutter

Authors
  1. Abhimanyu Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Jankovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Marsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Achint Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. A. Jinnah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cynthia Comella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard Barbano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joel Perlmutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Neepa Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the members of the Dystonia Coalition

Contributions

AM: research project: organisation, execution; statistical analysis: design and execution; manuscript preparation: writing of the first draft. JJ: research project: conception; statistical analysis: review and critique; manuscript preparation: review and critique. LM: statistical analysis: review and critique; manuscript preparation: review and critique. AP: statistical analysis: design and execution. HAJ: statistical analysis: review and critique; manuscript preparation: review and critique. CC: statistical analysis: review and critique; manuscript preparation: review and critique. RB: statistical analysis: review and critique; manuscript preparation: review and critique. JP: statistical analysis: review and critique; manuscript preparation: review and critique. NP: research project: conception; statistical analysis: design, review and critique; manuscript preparation: review and critique.

Corresponding author

Correspondence to Neepa Patel.

Ethics declarations

Conflicts of interest

Dr. Abhimanyu Mahajan has no conflicts of interest. Dr. Joseph Jankovic has no conflicts of interest. Dr. Achint Patel has no conflicts of interest. Dr. Laura Marsh has no conflicts of interest. Dr. H. A. Jinnah has active or recent grant support from the US government (National Institutes of Health), private philanthropic organisations (the Benign Essential Blepharospasm Research Foundation, Cure Dystonia Now), academically oriented institutions (the Dystonia Study Group), and industry (Cavion Therapeutics, Ipsen Pharmaceuticals, Retrophin Inc.). Dr. Jinnah has also served on advisory boards or as a consultant for Abide Therapeutics, Allergan Inc., Psyadon Pharmaceuticals, Retrophin Inc., Saol Therapeutics, and Medtronic Inc. He has received honoraria or stipends for lectures or administrative work from the American Academy of Neurology, the Dystonia Medical Research Foundation, the International Neurotoxin Society, the International Parkinson’s Disease and Movement Disorders Society, The Parkinson’s Disease Foundation, and Tyler’s Hope for a Cure. Dr. Jinnah serves on the Scientific Advisory Boards for Cure Dystonia Now, the Dystonia Medical Research Foundation, Lesch-Nyhan Action France, and Tyler’s Hope for a Cure. He also is principle investigator for the Dystonia Coalition, which receives the majority of its support through NIH grant TR001456 from the Office of Rare Diseases Research at the National Center for Advancing Translational Sciences, and previously NS065701 from the National Institutes of Neurological Disorders and Stroke. The Dystonia Coalition has received additional material or administrative support from industry sponsors (Allergan Inc. and Merz Pharmaceuticals) as well as private foundations (The American Dystonia Society, Beat Dystonia, The Benign Essential Blepharospasm Foundation, Cure Dystonia Now, Dystonia Inc., Dystonia Ireland, The Dystonia Medical Research Foundation, The European Dystonia Federation, The Foundation for Dystonia Research, The National Spasmodic Dysphonia Association, and The National Spasmodic Torticollis Association). Dr. Comella serves on the editorial board of Clinical Neuropharmacology, Sleep Medicine, and Continuum. She receives research support from the NIH R01NS074343, U54NS065701, Dystonia Medical Research Foundation, Merz Pharmaceutical, Revance Therapeutic, Retrophin, and Acorda Therapeutic. She receives compensation/honoraria for services as a consultant or an advisory committee member: Acorda Therapeutics, Allergan, Inc.; Lundbeck Ltd.; Medtronic Inc.; Merz Pharmaceuticals; Acadia Pharmaceuticals; Jazz Pharmaceuticals, Neurocrine Biosciences Inc., Revance Therapeutic. She receives royalties from Cambridge, Wolters Kluwer. She receives research support from the Parkinson’s Disease Foundation. Dr. Richard Barbano serves on a scientific advisory board and speaker’s bureau for Allergan; serves as an associate editor for Neurology: Clinical Practice, performs botulinum toxin injections at the University of Rochester (30% effort); receives research support from Allergan, Vaccinex, and Biotie; has received research support from NIH, NINDS, ORDR: Dystonia Coalition Projects, Site PI; holds stock/stock options in VisualDx; and has served as an expert witness in legal proceedings including malpractice, not involving commercial entities. Dr. Joel Perlmutter has support from NIH (NINDS, NIA), CHDI, APDA, Greater St. Louis Chapter of the APDA, MJ Fox Foundation, Barnes-Jewish Hospital Foundation. He has no conflicts of interest. Dr. Neepa Patel has received honoraria as a consultant for Acadia pharmaceuticals and as a speaker for Teva pharmaceuticals.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahajan, A., Jankovic, J., Marsh, L. et al. Cervical dystonia and substance abuse. J Neurol 265, 970–975 (2018). https://doi.org/10.1007/s00415-018-8840-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8840-9

Keywords

Search

Navigation