Journal of Neurology

, Volume 265, Issue 4, pp 970–975 | Cite as

Cervical dystonia and substance abuse

  • Abhimanyu Mahajan
  • Joseph Jankovic
  • Laura Marsh
  • Achint Patel
  • H. A. Jinnah
  • Cynthia Comella
  • Richard Barbano
  • Joel Perlmutter
  • Neepa Patel
  • For the members of the Dystonia Coalition
Short Commentary



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


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.


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).


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.


Dystonia Neuroepidemiology Psychiatric disorders Alcohol Substance abuse 



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.

Author 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.

Study 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.

Compliance with ethical standards

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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Abhimanyu Mahajan
    • 1
  • Joseph Jankovic
    • 2
  • Laura Marsh
    • 3
  • Achint Patel
    • 4
  • H. A. Jinnah
    • 5
  • Cynthia Comella
    • 6
  • Richard Barbano
    • 7
  • Joel Perlmutter
    • 8
  • Neepa Patel
    • 1
  • For the members of the Dystonia Coalition
  1. 1.Department of Neurology, Henry Ford Health SystemHenry Ford HospitalDetroitUSA
  2. 2.Department of NeurologyBaylor College of MedicineHoustonUSA
  3. 3.Department of Psychiatry and NeurologyBaylor College of MedicineHoustonUSA
  4. 4.Department of NeurologyUniversity of Arkansas Medical CenterLittle RockUSA
  5. 5.Department of Neurology and Human GeneticsEmory UniversityAtlantaUSA
  6. 6.Department of NeurologyRush UniversityChicagoUSA
  7. 7.Department of NeurologyUniversity of RochesterRochesterUSA
  8. 8.Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational TherapyWashington University at St. LouisSt. LouisUSA

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