Sara C LaHue1,2, Kathleen Albers3, Samuel Goldman1,4,5, Raymond Y Lo6, Zhuqin Gu7, Amethyst Leimpeter3, Robin Fross8, Kathleen Comyns1, Connie Marras9, Annelie de Kleijn10, Robin Smit10, Maya Katz1,2,4, Laurie J Ozelius11, Susan Bressman12,13, Rachel Saunders-Pullman12,13, Cynthia Comella14, Jeffrey Klingman15, Lorene M Nelson16, Stephen K Van Den Eeden3, Caroline M Tanner1,2,4. 1. Department of Neurology, School of Medicine, University of California, San Francisco, California, USA. 2. Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, California, USA. 3. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. 4. San Francisco Veteran's Administration Medical Center, San Francisco, California, USA. 5. Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, California, USA. 6. Hualien Tzu Chi Hospital/Tzu Chi University, Hualien, Taiwan. 7. Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China. 8. Department of Neurology, Kaiser Permanente Hayward Medical Center, Hayward, California, USA. 9. Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, University of Toronto, Toronto, Canada. 10. Department of Neurology, Radboud University Nijmegen, Nijmegen, Netherlands. 11. Department of Neurology, Massachusetts General Hospital, Charlestown, Massachusetts, USA. 12. Department of Neurology, Mount Sinai Beth Israel, New York, New York, USA. 13. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 14. Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA. 15. Department of Neurology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA. 16. Department of Health Research and Policy, Stanford University, Stanford, California, USA.
Abstract
BACKGROUND: Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized. OBJECTIVES: To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization. METHODS: We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration. RESULTS: CD incidence was 1.18/100,000 person-years (95% confidence interval [CI], 0.35-2.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person-years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2-164.5), cervical disc disease (OR 3.83; 95% CI, 2.8-5.2), neck sprain/strain (OR 2.77; 95% CI, 1.99-3.62), anxiety (OR 2.24; 95% CI, 1.63-3.11) and depression (OR 1.94; 95% CI, 1.4-2.68). CONCLUSIONS: CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects.
BACKGROUND: Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized. OBJECTIVES: To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization. METHODS: We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration. RESULTS: CD incidence was 1.18/100,000 person-years (95% confidence interval [CI], 0.35-2.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person-years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2-164.5), cervical disc disease (OR 3.83; 95% CI, 2.8-5.2), neck sprain/strain (OR 2.77; 95% CI, 1.99-3.62), anxiety (OR 2.24; 95% CI, 1.63-3.11) and depression (OR 1.94; 95% CI, 1.4-2.68). CONCLUSIONS: CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects.
Authors: Elizabeth Cisneros; Glenn T Stebbins; Qiyu Chen; Jeanne P Vu; Casey N Benadof; Zheng Zhang; Richard L Barbano; Susan H Fox; Christopher G Goetz; Joseph Jankovic; Hyder A Jinnah; Joel S Perlmutter; Charles H Adler; Stewart A Factor; Stephen G Reich; Ramon Rodriguez; Lawrence L Severt; Natividad P Stover; Brian D Berman; Cynthia L Comella; David A Peterson Journal: J Neurol Sci Date: 2020-11-01 Impact factor: 3.181
Authors: Meng Wang; Tolulope Sajobi; Francesca Morgante; Charles Adler; Pinky Agarwal; Tobias Bäumer; Alfredo Berardelli; Brian D Berman; Joel Blumin; Max Borsche; Allison Brashear; Andres Deik; Kevin Duque; Alberto J Espay; Gina Ferrazzano; Jeanne Feuerstein; Susan Fox; Samuel Frank; Mark Hallett; Joseph Jankovic; Mark S LeDoux; Julie Leegwater-Kim; Abhimanyu Mahajan; Irene A Malaty; William Ondo; Alexander Pantelyat; Sarah Pirio-Richardson; Emmanuel Roze; Rachel Saunders-Pullman; Oksana Suchowersky; Daniel Truong; Marie Vidailhet; Aparna Wagle Shukla; Joel S Perlmutter; Hyder A Jinnah; Davide Martino Journal: Eur J Neurol Date: 2021-08-04 Impact factor: 6.288