Static Graviceptive Functions in Patients With Cervical Dystonia (CD)

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ClinicalTrials.gov Identifier: NCT01180270

Recruitment Status : Completed

First Posted : August 12, 2010

Last Update Posted : January 31, 2012

Sponsor:

Information provided by (Responsible Party):

Kirsten Elwischger, Medical University of Vienna

Study Description

Brief Summary:

The purpose of this experimental pilot study is to test the effect of normalization of the head position on the sense of balance at patients with cervical dystonia under routine botulinum toxin treatment.

Condition or disease
Cervical Dystonia

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Detailed Description:

Background:

The pathophysiological mechanism of cervical dystonia remains unclear. Affection of static graviceptive function has been shown in these patients by measuring the Subjective Visual Vertical (SVV). Healthy subjects, tested with voluntary head tilt, would tilt SVV in the opposite direction of the head. (Müller "E" effect), whereas patients with cervical dystonia set SVV close to true upright with a minimal deviation toward head-tilt. The mechanism of this change in otolith activity in patients with cervical dystonia is still unknown. When treated with botulinum toxin, head deviation will be reversed during a period of approximate 6-9 weeks, with a first peak of action after approximate 3 weeks.

Aim

The aim of this study is to investigate the effect of normalization of the head position under routine intramuscular botulinum toxin application in the cervical muscles (screening, 3 weeks and 9 weeks after injection) on static graviceptive function in patients with cervical dystonia.

Rationale

To our knowledge, the effect of botulinum toxin therapy on static otolith function in patients with cervical dystonia has never been evaluated. This study may provide new informations on the neural plasticity of the vestibular system and may contribute to the understanding of pathophysiological mechanisms of cervical dystonia. Accordingly, it may help developing new treatment strategies for this disease.

Primary hypothesis

There is a difference of at least 6 degrees in subjective visual vertical of patients with CD tested in habitual head position at study inclusion and 3 weeks after injection of Botulinum Toxin.

Study design

Subjective visual vertical will be tested in Patients with CD, who are pre-treated with botulinum toxin and show a good treatment response.

Patients SVV will be assessed before routine botulinum toxin injection (on day of injection), 3 and 9 weeks after injection. For control, SVV will be assessed in normal subjects.

SVV assessment

SVV will be performed by the patient and control while sitting upright in a dark room in different head positions, the head is fixed using a head holder.

In CD patients, SVV will be assessed in different head positions:

the habitual head deviation (head deviation will be classified by Tsui score),
head fixed in neutral head position (defined as 0° or no head rotation).
ear deviated 15° and 30° to ipsilateral and contralateral side, respectively, starting at habitual head deviation

SVV in normal subject, with

A) head fixed in neutral position (defined as 0° or no head rotation),

B) ear deviated 30° to the left,

C) ear deviated 30° to the right,

D) ear deviated 15° to the left,

E) ear deviated 15° to the right, will be assessed.

Study Design

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Study Type :	Observational
Actual Enrollment :	45 participants
Time Perspective:	Prospective
Official Title:	Experimental Pilot Trial Assessing Static Graviceptive Function in Patients With Cervical Dystonia
Study Start Date :	June 2010
Actual Primary Completion Date :	January 2012
Actual Study Completion Date :	January 2012

Resource links provided by the National Library of Medicine

MedlinePlus Genetics related topics: Early-onset primary dystonia Dopa-responsive dystonia

MedlinePlus related topics: Dystonia

Genetic and Rare Diseases Information Center resources: Cervical Dystonia

U.S. FDA Resources

Groups and Cohorts

Group/Cohort
Cervical dystonia patients suffering from cervical dystonia under routine botulinum toxin treatment
healthy volunteers control group

Outcome Measures

Primary Outcome Measures :

Subjective visual vertical (SVV), measured in degree (°) [ Time Frame: screening ]
Assessment: sitting upright in dark room, head is fixed using a head holder with a strap and a neck rest covering the occiput and posterior neck. For deviation of head (0°, 15° and 30° to the left and right side), head holder can be rotated about its midpoint. In front of patient (distance of 100 cm) is dim light bar, which can be rotated about its midpoint by means of an electronic motor and a remote control device. Patients adjust bar for parallel alignment with the perceived gravitational vertical. The operator tilts the bar in a random order 18° from the physical vertical.
SVV in degree (°) [ Time Frame: 3 weeks after screeening ]
Assessment: sitting upright in dark room, head is fixed using a head holder with a strap and a neck rest covering the occiput and posterior neck. For deviation of head (0°, 15° and 30° to the left and right side), head holder can be rotated about its midpoint. In front of patient (distance of 100 cm) is dim light bar, which can be rotated about its midpoint by means of an electronic motor and a remote control device. Patients adjust bar for parallel alignment with the perceived gravitational vertical. The operator tilts the bar in a random order 18° from the physical vertical.
SVV in degree (°) [ Time Frame: 9 weeks after screening ]
Assessment: sitting upright in dark room, head is fixed using a head holder with a strap and a neck rest covering the occiput and posterior neck. For deviation of head (0°, 15° and 30° to the left and right side), head holder can be rotated about its midpoint. In front of patient (distance of 100 cm) is dim light bar, which can be rotated about its midpoint by means of an electronic motor and a remote control device. Patients adjust bar for parallel alignment with the perceived gravitational vertical. The operator tilts the bar in a random order 18° from the physical vertical.

Secondary Outcome Measures :

Degree of head deviation (°) [ Time Frame: screening ]
head deviation of patients group in relaxed posture, measured in degrees (°)
degree of head deviation (°) [ Time Frame: 3 weeks after screening ]
head deviation of patients group in relaxed posture, measured in degrees (°)
degree of head deviation (°) [ Time Frame: 9 weeks after screening ]
head deviation of patients group in relaxed posture, measured in degrees (°)

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 80 Years (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes
Sampling Method:	Non-Probability Sample

Study Population

outpatient botulinum toxin clinic of the department of neurology, medical university of Vienna healthy subjects, residents of vienna

Criteria

Inclusion Criteria:

Idiopathic CD and willing to participate on the study,
Isolated laterocollis or laterocollis and torticollis with maximum of 15°rotation
Aged 18-80 years,
Under routine treatment with botulinum toxin

Exclusion Criteria:

Patients and Control

History of vestibular disorders

Patients

Torticollis with >15°rotation
Secondary CD (structural MRI lesions, Mb. Wilson)
Contraindication for intramuscular botulinum toxin therapy: bleeding disorder or anticoagulation therapy

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01180270

Locations

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Austria
Department of neurology, Medical University of Vienna
Vienna, Austria, 1090

Sponsors and Collaborators

Kirsten Elwischger

More Information

Publications:

Vacherot F, Vaugoyeau M, Mallau S, Soulayrol S, Assaiante C, Azulay JP. Postural control and sensory integration in cervical dystonia. Clin Neurophysiol. 2007 May;118(5):1019-27. Epub 2007 Mar 23.

Bove M, Brichetto G, Abbruzzese G, Marchese R, Schieppati M. Neck proprioception and spatial orientation in cervical dystonia. Brain. 2004 Dec;127(Pt 12):2764-78. Epub 2004 Sep 8.

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Responsible Party:	Kirsten Elwischger, MD, Medical University of Vienna
ClinicalTrials.gov Identifier:	NCT01180270
Other Study ID Numbers:	SVV_CD1
First Posted:	August 12, 2010 Key Record Dates
Last Update Posted:	January 31, 2012
Last Verified:	January 2012

Keywords provided by Kirsten Elwischger, Medical University of Vienna:


Cervical dystonia torticollis spasmodicus botulinum toxin	Subjective visual vertical (SVV) SVV static graviceptive function

Additional relevant MeSH terms:

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Dystonia Dystonic Disorders Torticollis Dyskinesias	Neurologic Manifestations Nervous System Diseases Movement Disorders Central Nervous System Diseases

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