Titolo della tesi: Impact of non-motor symptoms on clinical heterogeneity and treatment strategies in patients with cervical dystonia
Cervical dystonia (CD) presents with significant clinical heterogeneity, encompassing a broad spectrum of motor and non-motor symptoms, with pain being a predominant factor contributing to disease-related disability and diminished quality of life. This variability underscores a critical gap in understanding and managing CD, particularly regarding the influence of non-motor symptoms (NMS) on its clinical heterogeneity. Botulinum toxin (BoNT) remains the first-line treatment for motor symptoms in CD; however, its effects on NMS, including psychiatric conditions, sleep disorders, and pain, are not well-understood, necessitating comprehensive studies to elucidate its broader therapeutic impacts. Additionally, the management of pain through neuromodulatory approaches is an area ripe for exploration and advancements.
This thesis presents three studies focused on addressing these gaps. The first study aimed to categorize clinical subtypes of CD through a comprehensive, hypothesis-free, data-driven analysis of both motor and non-motor symptoms within a cross-sectional framework. The second study longitudinally evaluated the effects of BoNT-A on NMS in CD, such as cognitive issues, psychiatric conditions, sleep disorders, and pain. The third study investigated the potential of vibrotactile stimulation (VTS) as a non-invasive neuromodulation method targeting the somatosensory system to modulate neck pain in CD patients. This research aimed to explore alternative pain management strategies that could alleviate the significant pain burden in CD, offering new avenues for treatment.