SUBGROUPS IN IDIOPATHIC SPASMODIC TORTICO LLIS FROM A PSYCHOSOMATIC PERSPECTIVE - RESULTS OF A CLUSTER-ANALYSIS OF 144 CASES

The question of subgroups in idiopathic spasmodic torticollis, which h as been discussed in earlier studies in order to define etiologically heterogeneous patient populations has lost some of its relevance since with the injection of botulinum toxin an effective treatment is avail able. However, psychosocial distress is linked with spasmodic torticol lis in a substantial number of patients. In order to define criteria f or psychosocial interventions in addition to the treatment with botuli num toxin, a cluster analysis was carried out to identify high-risk po pulations in terms of psychological and social distress. Five subgroup s were defined on the basis of eight variables. Two of these five grou ps, one group with rotational torticollis and one with laterocollis, e merged as particularly distressed by their physical complaints, the ef fects of their illness on various areas of life and in terms of psycho logical functioning. The consistency of the subgroups was tested and s tatistically confirmed by analysis of variance. In a cross-validation 83.02% of the ungrouped cases were predicted correctly, The authors su ggest that the evaluation of psychological and social aspects of the c ondition should be part of the neurological assessment in order to off er appropiate support to patients, who reveal a high degree of psychol ogical distress.