{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:06:47Z","timestamp":1784264807549,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Background<\/jats:bold>\n                    : Non\u2010motor symptoms are well established phenotypic components of adult\u2010onset idiopathic, isolated, focal cervical dystonia (AOIFCD). However, improved understanding of their clinical heterogeneity is needed to better target therapeutic intervention. Here, we examine non\u2010motor phenotypic features to identify possible AOIFCD subgroups.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods<\/jats:bold>\n                    : Participants diagnosed with AOIFCD were recruited via specialist neurology clinics (dystonia wales:\n                    <jats:italic>n<\/jats:italic>\n                    = 114, dystonia coalition:\n                    <jats:italic>n<\/jats:italic>\n                    = 183). Non\u2010motor assessment included psychiatric symptoms, pain, sleep disturbance, and quality of life, assessed using self\u2010completed questionnaires or face\u2010to\u2010face assessment. Both cohorts were analyzed independently using Cluster, and Bayesian multiple mixed model phenotype analyses to investigate the relationship between non\u2010motor symptoms and determine evidence of phenotypic subgroups.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Independent cluster analysis of the two cohorts suggests two predominant phenotypic subgroups, one consisting of approximately a third of participants in both cohorts, experiencing increased levels of depression, anxiety, sleep impairment, and pain catastrophizing, as well as, decreased quality of life. The Bayesian approach reinforced this with the primary axis, which explained the majority of the variance, in each cohort being associated with psychiatric symptomology, and also sleep impairment and pain catastrophizing in the Dystonia Wales cohort.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions<\/jats:bold>\n                    : Non\u2010motor symptoms accompanying AOIFCD parse into two predominant phenotypic sub\u2010groups, with differences in psychiatric symptoms, pain catastrophizing, sleep quality, and quality of life. Improved understanding of these symptom groups will enable better targeted pathophysiological investigation and future therapeutic intervention.\n                  <\/jats:p>","DOI":"10.1002\/brb3.2292","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T23:46:19Z","timestamp":1626911179000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Non\u2010motor phenotypic subgroups in adult\u2010onset idiopathic, isolated, focal cervical dystonia"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-6228","authenticated-orcid":false,"given":"Megan E.","family":"Wadon","sequence":"first","affiliation":[{"name":"Neuroscience and Mental Health Research Institute Division of Psychological Medicine and Clinical Neurosciences Cardiff University  Maindy Road Cardiff CF24 4HQ UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace A.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Neuroscience and Mental Health Research Institute Division of Psychological Medicine and Clinical Neurosciences Cardiff University  Maindy Road Cardiff CF24 4HQ UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehra","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Neuroscience and Mental Health Research Institute Division of Psychological Medicine and Clinical Neurosciences Cardiff University  Maindy Road Cardiff CF24 4HQ UK"},{"name":"Institute of Neurology University College London  Queen Square London WC1N 3BG UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Hubbard","sequence":"additional","affiliation":[{"name":"School of Medicine Cardiff University  Heath Park Campus Cardiff CF14 4YS UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meshari","family":"AlSaeed","sequence":"additional","affiliation":[{"name":"School of Medicine Cardiff University  Heath Park Campus Cardiff CF14 4YS UK"},{"name":"Division of Neurology University of British Columbia  Wesbrook Mall Vancouver British Columbia V6T 2B5 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Robinson","sequence":"additional","affiliation":[{"name":"School of Medicine Cardiff University  Heath Park Campus Cardiff CF14 4YS UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"McLauchlan","sequence":"additional","affiliation":[{"name":"Neuroscience and Mental Health Research Institute Division of Psychological Medicine and Clinical Neurosciences Cardiff University  Maindy Road Cardiff CF24 4HQ UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L.","family":"Barbano","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Rochester  Elmwood Avenue Rochester New York NY 14642 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Marsh","sequence":"additional","affiliation":[{"name":"Menninger Department of Psychiatry Baylor College of Medicine  Butler Boulevard Houston Texas 77030 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart A.","family":"Factor","sequence":"additional","affiliation":[{"name":"Departments of Neurology &amp; Human Genetics Emory University  Woodruff Circle Atlanta Georgia 30322 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan H.","family":"Fox","sequence":"additional","affiliation":[{"name":"Edmond J Safra Program in Parkinson Disease Movement Disorder Clinic Toronto Western Hospital  Bathurst Street Toronto Ontario M5T 2S8 Canada"},{"name":"Department of Medicine University of Toronto  Queen\u2019s Park Crescent West Toronto Ontario M5S 3H2 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles H.","family":"Adler","sequence":"additional","affiliation":[{"name":"The Parkinson's Disease and Movement Disorders Center Mayo Clinic Department of Neurology  East Shea Boulevard Scottsdale Arizona 85259 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon L.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Florida  Newell Drive Gainesville Florida 32611 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia L.","family":"Comella","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences Rush University Medical Center  West Harrison Street Chicago Illinois 60612 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen G.","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Maryland School of Medicine  south Paca Street Baltimore Maryland 21201 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Severt","sequence":"additional","affiliation":[{"name":"Beth Israel Medical Center  First Avenue New York New York 10003 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Goetz","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences Rush University Medical Center  West Harrison Street Chicago Illinois 60612 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel S.","family":"Perlmutter","sequence":"additional","affiliation":[{"name":"Neurology Radiology Neuroscience Physical Therapy and Occupational Therapy Washington University School of Medicine  South Euclid Avenue St. Louis Missouri 63110 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyder A.","family":"Jinnah","sequence":"additional","affiliation":[{"name":"Departments of Neurology &amp; 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