{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:40:10Z","timestamp":1792482010682,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical dystonia (CD) is the most common focal dystonia and shows significant heterogeneity in both motor and non\u2010motor symptoms. Although motor symptoms typically prompt clinical presentation, non\u2010motor features are the principal determinants of quality of life. Previous efforts to classify CD have focused on selected motor and non\u2010motor clinical characteristics, suggesting distinct subtypes with potential prognostic implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We employed cluster analysis to identify phenotypic subgroups within a large CD population with detailed motor and non\u2010motor assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients with idiopathic isolated CD were included. Data were collected across five domains using validated instruments: motor severity (TWSTRS2\u2010Severity), quality of life (CDIP\u201058 total and EQ\u20105D\u20105L utility index), disability (TWSTRS2\u2010Disability), pain (TWSTRS2\u2010Pain), and psychiatric symptoms (HADS\u2010Total). Hierarchical cluster analysis using Ward's linkage method was performed to identify phenotypic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      201 CD patients (67% female) were included for analysis. Median age was 62\u2009years. Hierarchical cluster analysis identified two distinct phenotypic subgroups (Clusters A and B). Cluster A patients (n\u2009=\u200978) demonstrated significantly earlier disease onset (35 vs 48\u2009years) and greater symptom burden across all variables (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) when compared with Cluster B (n\u2009=\u2009123). The largest between\u2010cluster differences were observed for CDIP\u201058, HADS\u2010Total, and TWSTRS2\u2010Pain. Motor severity showed a smaller effect size, suggesting non\u2010motor features more strongly distinguish these phenotypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hierarchical cluster analysis identified two distinct CD phenotypes: an earlier onset high\u2010burden subgroup and later onset low\u2010burden subgroup. These clusters were primarily distinguished by non\u2010motor features (quality of life, mood, pain, and disability). Our findings highlight age at onset as a key determinant of CD phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70658","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:00:36Z","timestamp":1777341636000},"page":"2453-2457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age at Onset Predicts Motor and Non\u2010motor Severity in Cervical Dystonia"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-3135","authenticated-orcid":false,"given":"Shameer","family":"Rafee","sequence":"first","affiliation":[{"name":"Department of Neurology St Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3077-2960","authenticated-orcid":false,"given":"Laura","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurology St Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"O\u2019Riordan","sequence":"additional","affiliation":[{"name":"Department of Neurology St Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Department of Neurology St Vincent's University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Fearon","sequence":"additional","affiliation":[{"name":"Department of Neurology St Vincent's University Hospital  Dublin 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