{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:09:53Z","timestamp":1791486593481,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T00:00:00Z","timestamp":1574812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["RO1 HS018413"],"award-info":[{"award-number":["RO1 HS018413"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001595","name":"Dystonia Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1RO1 NS046340"],"award-info":[{"award-number":["1RO1 NS046340"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CD incidence was 1.18\/100,000 person\u2010years (95% confidence interval [CI], 0.35\u20132.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person\u2010years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2\u2013164.5), cervical disc disease (OR 3.83; 95% CI, 2.8\u20135.2), neck sprain\/strain (OR 2.77; 95% CI, 1.99\u20133.62), anxiety (OR 2.24; 95% CI, 1.63\u20133.11) and depression (OR 1.94; 95% CI, 1.4\u20132.68).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects. \u00a9 2019 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.27927","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T07:49:51Z","timestamp":1574840991000},"page":"450-456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Cervical Dystonia Incidence and Diagnostic Delay in a Multiethnic Population"],"prefix":"10.1002","volume":"35","author":[{"given":"Sara C.","family":"LaHue","sequence":"first","affiliation":[{"name":"Department of Neurology School of Medicine, University of California  San Francisco California USA"},{"name":"Weill Institute for Neurosciences, Department of Neurology University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Albers","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Goldman","sequence":"additional","affiliation":[{"name":"Department of Neurology School of Medicine, University of California  San Francisco California USA"},{"name":"San Francisco Veteran's Administration Medical Center  San Francisco California USA"},{"name":"Occupational and Environmental Medicine School of Medicine, University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6510-1935","authenticated-orcid":false,"given":"Raymond Y.","family":"Lo","sequence":"additional","affiliation":[{"name":"Hualien Tzu Chi Hospital\/Tzu Chi University  Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuqin","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Xuanwu Hospital of Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amethyst","family":"Leimpeter","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Fross","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaiser Permanente Hayward Medical Center  Hayward California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Comyns","sequence":"additional","affiliation":[{"name":"Department of Neurology School of Medicine, University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Marras","sequence":"additional","affiliation":[{"name":"Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelie","family":"de Kleijn","sequence":"additional","affiliation":[{"name":"Department of Neurology Radboud University Nijmegen  Nijmegen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Neurology Radboud University Nijmegen  Nijmegen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Neurology School of Medicine, University of California  San Francisco California USA"},{"name":"Weill Institute for Neurosciences, Department of Neurology University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veteran's Administration Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie J.","family":"Ozelius","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital  Charlestown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Bressman","sequence":"additional","affiliation":[{"name":"Department of Neurology Mount Sinai Beth Israel  New York New York USA"},{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Saunders\u2010Pullman","sequence":"additional","affiliation":[{"name":"Department of Neurology Mount Sinai Beth Israel  New York New York USA"},{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Comella","sequence":"additional","affiliation":[{"name":"Department of Neurology Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Klingman","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaiser Permanente Walnut Creek Medical Center  Walnut Creek California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-8088","authenticated-orcid":false,"given":"Lorene M.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Health Research and Policy Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen K.","family":"Van Den Eeden","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Tanner","sequence":"additional","affiliation":[{"name":"Department of Neurology School of Medicine, University of California  San Francisco California USA"},{"name":"Weill Institute for Neurosciences, Department of Neurology University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veteran's Administration Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-003-0236-8"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000059525"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2011.06.014"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004150070094"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20674"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2006.01150.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10615"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073812469294"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20986"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03053.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25244"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2007.02.005"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10480"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870100406"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000267425.51598.c9"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870100513"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870030302"},{"key":"e_1_2_7_19_1","volume-title":"How Does the Adult Kaiser Permanente Membership in Northern California Compare with the Larger Community?","author":"Gordon NP","year":"2006"},{"key":"e_1_2_7_20_1","first-page":"126","article-title":"Cancer registration: principles and methods","volume":"95","author":"Boyle P","year":"1991","journal-title":"Statistical methods for registries. IARC Sci"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.60.2.204"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.64.1.25"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt138"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007165307652"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007117424491"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.7189902"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0149-7634(86)90029-1"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100012270"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.196"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.135.3.349"},{"issue":"2","key":"e_1_2_7_31_1","first-page":"95","article-title":"Factors affecting the health\u2010related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections","volume":"22","author":"Slawek J","year":"2007","journal-title":"Function Neurol"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8619(08)80003-5"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NMD.0000081667.02656.21"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.63.1.110"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.44.11.2006"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2009.04.005"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8619(18)30187-7"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870130318"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-004-0291-9"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(200101)16:1<13::AID-MDS1016>3.0.CO;2-W"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.54.8.713"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.51.12.1512"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(200101)16:1<7::AID-MDS1005>3.0.CO;2-0"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nbd.2010.12.011"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.27927","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mds.27927","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.27927","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:24:48Z","timestamp":1760959488000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.27927"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,27]]},"references-count":43,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1002\/mds.27927"],"URL":"https:\/\/doi.org\/10.1002\/mds.27927","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"value":"0885-3185","type":"print"},{"value":"1531-8257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,27]]},"assertion":[{"value":"2019-07-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}