Association of alcohol responsiveness and non-motor symptoms in isolated adult-onset dystonia.

Objective: About 30% of patients with isolated adult-onset dystonia report an improvement of their motor symptoms after the consumption of alcohol. In this cross-sectional study, we sought to investigate whether the observed improvement is attributable to the anxiolytic, euphoric, and analgesic properties of alcohol, rather than or in addition to its effect on dystonic movements, as psychiatric symptoms and pain frequently occur in dystonia patients and as emotional stress is a well-established trigger for symptom exacerbation.

Methods: We analyzed data from 339 prospectively enrolled participants with recently diagnosed isolated dystonia (mean age: 55.2 ± 12.5 years, 228 female) of the Natural History Project of the Dystonia Coalition, a large international multicenter study. Alcohol responsiveness was determined by patients´ self-report. Symptoms of depression, as well as generalized and social anxiety, were assessed using the Hospital Anxiety and Depression Scale and the Liebowitz Social Anxiety Scale. Severity of pain was measured using question 21 of the RAND 36-Item Health Survey.

Results: Participants with more severe pain reported greater response to alcohol than those with less severe pain (p = .004), whereas symptoms of depression (p = .986), generalized anxiety (p = .395) and social anxiety (p = .953) were not associated.

Conclusion: Alcohol responsiveness in isolated dystonia is associated with higher levels of pain, whereas self-reported alcohol-related improvements in dystonic movements or tremor do not depend on the euphoric or anxiolytic effects of alcohol. This finding underscores the potential role of pain management in alleviating motor symptoms in dystonia.