Delays to the diagnosis of cervical dystonia

The diagnosis of cervical dystonia (CD) is based on physical examination and is therefore reliant on clinicianexperience. Due to variability of presenting symptoms it may be misdiagnosed, thus delaying theprovision of effective treatment. We sought to determine the average time taken to make a diagnosisof CD in our clinical cohort and explore contributing factors to diagnostic delay. Forty-nine patients witha diagnosis of CD attending a movement disorder specialist for treatment completed a questionnaireregarding symptoms and clinical interactions at onset and diagnosis. The mean time from symptom onsetto diagnosis was 6.8 years (range 0–53 years). More than 50% of patients sought physical therapies initially,prior to consulting their general practitioner. Only 40% of patients sought medical advice withinthe first 6 months of symptom onset and only 10% were given an initial diagnosis of CD. The first referralfrom the general practitioner was to a specialist other than a neurologist in 31% of patients. Patients wereseen by a mean of three doctors (range one to nine) before being given the correct diagnosis of CD. Delayto diagnosis of CD may in part be due to lack of awareness of the condition amongst health care professionals.Improved diagnostic skill appears likely to have had a substantial impact on the delivery ofappropriate treatment in this population