• Evelien Zoons, Jan Booij, Catherine C S Delnooz, Joke M Dijk, Dreissen Yasmine E M YEM Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands., Koelman Johannes H T M JHTM Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands., van der Salm Sandra M A SMA Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. , Matej Skorvanek, Marenka Smit, Majid Aramideh, Henriette Bienfait, Boon Agnita J W AJW Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands., Jeroen W M Brans, Edo Hoogerwaard, Ad Hovestadt, Daan J Kamphuis, Alexander G Munts, Johannes D Speelman, and Tijssen Marina A J MAJ Department of Neurology, University Medical Center, Groningen, The Netherlands..
• Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
• J. Neurol. Neurosurg. Psychiatr. 2018 Jun 1; 89 (6): 579-585.

ObjectiveTrials for additional or alternative treatments for cervical dystonia (CD) are scarce since the introduction of botulinum neurotoxin (BoNT). We performed the first trial to investigate whether dystonic jerks/tremor in patients with CD respond to the selective serotonin reuptake inhibitor (SSRI) escitalopram.MethodsIn a randomised, double-blind, crossover trial, patients with CD received escitalopram and placebo for 6 weeks. Treatment with BoNT was continued, and scores on rating scales regarding dystonia, psychiatric symptoms and quality of life (QoL) were compared. Primary endpoint was the proportion of patients that improved at least one point on the Clinical Global Impression Scale for jerks/tremor scored by independent physicians with experience in movement disorders.ResultsFifty-threepatients were included. In the escitalopram period, 14/49 patients (29%) improved on severity of jerks/tremor versus 11/48 patients (23%) in the placebo period (P=0.77). There were no significant differences between baseline and after treatment with escitalopram or placebo on severity of dystonia or jerks/tremor. Psychiatric symptoms and QoL improved significantly in both periods compared with baseline. There were no significant differences between treatment with escitalopram and placebo for dystonia, psychiatric or QoL rating scales. During treatment with escitalopram, patients experienced slightly more adverse events, but no serious adverse events occurred.ConclusionIn this innovative trial, no add-on effect of escitalopram for treatment of CD with jerks was found on motor or psychiatric symptoms. However, we also did not find a reason to withhold patients treatment with SSRIs for depression and anxiety, which are common in dystonia.Trial Registration NumberNTR2178.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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