Effect of Cervical Dystonia on Employment: A Retrospective Analysis of the Ability of Treatment to Restore Premorbid Employment Status

Using a structured interview method, we sought to address the following questions regarding cervical dystonia (CD) and employment: (1) what is the frequency and severity of job impairment in CD; (2) what are the clinical features that contribute to job impairment; (3) how does the effectiveness of botulinum toxin (BTx) compare to oral medications in restoring employment status. In our population of 155 CD patients, employment was affected by CD in 53.3% (31.2% reduced hours or responsibilities, 3.3% changed to different job, 18.9% loss of employment) and 68.9% of patients reported reduced overall productivity. The likelihood of altered employment (P < 0.0006), reduced productivity (P < 0.0001), and seeking disability benefits (P < 0.003) was significantly associated with the presence of neck pain, but not type of employment, spasmodic head motions, or duration of CD symptoms before treatment with BTx. Treatment with BTx was more likely to improve employment status than oral medications (66.1 vs. 18.5%) and much more likely to restore full employment with normal productivity (12.9 vs. 0.0%). These findings suggest that employment status is frequently affected by CD, particularly in patients with neck pain. BTx is significantly more effective than oral medications in restoring premorbid employment status. (C) 2009 Movement Disorder Society