2019 Articles

Involuntary Thumb Flexion on Neurological Examination: An Unusual Form of Upper Limb Dystonia in the Faroe Islands

Kim, Christine Y.; Petersen, Maria Skaalum; Eliasen, Eina H.; Defazio, Giovanni; Greene, Paul; Jinnah, Hyder A.; Tijssen, Marina A. J.; Louis, Elan D.

Background: The prevalence of dystonia varies worldwide. A prior report suggested a high prevalence of focal dystonia in the Faroese population, possibly reflecting a founder effect. During standardized neurological examination as part of an ongoing neuroepidemiologic study in the Faroe Islands, we noted an unusual phenomenon of thumb flexion during repetitive hand movements in a subset of subjects and sought to define its phenomenology.

Methods: We requested commentary from a panel of dystonia experts regarding the phenomenology of the movements. These experts reviewed the videotaped neurological examination.

Results: Among the experts, dystonia was the leading diagnosis. Alternate causes were considered, but deemed less likely.

Discussion: Diagnosis of dystonia requires careful clinical assessment and consideration of associated features. We report a novel form of dystonia, not previously described to our knowledge, in this isolated population. Further studies of dystonia prevalence in the Faroe Islands are merited to characterize its burden in this population and its specific clinical characteristics.

Keywords: Dystonia, focal dystonia, Faroe Islands, thumb flexion, phenomenology