BRIEF RESEARCH REPORT article
Front. Neurosci.
Sec. Perception Science
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1599951
Neck and mind: Exploring emotion processing in cervical dystonia
Provisionally accepted
Federico Carbone1
Marina Peball1*
Philipp Ellmerer1
Beatrice Heim1
Wolfgang Nachbauer1
Elisabetta Indelicato1
Matthias Amprosi1
Philipp Mahlknecht1
Anna Hussl1Anna Hotter1Roberta Granata1Klaus Seppi1,2
Atbin Djamshidian1*
Sylvia Boesch1- 1Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- 2Bezirkskrankenhaus Kufstein, Kufstein, Tyrol, Austria
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Objective: A wide range of non-motor symptoms such as pain, mood disorders, insomnia, and executive dysfunction may occur in focal dystonia. Little is known, however, about emotional processing. We aim to assess emotion recognition and alexithymia in patients with cervical dystonia (CD) compared to healthy age-, sex-and education-matched controls (HC).Methods: Emotion processing was assessed with an eye-tracking paradigm using a validated dataset of facial expressions and the Toronto Alexithymia Scale (TAS-20). Dystonia severity and disability, cognition, and comorbid depression and anxiety were also assessed.We recruited 35 CD patients and 17 matched HC. In the eye-tracking task, CD patients recognized emotions less accurately than HCs (77.0% vs. 84.4%; p=0.001), primarily based on difficulties in identification of fear (p=0.003) and surprise (p=0.037). Moreover, patients had longer fixations within the mouth region (p=0.027) and left eye (p=0.037) than HC. CD patients also had significantly higher total TAS-20 scores (p=0.002) and subscores (difficulty identifying and describing feelings; all p≤0.026). Five patients (14.3%) reached the threshold for alexithymia and 6 (17.1%) for possible alexithymia. No HC scored positive for alexithymia and only 2 (11.8%) did for possible alexithymia. TAS-20 score correlated inversely with emotion recognition task performance (r=-0.411; p=0.014).We found poorer performance in emotion recognition in CD patients compared to HC. Together with a different gaze pattern and higher scores for alexithymia our results highlight deficits in emotion processing in CD.
Keywords: Cervical dystonia, eye-tracking technology, facial recognition, Emotions, Neuropsychological test
Received: 27 Mar 2025; Accepted: 05 May 2025.
Copyright: © 2025 Carbone, Peball, Ellmerer, Heim, Nachbauer, Indelicato, Amprosi, Mahlknecht, Hussl, Hotter, Granata, Seppi, Djamshidian and Boesch. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Marina Peball, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Atbin Djamshidian, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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