An Empirical Comparison of Commonly Used Universal Rating Scales for Dystonia

Deniz Boz, Gamze Kilic-Berkmen, Joel S. Perlmutter, Scott A. Norris, Laura J. Wright, Christine Klein, Tobias Bäumer, Sebastian Löns, Jeanne S. Feuerstein, Abhimanyu Mahajan, Aparna Wagle-Shukla, Irene Malaty, Mark S. LeDoux, William Ondo, Alexander Pantelyat, Samuel Frank, Rachel Saunders-Pullman, H. A. Jinnah

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: There are several widely used clinical rating scales for documenting the severity and distribution of various types of dystonia. Objectives: The goal of this study was to evaluate the performance of the most commonly used scales in a large group of adults with the most common types of isolated dystonia. Methods: Global Dystonia Rating Scale (GDRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) scores were obtained for 3067 participants. Most had focal or segmental dystonia, with smaller numbers of multifocal or generalized dystonia. These scales were also compared for 209 adults with cervical dystonia that had Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores and 210 adults with blepharospasm that had Blepharospasm Severity Scale (BSRS) scores. Results: There were strong correlations between the GDRS and BFM total scores (r = 0.79) and moderate correlations for their sub scores (r > 0.5). Scores for both scales showed positive skew, with an overabundance of low scores. BFM sub-scores were not normally distributed, due to artifacts caused by the provoking factor. Relevant sub-scores of the GDRS and BFM also showed moderate correlations with the TWSTRS (r > 0.5) for cervical dystonia and the BSRS (r > 0.5) for blepharospasm. Conclusions: The BFM is more widely used than the GDRS, but these results suggest the GDRS may be preferable for focal and segmental dystonias. The overabundance of very low scores for both scales highlights challenges associated with discriminating very mild dystonia from other abnormal movements or variants of normal behavior.

Original languageEnglish (US)
Pages (from-to)1777-1786
Number of pages10
JournalMovement Disorders Clinical Practice
Issue number12
StatePublished - Dec 2023


  • Blepharospasm rating scale
  • Burke-Fahn-Marsden dystonia rating scale
  • Toronto Western torticollis rating scale
  • blepharospasm
  • cervical dystonia
  • global dystonia rating scale
  • laryngeal dystonia
  • rating scale
  • segmental dystonia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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