Dystonia in Parkinson’s disease
Abstract
Dystonia can occasionally be found in idiopathic Parkinson's disease. It is very uncommon in untreated patients and is more frequently seen as a complication of its treatment. In this review, the various types of dystonia occurring in PD, the differential diagnosis with other parkinsonian syndromes associated with dystonia and treatments available are revised. Dystonia unrelated to treatment can be typical (blepharospasm, torticollis), atypical (parkinsonian writer's cramp, camptocormia, anismus), or occurring in earlyonset Parkinson disease (the so-called kinesigenic foot dystonia, considered a hallmark of early-onset Parkinson's disease). Early and prominent dystonia in untreated patients with parkinsonism should raise the suspicion of other entities other than Parkinson's disease, such as progressive supranuclear palsy, multiple system atrophy or corticobasal degeneration. In patients on chronic dopaminergic treatment, peak-dose dystonia, diphasic dystonia and off-dystonia can be seen. The later constitutes the major dystonic feature of chronic levodopa therapy, and a wide variety of strategies are available to manage this complication. Among them, deep brain stimulation of the subthalamic nucleus has proved to be the most effective one. Dystonic reactions (mainly involving oculomotor cranial nerves and limbs) in operated patients (especially carriers of deep brain stimulation (DBS) devices) are increasingly being reported, constituting a new type of dystonia in patients with Parkinson's disease: dystonia linked to surgical treatment.
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Typical prediagnostic dystonias in Parkinson's disease include unilateral equinovarus foot position, upper arm-forearm or forearm-hand flexion, writer's cramp, oro-mandibular dystonia, torticollis or combinations.
“The typical prediagnostic dystonias include unilateral equinovarus foot position, upper arm-forearm or forearmhand flexion, writer's cramp, oro-mandibular dystonia, torticollis or different combinations of these symptoms (Tolosa and Compta 2006).”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Tolosa and Compta 2006
In medically treated Parkinson's disease, dystonia along with dyskinesias constitutes one of the main motor complications related to chronic therapy, usually occurring as an off-period phenomenon, but can present as peak dose dystonia or diphasic dystonia.
“In medically treated PD, dystonia, along with dyskinesias, constitutes one of the main motor complications related to chronic therapy, usually occurring as an off-period phenomenon, but can present as peak dose dystonia or diphasic dystonia (Tolosa and Compta 2006).”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Tolosa and Compta 2006
Dystonia may rarely be a prediagnostic symptom in Parkinson's disease.
“This may rarely be a prediagnostic symptom in PD (Tolosa and Compta 2006)”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Tolosa and Compta 2006
In young onset familial Parkinson's disease, dystonia typically involves the foot with cramp-like discomfort or inversion of the affected foot.
“In young onset familial PD, dystonia typically involves the foot with cramp-like discomfort or inversion of the affected foot (Tolosa and Compta 2006).”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Tolosa and Compta 2006
In the majority of cases, Parkinson's disease symptoms appear within 10 years from onset of dystonia.
“In the majority of cases, the PD symptoms appear within 10 years from onset of the dystonia.”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Tolosa and Compta 2006
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- Authors
- Tolosa, E., & Compta, Y.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Tolosa, Eduardo
- Venue
- Journal of Neurology
- Published
- 2006-12
- Volume
- 253
- Issue
- S7
- Pages
- vii7-vii13
- ISSN
- 0012-1037 (ISSN-L)
- 0340-5354
- 1432-1459
- OpenAlex
- W2068778836
- Cited by
- 176
- References
- 79
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 10 · 2023: 7 · 2022: 14 · 2021: 13 · 2020: 7 · 2019: 13 · 2018: 12 · 2017: 8 · 2016: 12 · 2015: 9 · 2014: 7 · 2013: 5 · 2012: 8
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
- Keywords
- dystonia, Parkinson's disease, levodopa therapy, subthalamic nucleus, early-onset Parkinson's disease, camptocormia, anismus, blepharospasm, torticollis, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, differential diagnosis
- MeSH terms
- Dystonia, Humans, Parkinson Disease
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