The DOI matches its Crossref record; 78 of the 79 references it cites were found in a registry or an index.
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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“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 the citing paper
“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
In the citing paper
“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 the citing paper
“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 citing paper
“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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“Many patients with early onset Parkinson’s disease present with dystonia of one limb as the dominant clinical feature.(244,245) Imaging studies(114,115,246) and postmortem studies(247) also have revealed subtle abnormalities of dopamine systems in both inherited and sporadic primary dystonias.”
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“Dystonia also may occur in degenerative disorders that affect dopamine neurons, such as Parkinson's disease (Tolosa and Compta, 2006; Wickremaratchi et al., 2011).”
BackgroundDystonia and Parkinson's disease: What is the relationship?
Shetty, A. S., Bhatia, K. P., & Lang, A. E. (2019) · Neurobiology of Disease · doi:10.1016/j.nbd.2019.05.001 · Cited by 111
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Total hip replacement in patients with neurological conditions
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“, 2002); (2) other disease processes affecting DA, of which Parkinson's disease is the best example (Wagner et al., 1996; Tolosa and Compta, 2006); and (3) complications resulting from anti-DA therapies (Katzenschlager et al.”
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Riederer, P. F., Strobel, S., Nagatsu, T., Watanabe, H., Chen, X. M., Löschmann, P. A., Sian‐Hülsmann, J., Jost, W. H., Müller, T. H., Dijkstra, J. M., et al. (2025) · Journal of Neural Transmission · doi:10.1007/s00702-025-02893-4 · Cited by 96
“Diphasic dyskinesias (Tolosa and Compta 2006), which often occur when the pump is stopped at night, are another significant side effect (Marano et al. 2019).”
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“, blepharospasm and eyelid apraxia) and also following dopaminergic treatment or subthalamic nucleus stimulation.(5,6) Primary dystonia may be mistaken for PD mainly for two reasons.”
BackgroundPain in Parkinson's Disease: Pathophysiology, Classification and Treatment
Cattaneo, C., & Jost, W. H. (2023) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2205132 · Cited by 70
“One hypothesis is that the phenomenon of synaptic plasticity and dysregulation of neurotransmission, possibly associated with acetylcholine, are involved [50].”
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Wichmann, T. (2008) · Experimental Neurology · doi:10.1016/j.expneurol.2008.04.020 · Cited by 67
“For instance, it iswell known that dystonia occurs in many patients with Parkinson's disease (Tolosa and Compta, 2006), and that the gene defect causing ‘DOPA-responsive dystonia’ results in prominent Parkinsonism in some individuals (e.g., VanHove et al., 2006).”
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“The presence of (less prominent) LF oscillations in PD might be partially explained by the co-occurrence of dystonic symptoms that some PD patients experience (Tolosa and Compta, 2006).”
BackgroundBurrus, M. T., Werner, B. C., Cancienne, J. M., Gwathmey, F. W., & Brockmeier, S. F. (2015) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2015.05.048 · Cited by 65
“6times to 3-times higher than that of the general population.(1,11,20,24) Furthermore, patients with PD have a lower bone mineral density and are at a significantly increased risk for low-energy fractures.”
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Richter, F., & Richter, A. (2014) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2014.07.002 · Cited by 56
“Alterations of the dopaminergic system can result in dystonia symptoms or syndromes: (1) DOPA-responsive dystonia is caused by gene defects in enzymes of dopamine synthesis (Segawa, 2011), (2) dystonia can be caused by dopamine receptor blocking agents (Skidmore and Reich, 2005), (3) dystonia may occur as an early pre…”
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“Camptocormia in Parkinson’s disease [3] 19% (range, 0–33%)”
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Frucht, L., Perez, D. L., Callahan, J., MacLean, J., Song, P. C., Sharma, N., & Stephen, C. D. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2020.605262 · Cited by 58
“However, focal foot dystonia may occur as a secondary dystonia, such as in Parkinson’s disease, particularly in young onset cases (118).”
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Chronic Pain Treatment Strategies in Parkinson’s Disease
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“Given the heterogenous aetiology, there have been reports of varying responses to adjustment of dopaminergic therapy [64]; benzodiazepines, baclofen and lithium [65]; botulinum toxin to the rectus abdominis muscles (for presumed flexor dystonia) [63, 66] and stereotactic neurosurgery [67, 68].”
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“A less typical finding at presentation was dystonia (table 1).(10) Neither sex nor history of antipsychotic medication use appeared to affect the presence of motor symptoms.”
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“Dystonia may then present as axial dystonia and blepharospasm (levator inhibition) causing the starring expression associated with PSP; facial dystonia and antecollis-like postures inMSAor the dystonic arm posture seen in CBD. Parkinsonism and dystonia is also characteristic of genetic forms of parkinsonism, which oft…”
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“Further, comorbidity of dystonia with other diseases of the basal ganglia, such as Parkinson’s disease (Tolosa and Compta, 2006) and Huntington’s disease (Louis et al.”
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“Resistance training involved using weight machines or free weights.”
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“In these cases, the dystonic movements have an inconsistent response to levodopa [24].”
BackgroundSelf-citationStridor in Parkinson's disease: a case of ‘dry drowning’?
Gan, E. C., Lau, D. P. C., & Cheah, K. L. (2009) · The Journal of Laryngology & Otology · doi:10.1017/s0022215109992222 · Cited by 25
Animal models for drug discovery in dystonia
Jinnah, H. A., Richter, A., Mink, J. W., Caldwell, G. A., Caldwell, K. A., Gonzalez‐Alegre, P., Cookson, M., Breakefield, X. O., DeLong, M. R., & Hess, E. J. (2007) · Expert Opinion on Drug Discovery · doi:10.1517/17460441.3.1.83 · Cited by 25
“The dystonia in these models is analogous to that in some patients with early PD, or after chronic treatment [7,8] .”
BackgroundResultBotulinum toxin in movement disorders
Pandey, S., & Tater, P. (2018) · Neurology India · doi:10.4103/0028-3886.226441 · Cited by 24
Use of Botulinum Neurotoxin in Parkinson’s Disease: A Critical Appraisal
Jost, W. H. (2021) · Toxins · doi:10.3390/toxins13020087 · Cited by 24
“Dystonia is common in PD patients, especially in younger patients, occasionally as a primary symptom, more frequently as a motor complication of levodopa therapy [38,65].”
BackgroundInfluentialParkinsonism in Genetic Neurodevelopmental Disorders: A Systematic Review
von Scheibler, E. N. M. M., van Eeghen, A. M., de Koning, T. J., Kuijf, M. L., Zinkstok, J., Müller, A. R., van Amelsvoort, T., & Boot, E. (2022) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13577 · Cited by 26
“Many patients had co-existing neurologic disorders, of which dystonia, seizures, and ataxia were most common.(21,22) Although previous research has suggested that patients with neurodevelopmental disorders may be susceptible to druginduced parkinsonism,(14,23) drug-induced parkinsonism as the main cause was reported i…”
BackgroundDressler, D. W. (2011) · Handbook of clinical neurology · doi:10.1016/b978-0-444-52014-2.00038-0 · Cited by 23
Yoon, W. T. (2017) · Neurologia i Neurochirurgia Polska · doi:10.1016/j.pjnns.2017.11.004 · Cited by 23
“Rescue” of bilateral subthalamic stimulation by bilateral pallidal stimulation: case report
Matias, C. M., da Silva, D. R. P., Machado, A. G., & Cooper, S. E. (2015) · Journal of neurosurgery · doi:10.3171/2015.1.jns141604 · Cited by 22
“Our report describes a patient who experienced signifi - cant benefit for several years following STN DBS.”
InfluentialAngelopoulou, E., Bozi, M., Simitsi, A., Koros, C., Antonelou, R. C., Papagiannakis, N., Maniati, M., Poula, D., Stamelou, M., Vassilatis, D. K., et al. (2022) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2022.120405 · Cited by 22
Visual signs and symptoms of corticobasal degeneration
Armstrong, R. A. (2016) · Clinical and Experimental Optometry · doi:10.1111/cxo.12429 · Cited by 22
Dopamine Receptor Agonist Treatment of Idiopathic Dystonia: A Reappraisal in Humans and Mice
Fan, X., Donsante, Y., Jinnah, H. A., & Hess, E. J. (2018) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.117.246348 · Cited by 20
“Dystonia may also occur in degenerative disorders that affect dopamine neurons, such as Parkinson ’ s disease (Jankovic, 2005; Tolosa and Compta, 2006) or in response to dopamine receptor antagonists (Mehta et al., 2015).”
BackgroundSpanaki, C., Zafeiris, S., & Plaitakis, A. (2010) · Movement Disorders · doi:10.1002/mds.22988 · Cited by 19
Cell-intrinsic effects of TorsinA(ΔE) disrupt dopamine release in a mouse model of TOR1A dystonia
Downs, A. M., Fan, X., Kadakia, R. F., Donsante, Y., Jinnah, H. A., & Hess, E. J. (2021) · Neurobiology of Disease · doi:10.1016/j.nbd.2021.105369 · Cited by 17
Downs, A. M., Donsante, Y., Jinnah, H. A., & Hess, E. J. (2022) · Neurobiology of Disease · doi:10.1016/j.nbd.2022.105699 · Cited by 18
“Parkinson’s disease or typical antipsychotic treatment, and inherited dystonia (Ichinose and Nagatsu, 1999; Tolosa and Compta, 2006; Carbon et al., 2009; Berman et al., 2013; Rilstone et al., 2013; Ng et al., 2014; Mehta et al., 2015).”
Secondary Dystonia-Clinical Clues and Syndromic Associations
Schneider, S. A., & Bhatia, K. P. (2009) · Journal of Movement Disorders · doi:10.14802/jmd.09016 · Cited by 17
“While dystonia is uncommon in drug-naive patients with idiopathic Parkinson’s disease, its presence may be a red flag towards an atypical parkinsonian syndrome like PSP, multiple system atrophy (MSA) or corticobasal degeneration (CBD).(25) Dystonia may then present as axial dystonia and blepharospasm (levator inhibiti…”
BackgroundParkinsonism and multiple sclerosis—Is there association?
Barun, B., Brinar, V. V., Zadro, I., Lušić, I., Radović, D., & Habek, M. (2008) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2008.03.019 · Cited by 17
Treatment of Visual Disorders in Parkinson Disease
Savitt, J. M., & Mathews, M. K. (2018) · Current Treatment Options in Neurology · doi:10.1007/s11940-018-0519-0 · Cited by 16
Kim, J. J., Daadi, E. W., Oh, T. T., Daadi, E. S., & Daadi, M. M. (2022) · Genes · doi:10.3390/genes13111937 · Cited by 14
Wuqinxi Exercise Improves Hand Dexterity in Patients with Parkinson’s Disease
Wang, T., Xiao, G., Li, Z., Jie, K., Shen, M., Jiang, Y., Wang, Z., Shi, X., & Zhuang, J. (2020) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2020/8352176 · Cited by 15
“Deficits in hand dexterity may limit or restrict the individual’s capacity to complete basic life tasks, such as writing [39], personal hygiene [40], eating with chopsticks, and dressing.”
BackgroundRelative preservation of thalamic centromedian nucleus in parkinsonian patients with dystonia
Truong, L., Brooks, D., Amaral, F., Henderson, J. M., & Halliday, G. M. (2009) · Movement Disorders · doi:10.1002/mds.22747 · Cited by 14
“DOI: 10.1002/mds.22747 2128 difference between groups, P > 0.05) were selected from a regional brain donor program for PD. Written consent for autopsy was obtained in all cases and the project was approved by the Human Ethics Committees of South Eastern Sydney Area Health Service and the University of New South Wales…”
BackgroundInfluentialOlson, J. W., Nakhmani, A., Irwin, Z. T., Edwards, L. J., Gonzalez, C. L., Wade, M. H., Black, S. D., Awad, M. Z., Kuhman, D. J., Hurt, C. P., et al. (2022) · Movement Disorders · doi:10.1002/mds.29057 · Cited by 13
“Spectral power at rest and during contralateral hand and foot movements in patients with PD, with and without dystonia, was analyzed to test two primary hypotheses: (1) cortical and/or subcortical LFP spectral power differs between hand and foot movements in patients with PD (regardless of dystonia status); and (2) co…”
BackgroundResultStudy of the collagen type VI alpha 3 (COL6A3) gene in Parkinson’s disease
Jin, C., Zheng, R., Lin, Z., Xue, N., Chen, Y., Gao, T., Yan, Y., Fang, Y., Yan, Y., Yin, X., et al. (2021) · BMC Neurology · doi:10.1186/s12883-021-02215-7 · Cited by 12
Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter
Lefaucheur, J., Moro, E., Shirota, Y., Ugawa, Y., Grippe, T. C., Chen, R. E., Benninger, D. H., Jabbari, B., Attaripour, S., Hallett, M., et al. (2024) · Clinical Neurophysiology · doi:10.1016/j.clinph.2024.05.007 · Cited by 14
Long-term Outcome of Globus Pallidus Internus Stimulation for Pisa Syndrome
Anderson, B., Ziechmann, R., Huang, X., & McInerney, J. (2019) · Cureus · doi:10.7759/cureus.3838 · Cited by 12
Bannister, K., Smith, R. V., Wilkins, P., & Cummins, T. M. (2021) · npj Parkinson s Disease · doi:10.1038/s41531-021-00173-y · Cited by 12
Index Finger Pointing (Likely a Subtle Form of Hand Dystonia): Prevalence Across Movement Disorders
Vives‐Rodriguez, A., & Louis, E. D. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00542 · Cited by 12
“7% of patients with ET have been reported to have subtle features of dystonia (5).”
BackgroundParkinson’s disease and shoulder arthroplasty: a systematic review
Marigi, E. M., Shah, H. N., Sperling, J. W., Hassett, L. C., Schoch, B. S., Sánchez‐Sotelo, J., & Sperling, J. W. (2021) · JSES International · doi:10.1016/j.jseint.2021.11.004 · Cited by 10
Madeo, G., & Pisani, A. (2016) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-12-802206-1.00047-7 · Cited by 10
A novel diagnostic approach for patients with adult-onset dystonia
van Egmond, M. E., Lagrand, T. J., Lizaitiene, G., Smit, M., & Tijssen, M. A. J. (2022) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2021-328120 · Cited by 9
Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease—A Systematic Review
Jabbari, B., & Comtesse, S. M. (2023) · Toxins · doi:10.3390/toxins15020081 · Cited by 9
“PD related foot dystonia also can be kinesigenic or exercise induced [24].”
BackgroundCorrelation between head tremble and the severity of Parkinson’s disease
Yang, J., Guo, Q., Zou, X., Wang, M., Wen, Y., Chen, X., Weng, X., & Xu, F. (2021) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.13753 · Cited by 9
Morishita, T., Katayama, Y., Kobayashi, K., Oshima, H., Fukaya, C., & Yamamoto, T. (2008) · Neuromodulation Technology at the Neural Interface · doi:10.1111/j.1525-1403.2008.00153.x · Cited by 8
“Striatal deformities are atypical for dystonia and classified as one of the atypical dystonias in PD (3).”
BackgroundStereotypies after herpetic encephalitis with bitemporal lesions
Twardowschy, C. A., de Paola, L., Teive, H. A. G., & Silvado, C. E. (2010) · Movement Disorders · doi:10.1002/mds.22803 · Cited by 8
Kourtidou, E., Kasselimis, D. S., Potagas, C. M., Zalonis, I., & Evdokimidis, I. (2014) · Archives of Neuroscience · doi:10.5812/archneurosci.21087 · Cited by 8
Acute blepharospasm and torticollis associated with an ependymoma of the lateral ventricle
Lambrecq, V., Sibon, I., Loiseau, H., Jeannin, S., Dousset, V., Rotgé, J., Guehl, D., & Burbaud, P. (2010) · Movement Disorders · doi:10.1002/mds.22984 · Cited by 8
Essential tremor: tips and tricks
Lapeña-Motilva, J., Sánchez‐Ferro, Á., Méndez-Guerrero, A., Suárez, P. R., & Benito‐León, J. (2025) · Practical Neurology · doi:10.1136/pn-2024-004094 · Cited by 7
“43 Be aware that in cervical dystonia, there may not always be an abnormal head/neck posture, and up to 25% of patients may have upper limb tremor, which can further complicate the diagnosis.”
Metadata
- 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 › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Clinical 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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