More than 30% of people with Parkinson’s disease (PD) may experience dystonia, a movement disorder characterized by abnormal postures, rigid twisting, turning, and/or clenching (e.g., toe curling or leg cramps) (Shetty et al, 2019). Individuals may experience these symptoms in various parts of the body, including (Parkinson’s Foundation, n.d.):

  • shoulders, arms, hands, and feet
  • neck (when this part of the body is affected, it is called cervical dystonia or spasmodic torticollis)
  • muscles around the eyes and face
  • jaw and vocal folds (this may result in vocal changes, including hoarseness or a soft voice)
  • muscles in the abdomen

Many Parkinson’s disease symptoms tend to be asymmetric (occurring more on one side of the body than the other). Similarly, dystonia is also more commonly observed on the side of the body that is impacted by the symptoms of PD (Parkinson’s Foundation, n.d.). Depending on its severity, dystonia may be painful.

 

Causes of Dystonia

Dystonia may occur as a result of abnormal muscle contractions related to a dysfunction in the region of the brain affected by PD, called the basal ganglia. It may also occur as a complication of antiparkinsonian medication.

“Off” periods, when medication begins to wear off, may trigger an episode of dystonia known as “off” dystonia. For many, this may occur in the morning if the last dose of levodopa was taken before bed the previous evening. “Off” dystonia tends to be painful and most frequently affects the feet (Shetty et al, 2019).

In contrast, dystonia may also happen during periods when levodopa has recently been taken and muscle spasms occur as a result of too much dopamine in the brain at one time, referred to as “on” dystonia. “On” dystonia tends to affect the neck, face, and upper limbs (Shetty et al, 2019).

Dystonia appears to be more common in individuals whose PD symptoms appear before the age of 40, and can manifest nearly ten years before the onset of other clinical symptoms associated with Parkinson’s (Shetty et al, 2019). However, it is not limited to those diagnosed with Young Onset Parkinson’s Disease (YOPD) — dystonia can also occur in advanced stages of the illness (Parkinson’s Foundation, n.d.).

 

Treating Dystonia

Knowing what is causing your dystonia is the first step in treating it. If your dystonia is affected by your PD medications, your doctor may be able to work with you to minimize these side effects by modifying doses of levodopa, such as by adding a long-acting formulation before sleep, or by increasing the total number of daily doses (American Parkinson’s Disease Association, 2018).

Additional management options may include:

  • therapies such as yoga, tai chi, qi gong, and meditation
  • physical therapy
  • taking muscle relaxants or antispastic agents
  • botulinum toxin injections (i.e., Botox, Xeomin, Dysport), which will help weaken the affected muscles
  • Deep Brain Stimulation surgery

The above information is for general knowledge and should not guide specific individual treatment.

Speak to your neurologist or physician about what treatment is appropriate for you.

 

Sources

Ahlskog, J. E. (2015). The New Parkinson’s Treatment Book: Partnering with Your Doctor to Get the Most from Your Medications, Second Edition. New York, NY: Oxford University Press.

American Parkinson’s Disease Association (13 November, 2018). What is dystonia and how does it relate to Parkinson’s disease? www.apdaparkinson.org/article/dystonia-and-parkinsons

Christensen, Jackie Hunt. (2005). The First Year of Parkinson’s Disease: An Essential Guide for the Newly Diagnosed. New York, NY: Marlowe & Company

Parkinson’s Foundation (n.d.). Dystonia in PD. www.parkinson.org/library/fact-sheets/dystonia

Parkinson’s UK. Muscle Cramps and Dystonia. www.parkinsons.org.uk/information-and-support/muscle-cramps-and-dystoniapulsivity

Shetty, A. S., Bhatia, K.P, & Lang, A. E. (2019). Dystonia and Parkinson’s disease: What is the relationship? Neurobiology of Disease, 132. https://doi.org/10.1016/j.nbd.2019.05.001.

Wile, Daryl (2018). Personal communication.


Last updated: August 30, 2023