Dystonia in parkinson's disease: Clinical and pharmacological features

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Abstract
We studied the features of dystonia in 9 patients with untreated idiopathic Parkinson's disease and in 56 patients on sustained treatment with L‐dopa. Dystonia was seen as an initial symptom in patients with both early‐ and late‐onset Parkinson's disease and included action dystonia of the limbs and cranial dystonia. Although the coexistence of parkinsonism and dystonia suggests a common pathophysiology, antiparkinsonian drugs did not consistently influence dystonic spasms. L‐dopa‐induced dystonia was seen as an off‐period, biphasic, or peak‐dose phenomenon. Each type showed a distinctive pattern of localization of dystonic spasms, possibly reflecting neurochemical aspects of basal ganglia somatotopy. Neuropharmacological studies performed in 12 patients suggest that off‐period dystonia is genuinely induced by L‐dopa and best relieved by antiparkinsonian agents.