Objective: To describe characteristics of patients with secondary limb dystonia in Parkinson’s Disease, types of dystonia observed, and treatment/response with chemodenervation.

Background: Dystonia can be seen in up to 30% of patients with Parkinson’s Disease with a predilection for occurrence in up to 60% of patients that are considered to have young onset disease defined as having motor symptoms prior to 40 years of age. Limb dystonia, particularly foot dystonia, is often observed as the initial clinical manifestation for patients diagnosed with young onset Parkinson’s Disease prior to initiation of levodopa therapy.

Method: We performed a retrospective chart review of patients currently followed by movement disorders neurologists within the OHSU Neurotoxin Injection Clinic over the last one year with identification of gender, age of motor symptom onset, treatment modalities, type of neurotoxin used, response rate defined as greater than or equal to three visits allowing for first time injections with subsequent dose titration, and reasons for discontinuation of chemodenervation.

Results: 19 patients (11 females) with secondary limb dystonia were included. Mean age of PD motor symptom onset was 50 and mean age at time of diagnosis was 52. Foot dystonia was present in 18/19 patients. 2/19 elected to proceed with topical CBD treatment prior to neurotoxin injections. At time of study, 2/17 had just received their first injection. 12/15 remaining patients were deemed to be receiving benefit from chemodenervation based on an at least equal to or greater than 3 return visits conferring an 80% response rate. 3/15 did not continue injections after two visits given report of no benefit or response to alternate therapy.

Conclusion: This review demonstrates that focal chemodenervation is an effective therapy for secondary limb dystonia, particularly foot dystonia, in patients with Parkinson’s Disease. As limb dystonia tends to occur more often in younger PD patients, providers should be more cognizant to evaluate for this as well as offer treatment with chemodenervation given its high response rate with limited adverse effect profile. Within our population, one interesting finding was that several opted to either trial first or change to CBD therapy in lieu of neurotoxin injections. This concept may serve well for a future study evaluating efficacy of CBD in secondary limb dystonia in patients with Parkinson’s Disease.

References: 1. J.K. Sheffield, J. Jankovic, Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinson’s disease, Expert Rev.Neurother. 7 (6) (2007) 637–647.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-chemodenervation-for-secondary-limb-dystonia-in-parkinsons-disease-a-single-center-experience/