Objective: To report 3 cases with cervical dystonia and dystonic hand tremor who developed Parkinson´s disease (PD) years to decades later and to discuss if dystonia represents disease onset of PD, an epiphenomenon of a common genetic background or if it’s a coincidence.

Results: Case Presentations:

– All of these cases presented with typical cervical dystonia with or without tremor of the hands and without parkinsonism or other neurological abnormalities at disease onset. – Over years or decades, they didn’t progress and were well treated with Botulinum Toxin

– After years of stable disease Levodopa responsive parkinsonism started to develop well in line with Parkinson’s disease

– Dystonia often occurs during the course of Parkinson’s disease but can also be observed as the presenting symptom in young onset PD. Nevertheless it is unusual for PD to start with cervical dystonia a decade before bradykinesia occurs. – These cases are somehow comparable to the SWEDDs patients. These patients often present with dystonic tremor and a negative DaTSCAN with a minority (12%) going to develop PD many years later. – A similar relation between Essential Tremor (ET) and PD has been described in the past with a 4 fold increased risk of ET patients to develop PD. These ET patients mainly had late onset asymmetrical postural tremor and might represent dystonic tremor. Recently an association between LINGO1 and both ET and PD was reported.

Conclusions: Hence we conclude that our small case series represent more likely an epiphenomenon of a common genetic background rather than a coincidence. Literature: Papapetropoulos S. et al. Parkinsonism and Related Disorders 12, 2006; 514–516. Batla A. et al. Movement Disorders, Vol 29, No 14, 2014; 1820-1825. Mia T. Minen et al. Brief Reports, Movement Disorders Vol 23, No 11, 2008, 1602-1612. Vilarino-Guell C., et al. Parkinsonism and Relat Disord 2010;16:109–111.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cervical-dystonia-preceding-parkinsons-disease-continuum-coincidence-or-epiphenomenon-report-of-3-cases/