Objective: To report a case of focal, task-specific left leg dystonia who developed Parkinson’s disease (PD) two and half decades later.

Background: Dystonia in various regions of body is common after patients develop PD or Atypical Parkinsonism. Adult-onset cervical or lower-limb dystonia has been reported preceding PD or Atypical Parkinsonism. Time from dystonia onset to development of PD or Atypical Parkinsonism can vary and has been reported from less than a year to 20 years for cervical dystonia and 0.5 to 16 years for lower limb dystonia. We report a case of focal, task specific left leg dystonia who developed PD twenty five years after dystonia onset.

Method: Histor, serial exams, MRI, DaT scan.

Results: A 70 year old female who presented to Movement Disorders Clinic reporting difficulty walking involving her left leg starting in 1994. She described walking on uneven surface with left toe curling. She could march, run, walk backwards, and walk sideways just fine.  She noticed improvement in her gait when she applied pressure with her hand to her left thigh. Brain MRI in the past was normal. Physical Therapy helped her dystonia and gait. Recently she developed subtle resting tremors in her left hand. On most recent exam pt had mild left hand resting tremors, bradykinesia and rigidity, decreased arm swing bilateral, and dystonic posturing of left leg while walking. Pt denied any cognitive or autonomic symptoms, or falls. Recent DaT scan showed decreased tracer activity in the mid to distal aspect of the right-sided putamen. Pt reported benefit from trial of Carbidopa/Levodopa.

Conclusion: Interval between dystonia and onset of PD can vary from less than a year to two decades. Focal, task-specific leg dystonia can precede PD by as long as two and half decades. In our literature search our patient had longest interval between lower-limb dystonia and onset of PD.

References: References and Images to be provided during poster/platform presentation

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MDS Abstracts - https://www.mdsabstracts.org/abstract/focal-task-specific-left-leg-dystonia-preceding-parkinsons-disease-by-twenty-five-years/