Objective: To review dystonia as the presenting feature of Parkinson’s disease (PD).

Background: Dystonia in PD is most commonly described as a levodopa complication. It can also be a presenting feature, but although recognized in parkin PD this is not well-studied in PD in general.

Method: We identified English language publications using the terms “dystonia in PD,” “levodopa-induced dystonia,” “dystonia in young-onset PD,” and “autosomal recessive forms of PD” from PubMed, excluding atypical and secondary parkinsonism.

Results: We included 67 papers comprising 731 affected patients. Of these, 62 had autosomal recessive PD (mostly parkin) and 669 had IPD, with duration 0-28 years. Mean age was 61 years (34 papers), with male to female ratio 168: 147 (36 papers). 16% developed dystonia prior to PD diagnosis, with average time from diagnosis of dystonia to PD of 7.25 years. Foot dystonia was most common as a presenting feature, both in IPD and parkin PD. Standard PD and dystonia therapies were used to treat the dystonia, but foot dystonia was inconsistently levodopa responsive.

Conclusion: Dystonia as a presenting feature of PD occurred in approximately 16% of PD patients with dystonia in this systematic review.  We suggest the need for increased awareness of dystonia in PD to potentially make earlier diagnoses, and to identify an opportunity for improved treatment. Further studies are required to determine disease course in those who present with dystonia compared to other PD phenotypes.

References: Elia AA, Del Sorbo F, Romito LM et al. Isolated limb dystonia as presenting feature of parkin disease. J Neurol Neurosurgery Psychiatry. 2014; 85: 827 Tolosa E and Compta Y. Dystonia in Parkinson’s disease. Journal of Neurology. 2006; 253: Supplement 7

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MDS Abstracts - https://www.mdsabstracts.org/abstract/how-commonly-does-parkinsons-disease-present-with-dystonia/