Objective: To describe the occurence of parkinsonism after longstanding dystonia in a cohort of patients followed for long periods in our botulinum toxin injection clinic.

Background: Dystonia occurring in the context of parkinsonism is well-known, e.g. as foot dystonia in young-onset Parkinson’s disease (PD), anterocollis in multisystem atrophy (MSA) or blepharospasm in progressive supranuclear palsy.  We have, however, encountered a series of patients whose phenotype differed from the above described entities.

Method: We describe a cohort of patients in whom typical isolated cervical or craniocervical dystonia preceded the development of parkinsonism, sometimes by decades.

Results: In a cohort of 450 patients followed in our botulinum toxin injections clinic for treatment of isolated dystonia, we identified 11 (7 women) who developed parkinsonism at a median of 14 years after the onset of dystonia. Median age at onset of parkinsonism was 70 years (range 59-87), manifesting with a new tremor or a change of tremor pattern, complaints of ‘slowing down’ or new walking difficulties. Parkinsonism resembled PD in 5 cases (one pathologically confirmed); the remainder had atypical parkinsonism of MSA (n=3) or indeterminate phenotype (n=3).

Conclusion: The relatively frequent occurrence of parkinsonism after longstanding dystonia would suggest a link between the two, in line with supporting evidence from other clinical reports, imaging studies, animal models and genetics. Longstanding dystonia could be part of the parkinsonian syndrome, or it may be a risk factor for parkinsonism. In practice, it is important to be alert to new symptoms in patients with longstanding dystonia. From a research point of view, longitudinal case-control studies would be required to further investigate the link between longstanding dystonia and subsequent parkinsonism.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/longstanding-cervical-dystonia-followed-by-parkinsonism-coincidence-risk-factor-or-syndromic-association/