Dystonia versus dyskinesia in Parkinson's disease

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Dystonia and dyskinesia are movement problems that commonly occur with Parkinson's disease (PD) . You may experience one or both, especially in the advanced stages of Parkinson's disease. Dystonia is muscle stiffness caused by PD, while dyskinesia is a type of muscle torsion caused by certain PD medications.

Dystonia and dyskinesia can be distressing and can be distinguished from each other by their visible features. They can be treated with medicine or surgery, usually with a slight improvement in symptoms.

Get Medical Information / Cindy Chang

Symptoms

PD is characterized by four main symptoms:

  • Resting tremor
  • Bradykinesia (slow motion)
  • Postural instability (instability and tendency to fall)
  • Stiffness (muscle stiffness)

Although they can vary in severity, the main symptoms of PD tend to be present most of the time.

Dystonia and dyskinesia are short, jerky, repetitive muscle movements. Not all people with PD have dystonia and dyskinesia. If they do, then the symptoms they are experiencing may indicate it.

Dystonia

  • Prolonged involuntary muscle contractions.

  • It targets a specific muscle or muscle group.

  • Causes poor posture or muscle spasms

  • Distorts a part of the body

  • Painful (sometimes debilitating)

  • It usually occurs when the effects of PD medications are reduced.

Dyskinesia

  • Involuntary continuous muscle movements

  • It affects large groups of muscles (arms, head, trunk, legs).

  • A smooth, repetitive movement, often described as rolling or writing.

  • It can start suddenly and stop after a few minutes.

  • It is usually not painful

  • This is more likely to happen when the effects of PD medications peak.

For example, dystonia causes the toes to bend, making it difficult to walk. Or it can manifest itself mainly in the neck muscles, causing a painful head turning to one side.

With dyskinesia, you may experience snake-like arm twisting or head and neck movements that resemble a slow-motion dance.

It is very important to be able to describe your symptoms to medical staff, especially when it comes to adjusting your medication dose. Consider keeping a symptom log to record these important details.

Causes

Parkinson's disease is caused by the decreased action of dopamine, a neurotransmitter that helps mediate voluntary muscle movement. PD is also associated with brain degeneration. These factors are considered the main cause of all PD symptoms, including dystonia.

Side effects of medications

Treatment of PD involves a number of medical and surgical approaches, including drugs that replace the effects of dopamine, often referred to as dopaminergic drugs .

Dyskinesia is considered a side effect of long-term use of dopamine replacement drugs. The effect is usually more pronounced when dopaminergic drugs such as levodopa are at their highest concentration in the body.

Paradoxical effects

However, the causes of dystonia and dyskinesia are not entirely unequivocal. Rarely, dystonia occurs as a side effect of medications, and dyskinesia occurs due to Parkinson's disease.

A phenomenon called biphasic dyskinesia can occur just before the next dose of PD medicine is given, when the concentration of PD medicine in the body is at its lowest level.

Also, dystonia can occur as a side effect of dopamine drugs. It is believed that long-term treatment can sometimes make the body less responsive to dopamine, which can make the symptoms of Parkinson's disease worse.

Diagnostics

The diagnosis of dystonia and dyskinesia in PD is usually based on visual evaluation of physical movement.

However, although some people with PD may experience these effects several times an hour, you may not have them often, especially if they started recently. If this applies to you, you should describe your episodes to your healthcare team in as much detail as possible.

You can ask a family member or friend to record your episodes so you can show them to your doctor.

Differential diagnosis

There are several conditions that have symptoms similar to dystonia and dyskinesia that your healthcare team may mention as possible. In addition to dystonia or dyskinesia, you may experience other movement problems.

  • Tardive dyskinesia (TD) : This is a type of involuntary movement that is usually characterized by repetitive movements of the mouth, tongue, eyelids, or face. This can occur as a side effect of antipsychotic medications. Antipsychotic medications generally reduce excessive exposure to dopamine in the brain. Ingrezza (valbenazine) is a drug approved for the treatment of TD, but not approved for the treatment of dystonia or dyskinesia .
  • Dystonic reaction : This is a sudden and prolonged muscle spasm that usually requires treatment with muscle relaxants. It can occur in response to Raglan (metoclopramide) , a drug that counteracts the effects of dopamine and is used to treat gastrointestinal conditions.

Watch out

The approaches to treating dystonia and dyskinesia are different. Because dystonia is commonly thought to be due to Parkinson's disease, it is often treated with the same approaches that are commonly used to reduce other symptoms of the disease.

Treatment of dyskinesia is often more difficult because the treatment of dyskinesia depends on the drugs used to treat PD.

Unfortunately, treating dystonia in PD often exacerbates dyskinesia in PD.

Medicines

Artan (trihexyphenidyl) is an anticholinergic drug that is commonly used to treat dystonia in PD. Muscle relaxants can also be used, but they can cause side effects like drowsiness that should be taken into account.

Treatment for dyskinesia is often based on reducing the dose of the medications used to treat PD.

Operation

Surgical approaches are often considered for the treatment of severe dystonia or dyskinesia that does not respond to drug therapy. Surgical options for both conditions include deep brain stimulation (DBS) with an implanted stimulator or surgery on injuries that physically cut a small area of the brain to relieve symptoms.

Surgical treatment for dyskinesia aims to reduce the need for dopaminergic drugs or to directly target the area of the brain that is believed to be responsible for dyskinesia.

Surgical treatment of dystonia or dyskinesia requires extensive preoperative testing to ensure that implants and injuries will be effective and optimally placed.

In addition to medical and surgical treatments for dystonia and dyskinesia, you may experience better motor control and / or symptom relief with physical therapy.

Get the word of drug information

Dystonia and dyskinesia in PD can be very unpleasant. These involuntary movements cause discomfort and can attract unwanted attention. Finding the right balance in treating PD can be a trial and error process that requires delicate handling. You may need to work closely with your healthcare team, as the approach that is right for you will improve over time.

Guidelines for Discussion with a Dyskinesia Physician

Get our printable guide to your next doctor's appointment to help you ask the right questions.

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