Acknowledgement
We would like to acknowledge use of information taken from The Parkinson’s Disease Society (UK) information sheet ‘Muscle Cramps and Dystonias '.
Although dystonia is a medical condition in its own right (known as primary dystonia), it can also be a symptom of several other diseases or syndromes (known as secondary or symptomatic dystonia), including Parkinson’s.
It can affect people of all ages, but for people with Parkinson’s, dystonia is more common when the onset of the disease was at a young age. It tends to develop gradually, and may worsen as the condition progresses. The side of the person where Parkinson’s symptoms are more pronounced is usually most affected. However, dystonia can be experienced in more than one part of the body. In fact, when the onset of Parkinson’s is after the age of around 40, dystonia usually remains focal, affecting a single area of the body. But when onset of Parkinson’s is young, dystonia is likely to affect a number of parts of the body, or become generalised (where most of the body is affected).
According to the National Institute of Neurological Disorders and Stroke (NINDS), most cases of primary dystonia cases are inherited in a dominant manner. This means if one parent has the dystonia gene, there is a 50% chance that the gene will be passed on to the child. However, not everyone who inherits the gene develops dystonia – a phenomena known as ‘penetrance’.
People with Parkinson’s mainly experience dystonia in their feet. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, and occasionally the big toe sticks up. This position, caused by spasms in the calf muscles, can be very uncomfortable and makes it hard to fit feet into tight shoes.
Sustained dystonic spasms cause varying degrees of pain, from mild to severe, and sometimes such spasms are mistaken for the muscle cramps that result from rigidity and bradykinesia in Parkinson’s.
Less commonly, dystonia may appear as:
Dystonia in Parkinson’s may be a symptom of the condition, but it can also be a side effect of the drug, levodopa. Levodopa-related dystonia tends to last longer than symptomatic dystonia and is very complicated. The wearing off side effects that some people experience with this drug (where the medication becomes less effective before the next dose is due) can cause off-dystonia. This is particularly common in the morning and many people find that when they wake they have difficulties getting out of bed until the next dose of medication starts to take effect.
On-dystonia can also occur when levodopa reaches its peak of effectiveness and there is too much dopamine in the brain, as this over-stimulates the muscles and causes spasms.
According to the Dystonia Society, there is a small chance of dystonia improving or disappearing spontaneously, with around 10 - 15% of patients experiencing temporary (or occasionally even permanent) “remission”. Why this happens, to whom it will happen, or when it will happen cannot be predicted.
Muscle cramps, which are common in Parkinson’s, are very different to dystonia. Rather than contracting muscles, cramps are caused by the muscular rigidity and reduced movement (bradykinesia). But, like dystonia, cramps can also be painful and very distressing. Normal painkillers do not usually relieve them, but muscle cramps often respond well to massage and the use of a hot water bottle or heated pad. Movement and exercise may also help to release cramps and reduce stiffness. If these methods do not help, then your doctor may prescribe muscle relaxants.
Term used to describe the gradual return of symptoms that occurs at the end of a dose of levodopa. This pattern appears when a person with Parkinson's disease has been using levodopa for many years.
The main type of drug prescribed to treat Parkinson's disease and has been in use since the late 1960s. The aim is to increase the levels of dopamine in the brain. Dopamine cannot be directly replaced because it cannot cross the blood-brain barrier that prevents potentially harmful substances in the blood from entering the brain. Levodopa is a chemical compound that can cross this barrier and is then converted into dopamine.
See also Types of medication available.
Dystonia that occurs as a symptom of other diseases or syndromes including Parkinson’s.
See section on Dystonia.
Medications used to treat muscular tension and pain.
Bradykinesia describes the slow execution of movement and impaired ability to adjust the body's position.
The word bradykinesia is derived from the Greek roots: bradys(slow) and kinesis(movement).
A neurotransmitter produced in the substantia nigra, which forms part of the basal gangia in the brain. It sends messages from the brain to other parts of the body and has a major role in the control of movement. There is a shortage of dopamine in the brains of people with Parkinson's disease.
Dystonia affecting only one part of the body such as the hands.
See section on Dystonia.
Stiffness of the limbs, joints or body that make movement and bending difficult.
