Dystonia and parkinsonism

Parkinsonism and dystonia may coexist in a number of neurodegenerative, gen etic, toxic, and metabolic disorders and as a result of structural lesions in the basal ganglia. Parkinson's disease (PD) and the 'Parkinson-plus' syn dromes (PPS) account for the majority of patients with the parkinsonism-dys tonia combination. Dystonia, particularly when it involves the foot, may be the presenting sign of PD or PPS and these disorders should be suspected w hen adults present with isolated foot dystonia. Young age, female gender, a nd long disease duration are risk factors for PD-related dystonia, but dyst onia in patients with PD is usually related to levodopa therapy. The mechan ism of dystonia in PD is not well understood and the management is often ch allenging because levodopa and other dopaminergic agents may either improve or worsen dystonia. Other therapeutic strategies include oral medications (baclofen, anticholinergics and benzodiazepines), local injections of botul inum toxin, intrathecal baclofen, and surgical lesions or high frequency st imulation of the thalamus, globus pallidus, or subthalamus. (C) 2001 Elsevi er Science Ltd. All rights reserved.