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Parkinson's Disease

Dystonia ?

04/07/1999

Question:

I have P.D. (dxd 2 years) and lately have been having more stiffness along with pain in the upper thigh when trying to walk . My question is , does this sound like dystonia ? It is difficult to walk or get in and out of a car because of the pain . If it might be dystonia ,is there anything that can bring relief ?

Answer:

Persons with PD often have cramping pains most often in the calf muscles when their medication begins to wear off. This phenomenon is called an "off dystonia". This form of dystonia tends to resolve once the medications "kick in" and the patient moves into the "on state." If you notice such a cycle with your pain, it is likely to be an off dystonia. The best management is to adjust your Parkinson`s meds so you have a smooth response through the day. This can be done by using SinemetCR, adding a dopamine agonist or using a COMT inhibitor. Pallidotomy, a form of surgery for PD can occasionally be of benefit as well.

However, there are other causes of pain such as you describe including herniated discs or nerve root impingement. You should see a neurologist for a complete evaluation.

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Response by:

Arif Dalvi, MD
Assistant Professor
College of Medicine
University of Cincinnati