Parkinson’s Dystonia and Dyskinesia

Dystonia and dyskinesia are involuntary movement problems that can occur in people with Parkinson’s disease (PD). Below highlights the difference and treatments for each.

Dystonia 

Dystonia is a symptom of PD, but just because you have PD does not mean you will develop dystonia. Muscles experience a sustained contraction causing twisting and repetitive movements, or abnormal postures. These muscle contractions can involve the limbs, face, neck, eyelids, and vocal cords. One body part can be involved (focal dystonia), two or more adjacent areas in the body (segmental dystonia), or all areas of your body (general dystonia). Pain is often experienced.  

Treatments

Oral Medication: 

Anticholinergic medications (such as Artane/trihexyphenidyl or Cogentin/benztropine) and levodopa may be used to improve symptoms. Your medical doctor might trial levodopa to see if you have a “dopa-responsive dystonia.” 

Botulinum toxin injections

This helps the muscle(s) to relax, antispasticity drug. It is often used for the treatment of focal dystonia. 

Deep brain stimulation 

This is usually the treatment for general dystonia. This is a surgical treatment to reduce tremors and block involuntary movements like dystonia. 

Exercise and physical therapy

These services act to supplement and complement other interventions. Many people will report improvement in symptoms with exercise. I do recommend you seek a neuro-trained and/or PD-trained physical therapist as they are more familiar with treatment for dystonia. 

Additionally, a speech therapist can assist with dystonia that occurs in the face, neck, and vocal cords.     

Dyskinesia 

Dyskinesia is a side effect of long-term levodopa use a medication used to treat PD. It occurs in 30–40% of chronically treated PD patients. With dyskinesia, movements are more fluid and dance-like and can be jerky. It can involve the limbs, trunk, and face. Females are more likely to develop dyskinesia, with the proposed reason being hormone-related, and it is more likely with young-onset-Parkinson’s. 

Types of Dyskinesias 

Peak dose dyskinesia 

This is the most common kind of dyskinesia. These dyskinesias occur when the concentration of a person’s levodopa is at its highest, seen in the “on state” of medication, and often helps people's motor symptoms the most. This usually occurs one to two hours after someone takes their PD medication. 

Diphasic dyskinesia 

These dyskinesias occur when someone beings their “on state” of medication and again as they begin to experience wearing of their medication or the “off state” of medication. Diphasic dyskinesias are more likely to occur with relatively low doses of levodopa and long-term use of levodopa. 

Treatments

Adjusting your levodopa dosage and/or adding adjunctive dopaminergic therapies

This should be done with the supervision and guidance of your medical provider managing your PD and PD medication. Note, this might cause some of your motor symptoms to increase, which some people do not prefer.

Amantadine: 

This is an antidyskinetic medication and it can also help PD symptoms. More used for dyskinesia in advanced PD stages. Consult with your medical doctor if this could be right for you. 

Exercise, it’s neuroprotective!

To ensure less use of levodopa medication, exercise helps increase the effectiveness of the dopamine already in your body so you need less medication to achieve dopamine boosts.   

If you are unsure of how to exercise to help with dyskinesia or PD symptoms I recommend you work with a PD physical therapist. They can help you build a comprehensive exercise program to more specifically address your symptoms so that you can live well with PD.

Stress management is also helpful in the management of dystonia and dyskinesia as they can be triggered by mental or physical stress.