Dystonia in parkinsons

len stevens · Mar 27, 2016

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Hi folks,
I recently had a 70 year old patient come in with Parkinson's. Her left foot was painful because her hallux was fixed in extension and the lesser toes were all splayed and clawed or hammered and in addition deviated either medially or laterally. I am a student on placement and I simply gave her toe props to alleviate the pressure on the lesser toes and referred her to an MSK specialist. I have looked for some papers on this subject but the only similar condition I can find is where this pattern occurs during waking but is relieved by rest which was not the case. Does anyone know of any research done on foot deformities in Parkinsons? I have looked in all the obvious places to no avail.
Cheers for reading.
Len

Admin2 · Mar 27, 2016

Related Topics:
Gait in Parkinsons Disease
Dystonia in a Runner
Focal Dystonia EHL and EDL
Parkinsons and forefoot pain

NewsBot · Apr 29, 2016

Botulinum toxin for foot dystonia in patients with Parkinson's disease having deep brain stimulation: A case series and a pilot study.
Gupta AD, Visvanathan R.
J Rehabil Med. 2016 Apr 28

BACKGROUND:
Six patients with Parkinson's disease with deep brain stimulation who were experiencing disabling foot dystonia were referred to the spasticity clinic for a trial of botulinum toxin. The foot and ankle muscles were injected with onabotulinum toxin (Botox) to determine the effects on foot dystonia, pain and lower limb functional outcomes.
DESIGN:
Case series.
SUBJECTS/PATIENTS:
Six patients with Parkinson's disease with deep brain stimulation experiencing disabling foot dystonia.
METHODS:
Dystonic foot and ankle muscles were identified and injected with 250-400 units botulinum toxin and re-coded pre- and 3 weeks post-injection with the Burke Fahn Marsden Dystonia score, visual analogue score of pain, Unified Parkinson's Disease Rating Scale (UPDRS) - lower limb score, Timed up and Go test (TUG), 6-Minute Walk Test (6MWT), gait velocity, cadence in an instrumented walkway, and Goal Attainment Scale (GAS).
RESULTS:
Three weeks after botulinum toxin injection, significant improvements were noted in dystonia, pain, UPDRS, 6MWT, gait velocity, and cadence. Five out of 6 patients improved on the TUG test. Patients also reported improvements in their GAS goals.
CONCLUSION:
Botox injection significantly improved foot dystonia, pain and lower limb functional outcomes in patients with Parkinson's disease with deep brain stimulation.
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NewsBot · Aug 22, 2016

Effect Of Novel Toe Stretcher Device On Foot Dystonia In Patients With Parkinson's Disease
Taylor, D.C.
MDS Abstract of the 16th International Congress of Parkinson's Disease and Movement Disorders, Volume 27,
June 2012 Abstract Supplement

Objective:
To evaluate whether an external stretching device will decrease the pain and foot and/or toe posturing that patients with foot dystonia associated with PD experience.
Background:
Foot and toe dystonia are experienced by many patients with PD. Although this dystonia is often responsive to levodopa, the short half-life of this medication leads to erratic control of this condition. Longer-lasting dopaminergic agents may not provide as much benefit as levodopa. Many patients limit daily activities due to the abnormal posturing of their feet. Use of an external toe stretching device has been effective in alleviating other foot problems and use of this device may reduce the dystonic posturing that patients experience.
Methods:
A total of 19 patients with PD were initially enrolled in this study. After being shown how to apply the toe stretching device, the patients were supplied with diaries and instructed to gradually titrate the length of time they wore the device. After 12 weeks, patients were re-evaluated and improvement in foot dystonia assessed. Any change in the amount of medication that patients were using was additionally assessed.
Results:
Several patients had difficulty applying the device or completing the diaries and withdrew from the study because of this issue. Of the seven (7) patients that were able to utilize the device and accurately complete the diaries, six (6) reported benefit in their symptoms. No adverse effects were reported from the use of this device.
Conclusions:
This pilot study suggests that an external toe stretching device may be beneficial for patients with PD who experience foot dystonia. Further study is suggested to confirm these findings.
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consumerep · Nov 28, 2016

I think I can reply to this one as up my alley! I have Botulinum toxin (Dysport) treatment due to Dystonia but not for lower limb, foot or toe. You can definitely have dystonic systems though due to Parkinson's (so secondary dystonia). However to rule out lower limb dystonia or focal dystonia it is best that patients are referred to a Neurological Movement Disorder specialist that has an interest in Dystonia . Many of them can administer botox injections but even if they do not they refer them on to clinic or to a specialist that does. In Australia at the moment Botulinum toxin for lower limb Dystonia is not funded under PBS so have to pay the full cost, however if treatment done at a hospital they may bear the cost. Refer to factsheet More about Parkinson's and Dystonia

NewsBot · Jul 21, 2019

Toe dystonia in Parkinson's disease: Impact of subthalamic nucleus deep brain stimulation.
Laurencin C et al
J Neurol Sci. 2018 Sep 15;392:65-68

BACKGROUND:
Off state toe dystonia (TD) is a symptom frequently encountered in Parkinson's disease (PD), but little is known about its evolution after subthalamic nucleus deep brain stimulation (STN-DBS).

OBJECTIVE:
To analyze the prevalence and the evolution of TD in PD patients candidate to STN-DBS.

METHODS:
Individual data of consecutive 130 PD patients who underwent STN-DBS between 2010 and 2015 were collected.

RESULTS:
Data were successfully collected in 95 patients. TD affect 45.3% of the patients in our cohort. TD was present in 32.7% of patients before surgery and was alleviated by STN-DBS in 48% of the cases. Motor improvement provided by STN-DBS, levodopa-equivalent treatment diminution after surgery, disease duration or age at the time of surgery were not predictive of TD evolution. A younger age at PD diagnosis was significantly associated with TD resolution.

CONCLUSION:
STN-DBS is partially efficient for TD but its evolution seems independent of significant predictive factors.
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NewsBot · Jan 19, 2024

Evaluation of therapeutic benefits of botulinum toxin for foot dystonia associated with Parkinson's disease
Ping Ni et al
Toxicon. 2023 Dec 22:238:107587

Background: Foot dystonia occurs in patients with Parkinson's disease (PD) and leads to pain, malformation, and difficulty with walking. Botulinum toxin injections may be effective for foot dystonia, but the extent of improvement and effects on motor function are unclear.

Methods: In this study, we performed botulinum toxin injections for foot dystonia in 25 patients with PD. At 3 weeks and 3 months post-infection, we assessed changes in plantar pressure distribution utilizing the Pressure Plate system; dystonia using the Modified Ashworth Spasm score; pain using the visual analog scale (VAS) score; and lower extremity function using the Calf-raise Senior (CRS) test, Timed Up and Go (TUG) test, and gait parameters (eg, stride length, step length).

Results: We found improved Modified Ashworth Spasm score (p < 0.01) and VAS score (p < 0.01) post-injection. CRS test score (3 weeks, p = 0.006; 3 months, p = 0.068), stride length (3 weeks, p = 0.012; 3 months, p = 0.715), and step length (3 weeks, p = 0.011; 3 months, p = 0.803) also improved. Plantar pressure distribution improved after botulinum toxin injection (metatarsal 1, 3 weeks, p = 0.031; 3 months, p = 0.144; metatarsal 2, 3 weeks, p = 0.049; 3 months, p = 0.065; metatarsal 3, 3 weeks, p = 0.002; 3 months, p = 0.017; metatarsal 4, 3 weeks, p = 0.017; 3 months, p = 0.144; medial heel, 3 weeks, p = 0.01; 3 months, p = 0.395; lateral heel, 3 weeks, p = 0.035; 3 months, p = 0.109).

Conclusion: Botulinum toxin injection for foot dystonia in patients with PD can reduce spasms and pain and normalize plantar pressure distribution, which improves balance and lower extremity function.
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len stevens Member

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consumerep Member

Attached Files:

fs43_musclecrampsanddystonia.pdf

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