Parkinson's Disease and Dystonia

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Senior woman in hospital or exam room holding head in pain

Painful muscle cramping and twisting, known as dystonia occurs in many people with Parkinson’s disease (PD). Dystonia can also develop in people without PD. Researchers have not pinpointed the relationship between dystonia and PD, but as many as one-third of people with PD will experience some type of dystonia, according to Britain’s Dystonia Society. If you experience foot cramps or other types of dystonia as a symptom of Parkinson’s disease, your doctor may be able to treat the spasms and improve your mobility.

Dystonia in Parkinson’s Disease

Dystonia refers to a condition in which the muscles repeatedly contract or twist involuntarily, leading to movement and postural abnormalities. Dystonia can affect a single muscle, a group of muscles, or the whole body. These symptoms can occur on their own or as a symptom of another disorder, such as Parkinson’s disease. Dystonia does not always indicate a person has PD, and not every person with Parkinson’s will experience dystonia.

When dystonia does occur in PD, it frequently affects the feet and toes. A significant portion of people with Parkinson’s disease awake with painful cramping in one or both feet. Dystonic Parkinson’s disease also can cause a rare condition called cervical dystonia (also known as spasmodic torticollis). Cervical dystonia causes involuntary muscle spasms in the neck that cause painful misalignment of the spine. Fortunately, the vast majority of people with PD will not develop this type of dystonia.

What Dystonia Looks Like in PD

The involuntary muscle movements of dystonia can be subtle or very noticeable. They may manifest as:

  • Blepharospasm (eyelid twitching), squinting or repeated blinking

  • Grimacing or repeated jaw clenching

  • Thin, hoarse or shaky voice

  • Twisting of the neck into an abnormal posture (cervical dystonia)

  • Twitching and cramping of the hands, fingers, feet or toes

If you experience symptoms of cervical dystonia, you should notify your doctor right away. Keeping a log of your dystonia symptoms can be helpful in finding the right treatment.

Treatment for Dystonia in Parkinson’s Disease

The exact relationship between PD and dystonia remains unknown, which makes treatment challenging. The Parkinson’s Foundation recommends tracking when dystonia symptoms occur in relation to taking levodopa, the most commonly prescribed medication for PD. If dystonia occurs when levodopa levels are low, such as upon waking in the morning, then your doctor may recommend adjusting the timing or dosage of your medication.

If dystonia occurs even when levodopa has achieved peak levels in your body, then your doctor may recommend injections of botulinum toxin to the affected muscles. Botulinum toxin relaxes muscles and makes it difficult for them to contract, even involuntarily. The injections are repeated every few weeks.

Deep brain stimulation (DBS) also has shown promise for relieving dystonia in Parkinson’s disease (and in people with dystonia not related to PD). However, sometimes DBS can trigger a dystonia, such as eyelid twitching, so this treatment usually is reserved as a last resort.

As a symptom of Parkinson’s disease, dystonia can inhibit you from pursuing physical activities you enjoy. But exercise and physical activity are powerful tools in managing PD. Work with your doctor to find medications that improve dystonia symptoms and keep you as mobile as possible. Staying active can help you maintain a high quality of life when living with PD.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Dec 18
  1. Parkinson’s Disease. MedlinePlus, U.S. National Library of
    Medicine. https://medlineplus.gov/parkinsonsdisease.html
  2. Dystonia and Parkinson’s Disease. The Dystonia
    Society. https://www.dystonia.org.uk/dystonia-and-parkinsons
  3. Dystonia. Parkinson’s Foundation. https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Movement-Symptoms/Dystonia
  4. Dystonias Information Page. U.S. National Institute of
    Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Dystonias-Information-Page
  5. Cervical Dystonia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cervical-dystonia/symptoms-causes/syc-20354123
  6. Shetty AS, Bhatia KP, Lang AE. Dystonia and Parkinson's
    disease: What is the relationship? Neurobiol Dis. 2019 May 9;132:104462. https://www.ncbi.nlm.nih.gov/pubmed/31078682











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