Levodopa responsiveness in adult-onset lower limb dystonia is associated with the development of parkinson's disease

Florence C.F. Chang, Keith A. Josephs

Research output: Contribution to journalArticlepeer-review


ackground: Adult-onset primary lower limb dystonia (AOPLLD) has been reported as an early sign of Parkinson's disease (PD) or Parkinson-plus syndrome in case series. No prior systematic analysis has assessed clinical clues predicting later development of PD or Parkinson-plus syndrome. Methods: We identified patients with AOPLLD from medical records. We excluded patients who had not been diagnosed by a neurologist, and who had a pre-existing diagnosis of PD, psychogenic, or secondary dystonia. Records were subdivided into those who later developed PD or Parkinson-plus disorders and those who did not. The following clinical characteristics were compared between the two groups: dystonia onset age, type of dystonia, levodopa response, anticholinergic response, and family history of Parkinsonism or tremor. Results: Twenty-two AOPLLD patients were identified: 77% female; the median dystonia onset age was 53 years. Eight (37%) developed Parkinson's disease; 2 (9%) developed corticobasal syndrome. Twelve patients (54%) did not develop Parkinsonism after a median follow-up period of 1.5 years. There was a significant difference in leg dystonia levodopa response between the two groups (p = 0.02). Conclusion: In patients with AOPLLD, leg dystonia with levodopa response is associated with the future development of PD.

Original languageEnglish (US)
JournalProceedings of the Royal Society B: Biological Sciences
Issue number1760
StatePublished - Jun 7 2013


  • Dystonia
  • Leg dystonia
  • Levodopa
  • Parkinson's disease

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology
  • General Immunology and Microbiology
  • General Environmental Science
  • General Agricultural and Biological Sciences


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