Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Dystonia and dyskinesia can both cause distress, and they are distinguished from each other based on their visible features. They can be managed with medication or surgery, typically with a moderate improvement of symptoms.
Verywell / Cindy Chung
While they can fluctuate in severity, the primary symptoms of PD tend to be present most of the time.
Dystonia and dyskinesia are recurrent, abrupt, and short-lived muscle movements. Not everyone who has PD experiences dystonia and dyskinesia. If they do, the symptoms they experience can be telling.
DystoniaProlonged, involuntary muscle contractionsAffects a specific muscle or group of musclesCauses abnormal posture or muscle spasmContorts part of the bodyCauses pain (sometimes debilitating)Tends to occur when effects of PD medication dipDyskinesiaInvoluntary, continuous muscle movementsAffects large muscle groups (arms, head, trunk, legs)Smooth, repetitive movement often described as a rolling or writing motionCan begin suddenly and stop after several minutesNot typically painfulMore likely to occur when PD medication effects are at their peak
DystoniaProlonged, involuntary muscle contractionsAffects a specific muscle or group of musclesCauses abnormal posture or muscle spasmContorts part of the bodyCauses pain (sometimes debilitating)Tends to occur when effects of PD medication dip
Prolonged, involuntary muscle contractions
Affects a specific muscle or group of muscles
Causes abnormal posture or muscle spasm
Contorts part of the body
Causes pain (sometimes debilitating)
Tends to occur when effects of PD medication dip
DyskinesiaInvoluntary, continuous muscle movementsAffects large muscle groups (arms, head, trunk, legs)Smooth, repetitive movement often described as a rolling or writing motionCan begin suddenly and stop after several minutesNot typically painfulMore likely to occur when PD medication effects are at their peak
Involuntary, continuous muscle movements
Affects large muscle groups (arms, head, trunk, legs)
Smooth, repetitive movement often described as a rolling or writing motion
Can begin suddenly and stop after several minutes
Not typically painful
More likely to occur when PD medication effects are at their peak
For example, dystonia can cause your toes to curl, making it difficult to walk. Or it may manifest primarily in your neck muscles, causing your head to turn painfully to one side.
With dyskinesia, you may experience a snakelike twisting of your arm or movements of your head and neck that appear like dancing in slow motion.
Being able to describe your symptoms to your medical team is important, especially when it comes to adjusting your medication dose. Consider keeping a symptom log to capture these important details.
Medication Side Effects
Treatment of PDincludes a number of medical and surgical approaches, including medications that replace the effects of dopamine, which are often described as dopaminergic medications.
Dyskinesia is considered to be a side effect of long-term use of dopamine replacement medications. The effect is often more prominent when dopaminergic medications like levodopa are at their peak concentration in the body.
Paradoxical Effects
The causes of dystonia and dyskinesia are not completely straightforward, however. Rarely, dystonia occurs as a medication side effect and dyskinesia occurs due to PD.
A phenomenon calleddiphasic dyskinesiacan occur right before the next PD medication dose is due—when the body’s concentration of PD medication is at its lowest.
Similarly, dystonia can occur as a side effect of dopaminergic medication. It is believed that long-term treatment can sometimes make the body less receptive to dopamine, possibly exacerbating the symptoms of PD.
The On-Off Phenomena of Parkinson’s Treatment
The diagnosis of dystonia and dyskinesia in PD is typically based on a visual assessment of the physical movements.
However, while some people who have PD can experience these effects several times per hour, you might not have them frequently, especially if they have just recently started. If this applies to you, you will have to describe your episodes in as much detail as possible to your medical team.
You may consider having a family member or friend videotape your episodes so that you can show them to your healthcare provider.
Differential Diagnoses
There are several conditions that have features similar to those ofdystonia and dyskinesia, and your medical team may mention them as possibilities. It is possible to experience another movement problem in addition to your dystonia or dyskinesia.
The management approaches used in the treatment of dystonia and dyskinesia are different. Because dystonia is usually considered an effect of PD, it is often treated with the same approaches that are usually used to reduce the other symptoms of the disease.
Treatment of dyskinesia is usually more complicated because the management of dyskinesia hinges on the very medications used to manage PD.
Often, and unfortunately, management of dystonia in PD worsens dyskinesia in PD.
Medications
Artane (trihexyphenidyl) is an anticholinergic medication that is commonly used to manage dystonia in PD. Muscle relaxers may be used as well, but they can result in side effects such as drowsiness, which should be considered.
Treatment of dyskinesia often relies on reducing the dose of the medications used to treat PD. Both, dyskinesia and dystonia can be treated with amantadine or amantadine ER.
Dystonia: Medical, Surgical, and Supportive Therapies
Surgery
Surgical approaches are often considered for the treatment of severe dystonia or dyskinesia that do not respond to medical therapy. Surgical options for both of these conditions include deep brain stimulation (DBS) with an implanted stimulator or lesional surgeries that physically cut a small area of the brain to reduce symptoms.
Surgical management of dyskinesia is aimed at reducing the need for dopaminergic medications or directly targeting the area of the brain believed to be responsible for the dyskinesia.
Surgical treatment of dystonia or dyskinesia requires extensive presurgical testing to ensure that implants and lesions will be effective and that they are placed optimally.
In addition to medical and surgical management of dystonia and dyskinesia, you may experience improved motor control and/or reduction of symptoms with physical therapy.
A Word From Verywell
Dystonia and dyskinesia in PD can be very troublesome. These involuntary movements are uncomfortable and may bring unwanted attention. Finding the right balance in the treatment of PD can be a trial-and-error process that requires delicate management. You may need to work closely with your medical team as the right approach for you is refined over time.
Dyskinesia Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Download PDF
Email AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Sign Up
Thank you, {{form.email}}, for signing up.
There was an error. Please try again.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi: 10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors.Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi: 10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease.Neurol Med Chir (Tokyo). 2019 Jun 21. doi: 10.2176/nmc.oa.2019-0040. [Epub ahead of print]Additional ReadingFactor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi:10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors. Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi:10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease. Neurol Med Chir (Tokyo). 2019 Jun 21. doi:10.2176/nmc.oa.2019-0040. [Epub ahead of print]
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi: 10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors.Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi: 10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease.Neurol Med Chir (Tokyo). 2019 Jun 21. doi: 10.2176/nmc.oa.2019-0040. [Epub ahead of print]Additional ReadingFactor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi:10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors. Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi:10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease. Neurol Med Chir (Tokyo). 2019 Jun 21. doi:10.2176/nmc.oa.2019-0040. [Epub ahead of print]
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi: 10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors.Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi: 10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease.Neurol Med Chir (Tokyo). 2019 Jun 21. doi: 10.2176/nmc.oa.2019-0040. [Epub ahead of print]
Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi: 10.1016/S1474-4422(19)30152-8. [Epub ahead of print]
Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors.Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi: 10.1097/WNF.0000000000000326.
Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease.Neurol Med Chir (Tokyo). 2019 Jun 21. doi: 10.2176/nmc.oa.2019-0040. [Epub ahead of print]
Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi:10.1016/S1474-4422(19)30152-8. [Epub ahead of print]Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors. Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi:10.1097/WNF.0000000000000326.Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease. Neurol Med Chir (Tokyo). 2019 Jun 21. doi:10.2176/nmc.oa.2019-0040. [Epub ahead of print]
Factor SA, Burkhard PR, Caroff S, Friedman JH, Marras C, Tinazzi M,et al.Recent developments in drug-induced movement disorders: a mixed picture.Lancet Neurol. 2019 Jul 3. pii: S1474-4422(19)30152-8. doi:10.1016/S1474-4422(19)30152-8. [Epub ahead of print]
Niemann N, Jankovic J.Real-World Experience With VMAT2 Inhibitors. Clin Neuropharmacol. 2019 Mar/Apr;42(2):37-41. doi:10.1097/WNF.0000000000000326.
Samura K, Miyagi Y, Kawaguchi M, Yoshida F, Okamoto T, Kawashima M.Predictive Factors of Antiparkinsonian Drug Reduction after Subthalamic Stimulation for Parkinson’s Disease. Neurol Med Chir (Tokyo). 2019 Jun 21. doi:10.2176/nmc.oa.2019-0040. [Epub ahead of print]
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
