Dystonia and stereotypy due to levodopa in Parkinson disease

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Dystonia and stereotypy due to levodopa in Parkinson disease

This woman has advanced Parkinson disease and levodopa-related diphasic, dyskinesia-improvement-dyskinesia (D-I-D) pattern of dyskinesia. The dyskinesias are characterized mostly by right foot dystonia and rhythmic, stereotyped banging of the right arm. After taking levodopa, she experiences dyskinesias, which improve but then recur as the therapeutic effect of levodopa wears off. Dyskinesias recur again after taking the next dose of levodopa and abate while the therapeutic effect peaks. (Contributed by Dr. Joseph Jankovic.)