Lower limb post-immobilization dystonia in Parkinson's disease

Fixed dystonic posturing of the hands and feet may complicate advanced Parkinson's disease (PD) and add considerably to the functional disability of patients. We report 3 PD patients who developed lower limb fixed dystonic posturing after a brief period of immobilization (<2 months). Two patients had been immobilized after hip and back injuries and one for transfusion therapy for anemia. This fixed dystonic posturing resulted in severe functional disability. Oral medications failed to control symptoms. Of two patients who received botulinum toxin injections only one experienced benefit. Orthopedic surgery resulted in clinical improvement with increased mobility and independence in one patient. Post-immobilization dystonia of lower limbs in PD is resistant to medical treatment and leads to significant functional disability. Botulinum toxin may provide partial relief in some cases and orthopedic surgery can also be considered.