Focal Dystonia in a Patient With Young-Onset Parkinsonism: A Diagnostic Challenge

Oropharyngeal dystonia (OPD) is a form of focal dystonia characterized by involuntary movements that affect the facial, labial, and tongue muscles. OPD is frequently underrecognized and underdiagnosed, despite its relatively high prevalence among individuals with Parkinson's disease (PD), including during the early stages of the disease. Limited awareness among both patients and healthcare providers can contribute to delays in diagnosis. We present the case of a 45-year-old Emirati male who presented with left-sided resting tremors followed by progressive tongue dystonia over four months. Clinical and radiological examination revealed him to have early-onset clinically established PD based on the Movement Disorder Society Clinical Diagnostic Criteria 2015. The patient was initiated on dopaminergic therapy, resulting in significant symptom improvement. Early recognition and timely intervention are essential, as they can substantially mitigate morbidity and enhance quality of life. This report examines the characteristics of dystonia, including its prevalence, etiologies, and clinical presentation within the context of early-onset PD, and outlines a tailored strategy to facilitate early diagnosis. The case highlights the importance of recognizing atypical features such as OPD in early-onset PD, which may present diagnostic challenges but respond well to timely treatment.