Focal Task-Specific Lower Limb Dystonia Only When Walking Stairs: Is It a New Disease Entity?

Takaomi Taira,Phil Hyu Lee,Jong Sam Baik,Hyeo-Il Ma

doi:10.3389/fneur.2019.01081

Abstract

Introduction: Focal task-specific dystonia in the lower limb or foot often occurs only during walking, running, hiking, or cycling. Several medications and botulinum toxin injection are effective in patients with this disorder. The objective of this study was to understand the spectrum of focal task-specific dystonia in the lower limb only when walking stairs and to compare other types of task-specific dystonia.Methods: All original articles and case reports were collected and reviewed using PubMed. In addition, all video clips of published cases were evaluated, and patients' clinical findings analyzed. The present study included 12 patients described in previous studies and five new Asian patients found in the medical records.Results: Most of the patients were women, and the onset age was 42 years. Ten patients were classified as the Kicking type, including three patients with the rKicking type, and six patients were considered as the Lifting type; however, only one patient was not included in any of the types. Symptoms in most of the patients did not improve with any medications or botulinum toxin injection. The symptoms of most patients did not change over a long time.Conclusion: Most patients showed the dystonic symptom when walking downstairs rather than upstairs. Psychogenic dystonia is a disease differentially diagnosed with this dystonia. Unlike other types of focal task-specific dystonia, the response to treatment was disappointing because most of the medications and botulinum toxin injection were not effective. The prognosis is completely different from that of other types of focal task-specific dystonia.

Highlights

Focal task-specific dystonia in the lower limb or foot often occurs only during walking, running, hiking, or cycling
Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both [1]
If patients have Focal task-specific dystonia (FTSD) in the lower limb or foot, they tend to complain of their symptoms occurring during walking, running, hiking, or cycling

Summary

Introduction

Focal task-specific dystonia in the lower limb or foot often occurs only during walking, running, hiking, or cycling. If patients have FTSD in the lower limb or foot, they tend to complain of their symptoms occurring during walking, running, hiking, or cycling. In addition to these intense repetitive exercises as triggering factors, in several recent case reports [5,6,7,8,9,10] and series [11], patients with unusual ambulatory characteristics as triggering factors, which occur only when walking stairs, have been reported. The authors of the present study recently encountered five patients with this unique triggering factor, and with the combination of previously reported cases, the spectrum of FTSD in the lower limb only when walking stairs was analyzed

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Discussion

Conclusion