Abstract
Objective: To investigate the prevalence of index finger pointing (IFP) while walking, which is likely a subtle form of hand dystonia, in cranio-cervical focal dystonia syndromes, Parkinson's disease (PD), essential tremor (ET), and controls.Methods: We recruited patients with an established diagnosis of PD, dystonia, or ET and healthy controls. All participants were videotaped while walking. Videotapes were evaluated by the authors, blinded to diagnosis, to assess the presence or absence of IFP.Results: Two-hundred-fifty participants included 50 dystonia, 50 PD, 80 ET and 70 controls. IFP was present in 29/250 (11.6%) participants: 10 dystonia (20.0%), 8 PD (16.0%), 8 ET (10.0%), and 3 controls (3.8%) (p = 0.03). There was a significant evidence of a trend in the odds of having this sign among disorders with higher risk of dystonic features (dystonia>PD>ET>control; test for trend = 0.004). Among the 180 patients (dystonia, PD, and ET, i.e., excluding the 70 controls), IFP was present in 26 (14.4% prevalence).Conclusion: IFP during gait, likely a subtle form of hand dystonia, was observed in 14.4% of movement disorder patients. The highest prevalence was in dystonia, the second highest in a disease that is often accompanied by dystonia (PD), a lower prevalence among individuals with a disease that is rarely accompanied by dystonia (ET), and the lowest in controls.
Highlights
Movement disorders, including Parkinson disease (PD), essential tremor (ET) and dystonia, are common conditions encountered in neurological practices
We aimed to investigate the prevalence of index finger pointing (IFP) during gait in patients with PD, cranio-cervical focal dystonia, ET and healthy controls
We decided to compare two different disease groupings: Group 1 (PD and dystonia, both of which are associated with basal ganglia dysfunction) vs. Group 2 (ET and healthy controls, neither of which are known to be associated with basal ganglia dysfunction)
Summary
Movement disorders, including Parkinson disease (PD), essential tremor (ET) and dystonia, are common conditions encountered in neurological practices. Their clinical presentation is often variable and complex. We observed that several patients with PD held one of their index fingers in a pointing position (i.e., pointing downwards) while walking. This is likely a subtle form of hand dystonia that has not been formally described and its prevalence is unknown among different movement disorders. We aimed to investigate the prevalence of index finger pointing (IFP) during gait in patients with PD, cranio-cervical focal dystonia, ET and healthy controls
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