Objective: To understand of the spectrum of focal task-specific lower limb dystonia only during walking stairs

Background: Focal task-specific dystonia in the lower limb or foot are occurred only during a specific activity or task, including walking, running, hiking or cycling. Several medication and botulinum toxin injection are effective in these patients.

Method: We performed multiple searches with some key words, using PubMed from 2005 to 2018. We gathered and reviewed all original articles and case reports. Our inclusion criteria were (1) lower limb dystonia causing foot, knee or hip abnormal posture (2) dystonia only during walking down/upstairs (3) dystonia involving only single lower limb. We excluded some patients with (1) abnormal movements in the other body parts, except one lower limb (2) dystonia, triggered by intense repetitive exercise, such as walking on the floor, running, or cycling, despite walking down/upstairs. Ten patients were in previous published 5 cases series and we added 5 new Asian patients (3 in Korea and 2 in Japan).

Results: Eleven (73%) of 15 patients were women. The mean age of initial diagnosis was 45.3 years (range 21-67), and age of onset was 40.9 years (range 20-56). According to their clinical findings, 8 patients (50%) had the Kicking type, including 2 patients with the rKicking type, 6 patients had the Lifting type, however one patient was not included in the two types. None were improved by any medication or botulinum toxin injection. After average 6.2 years (range 0.5-15) follows up period, all patients’ symptom was not aggravated or not improved.

Conclusion: We found that there were big two types (Lifting and Kicking type) in focal task-specific dystonia during walking stairs. This movement had two unique features, comparing with those associated with intense repetitive exercise. One is that none treatment is effective on this movement, and the other is that the course of this movement is always static without any improvement and aggravation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/task-specific-lower-limb-dystonia-only-during-walking-stairs/