Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of Parkinson's disease presenting with unique dyspneic attacks caused by oromandibular dystonia and sleep apnea syndrome

Bunta Kato, M.D., Koji Yamada, M.D., Masahiro Horiuchi, M.D., Toshikazu Hirayama, M.D. and Yasuhiro Hasegawa, M.D.

Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine

A 79-year-old woman with a 4-year history of Parkinson's disease was admitted due to unique dyspneic attacks with cyanosis while eating. Dyspneic attacks with cyanosis occurred mainly during actions such as taking meals or rehabilitation. Due to increased tonus of the orbicularis oris muscle, she was unable to open her mouth and breathe out, and finally experienced hypoxemia as revealed by pulse oxymetry. Dystonic hypertonus was relieved by touching the mandible with the fingers, and she was able to open her mouth again. These symptom was compatible with the sensory trick. Based on these findings, we considered that dyspneic attacks were produced by focal oromandibular dystonia. Polysomnography also showed central sleep apnea. We report herein a rare case of Parkinson's disease presenting with respiratory insufficiency caused by focal dystonia and central sleep apnea.

(CLINICA NEUROL, 47: 577|580, 2007)
key words: Parkinson' disease, dystonia, dyspnea, sleep apnea syndrome

(Received: 3-Dec-06)