Camptocormia (dystonic) in Parkinson disease helped by botulinum toxin

This woman has Parkinson disease and dystonic camptocormia. Examination shows characteristic signs of Parkinson disease, including rigidity (not shown), bradykinesia, poverty of associated movements, en bloc turning in small steps, and stooped posture with flexed knees. She is unable to stand erect and has dystonic contraction of her abdominal muscles. She improves markedly after botulinum toxin injections into her rectus abdominus muscles bilaterally. Several months later, as the botulinum toxin loses its effect, she has to clasp her hands behind her to resist the dystonic contraction of her abdominal muscles. (Contributed by Dr. Joseph Jankovic.)