[Clinical characteristics of painful dystonic foot response in patients with Parkinson's disease].

We analyzed clinical characteristics of painful dystonic foot response (PDFR) which was observed in 7 patients with Parkinson's disease during levodopa therapy. PDFR was divided into 3 types, (1) early morning type (2) end of dose type (3) peak dose type, according to the serum levodopa concentration and clinical picture. Four patients showed different type of PDFR during observation. Provocative factors included stimulations to sole such as sacking or standing, abrupt change of mode of levodopa administration. Clonazepam ameliorated markedly the frequency and severity of PDFR in 3 out of 4 patients. Several trials to reduced fluctuation of the serum levodopa concentration such as fractionation into small doses and frequent administration, and to use of levodopa alone instead of dopa-decarboxylase inhibitor combined tablet, failed to show improvement and gave rather transient aggravation. For the control of PDFR most important thing was the reduction of dosage of levodopa. The efforts to avoid the above provocative factor are also needed. If the patient suffered from the frequent PDFR attack, the PDFR ameliorating drugs such as clonazepam would be useful.