The study by Djaldetti and colleagues 1 describes eight cases of camptocormia and raises the question of whether this syndrome is a form of dystonia. The following case illustrates that camptocormia may be a form of dystonia in Parkinson's disease (PD).
Case Report
This 75-year-old man developed symptomatic orthostatic hypotension, requiring fludrocortisone, followed 1 year later by the typical symptoms and signs of PD including akinesia, bradykinesia, resting tremor, rigidity, and the typical posture and gait. He was started on carbidopa/levodopa 50/200 mg/day without significant benefit. He reported the onset of involuntary, painless truncal flexions that began with the onset of the PD motor symptoms. These occurred only while standing, and lasted for variable periods of time but generally until the patient sat down. The patient had a seated blood pressure of 82/60 which dropped to 60/40 on standing. He was akinetic, bradykinetic, rigid, and had a typical PD rest tremor in both hands, one greater than the other. His gait was typically parkinsonian with a mild stoop and curvature to one side. Suddenly he bent at the waist so that his back was parallel to the ground. This posture resolved when he sat down.
Medications
Midodrine 5.0 mg tid, fludrocortisone 0.1 mg twice daily, and carbidopa/levodopa 50/200 mg/day were administered.
Discussion
This case is unusual for PD in that severe orthostatic hypotension was a presenting feature. However, all the cardinal features of PD were present in classical fashion. The lack of levodopa response probably represents too low of a dose used. Camptocormia occurred as a dystonic phenomenon unrelated to medications. This may be the first case of episodic camptocormia complicating PD, indicating that this is even rarer than the camptocormia described by Djaldetti and colleagues. 1 It does not answer the question, however, of whether sustained camptocormia is a form of dystonia in their PD patients.