ABSTRACT
INTRODUCTION Discussion of nonmotor features in the fi eld of movement disorders has largely focused on Parkinson’s disease (PD). In PD nonmotor phenomena have been characterized in relationship to the time course of disease, and in some instances to its pathophysiology. These nonmotor features are common in PD and have a signifi - cant impact on quality of life (QoL). The presence of such symptoms as cognitive dysfunction, psychiatric symptoms (psychosis, depression, anxiety, apathy, and poor impulse control), sensory phenomena (pain, restless leg syndrome, and akathisia), fatigue, and autonomic dysfunction have been so important as to lead to the development of a nonmotor unifi ed PD rating scale. The occurrence of nonmotor features in dystonia is not as well established, and the body of research on this topic is limited. While both disorders are due to abnormalities in the basal ganglia, they differ in that PD is neurodegenerative while primary dystonia is not. This may explain, at least partially, why PD manifests such fl orid nonmotor phenomena by comparison. Nevertheless, in light of the widespread connections among basal ganglia, sensory cortex, thalamus, limbic structures, and brainstem, it would appear likely that primary dystonia could also manifest some nonmotor symptoms. This chapter will focus on nonmotor features associated with the primary dystonias and review fi ve areas: cognitive functioning, psychiatric symptoms, sleep disorders, pain, and somatosensory changes, and the nonmotor hallmark of dystonia, sensory tricks.
