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Paroxysmal exercise-induced dystonia
Paroxysmal exercise-induced dystonia or PED is a rare neurological disorder characterized by sudden, transient, involuntary movements, often including repetitive twisting motions and painful posturing triggered by exercise or other physical exertion.〔Poon, Michael. ''Paroxysmal Dyskinesias.'' Shrine of Neurology. Nov. 2004 http://www.angelfire.com/retro/michaelpoon168/paroxysmal_dyskinesias.htm〕 PED is in the class of paroxysmal dyskinesia which are a group of rare movement disorders characterized by attacks of hyperkinesia with intact consciousness.〔Blueprints Neurology, 2nd ed.〕 The term paroxysmal indicates that the episodes are sudden and short lived and usually unpredicted, and return to normal is rapid.〔 The number of reported cases of people with PED is very small leading to difficulty in studying and classifying this disease and most studies are limited to a very small number of test subjects.
== Symptoms ==
Episodes are relatively short-lived, lasting anywhere from 5–30 minutes, and in most cases disappear completely after cessation of the physical exercise. Most patients will experience 1 to 5 episodes per month, but some can have attacks daily.〔 The muscles most often affected are usually in the legs and feet (75% of reported cases), but the upper body muscles such as the arms, face, neck, and trunk have also been observed to be affected during the episodes of dystonia.〔 .〕 Age of onset is usually sometime in childhood, but can range from 1–30 years old. In one study it was found that the mean age of onset was around 8 years. Similarly in the study, the legs were the most common affected part of the body and the attacks were reported as stiffening and cramps by those affected.During an episode of PED patients find walking nearly impossible.Cerebral spinal fluid (CSF) analysis showed a two-fold increase of homovanillic acid and 5-hydroxyindoleacetic acid immediately following exercise compared to normal levels. This indicated that increased dopaminergic transmission could contribute to PED and other paroxysmal dyskinesias. Neurological examinations, EEG, and brain imaging are all normal in PED patients.〔''Diagnosis and Treatment of Paroxysmal Dyskinesias Revisited: Paroxysmal Exercise-induced (Exertion-induced) Dyskinesia'' Medscape Today 2008 London. http://www.medscape.com/viewarticle/581684_5〕
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