title: Bent knees and tiptoeing: late manifestations of end-stage Parkinson's disease.
abstract: We describe a unique gait phenomenon of bent knees in 9 patients with idiopathic Parkinson disease (mean age, 73.1 +/- 11.1 years), 3 of whom also manifested tiptoeing. The bent-knee posture appeared only during ambulation; in the recumbent position, full or nearly full extension was possible in all patients. The abnormality emerged after long-standing disease (6-23 years from onset) and failed to respond to dopaminergic treatment. Most of the patients also had bent spine (camptocormia). The pathogenesis of these phenomena are unknown, but they might represent a rare type of dystonia.
authors.affiliation: Department of Neurology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ruthdjal@clalit.org.il
authors.forename: Ruth
authors.initials: R
authors.lastname: Djaldetti
authors.forename: Mark
authors.initials: M
authors.lastname: Hellmann
authors.forename: Eldad
authors.initials: E
authors.lastname: Melamed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D018450:Disease Progression; D004421:Dystonia / Q000175:diagnosis*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007717:Knee; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000175:diagnosis*; D011187:Posture; D011379:Prognosis; D014034:Toes; D017211:Treatment Failure
chemical_list: D000978:Antiparkinson Agents