July 28, 2026

@michaelokun

One of the talks that really made me think this morning at the Aspen Course was Jen Goldman's discussion of paroxysmal exercise-induced dystonia (PED). It was a great reminder that not every patient with exercise-triggered dystonia or dyskinesia has a primary paroxysmal dyskinesia syndrome. In some cases, these episodes may be an early clue to dopamine-responsive dystonia or even young-onset Parkinson's disease. Jen emphasized the importance of looking carefully at the family history, considering genetic causes such as GCH1 mutations, asking about associated restless legs syndrome, and remembering that many of these patients can respond dramatically to levodopa. The lesson for me was simple: when someone tells you their abnormal movements are consistently triggered by exercise, pause before assigning a diagnosis. These cases may be trying to tell us something much more important, and recognizing the pattern can lead to a highly effective treatment.