An 11-year-old girl with a gait disturbance and foot dystonia, especially after exertion at the end of the day, and handwriting difficulty with cramps after a short school exercise, was evaluated at the Neuropaediatric Unit, CHUV, Lausanne, Switzerland. Her gait was better in the morning and after rest, but when lying down, her feet were inverted and plantar flexed in a dystonic posture. Treatment with L-dopa, 100 mg, and benzerazide 25 mg, 2 to 3 times a day, relieved all symptoms and signs, but dystonia returned when L-dopa was discontinued. The mother had parkinsonism relieved by L-dopa. [1]

COMMENT. Children presenting with dysgraphia, fatigue, and cramps should be examined for possible dopa responsive dystonia, especially if the symptoms are associated with a gait disturbance at the end of the school day.