Rapid-onset dystonia parkinsonism (RDP), a rare neurological disorder, is caused by mutation of the neuron-specific ␣3-isoform of Na ؉ ,K ؉ -ATPase. Here, we present the functional consequences of RDP mutation D923N. Relative to the wild type, the mutant exhibits a remarkable ϳ200-fold reduction of Na ؉ affinity for activation of phosphorylation from ATP, reflecting a defective interaction of the E 1 form with intracellular Na ؉ . This is the largest effect on Na ؉ affinity reported so far for any Na ؉ ,K ؉ -ATPase mutant. D923N also affects the interaction with extracellular Na ؉ normally driving the E 1 P to E 2 P conformational transition backward. However, no impairment of K ؉ binding was observed for D923N, leading to the conclusion that Asp 923 is specifically associated with the third Na ؉ site that is selective toward Na ؉ . The crystal structure of the Na ؉ ,K ؉ -ATPase in E 2 form shows that Asp 923 is located in the cytoplasmic half of transmembrane helix M8 inside a putative transport channel, which is lined by residues from the transmembrane helices M5, M7, M8, and M10 and capped by the C terminus, recently found involved in recognition of the third Na ؉ ion. Structural modeling of the E 1 form of Na ؉ ,K ؉ -ATPase based on the Ca 2؉ -ATPase crystal structure is consistent with the hypothesis that Asp 923 contributes to a site binding the third Na ؉ ion. These results in conjunction with our previous findings with other RDP mutants suggest that a selective defect in the handling of Na ؉ may be a general feature of the RDP disorder.