Dyskinesia is uncontrolled, involuntary movement that may occur with long-term levodopa use and longer time with Parkinson’s. Not everyone will develop this complication, and the experience of dyskinesia varies. New and emerging treatments aim to help avoid dyskinesia.

Dyskinesia can affect one body part, such as an arm, leg or the head, or it can spread over the entire body. Dyskinesia can look like fidgeting, writhing, wriggling, head bobbing or body swaying. It doesn’t happen in everyone with Parkinson’s, and in those who do have it, it occurs to different degrees of severity. In some people, dyskinesia may be painful or bothersome to the point that it interferes with exercise, social life or other daily activities. Many people, though, say they prefer having dyskinesia to being rigid or less mobile due to Parkinson’s.

Dyskinesia tends to occur most often during times when other Parkinson’s symptoms, such as tremor, slowness and stiffness, are well controlled. (This is what doctors and researchers call “on” with dyskinesia.) Stress or excitement can exacerbate dyskinesia.

Causes of Dyskinesia

Dyskinesia typically occurs as a complication of long-term levodopa use. Additional factors that may contribute to dyskinesia include a younger age at diagnosis and the use of higher doses of levodopa for extended periods of time.

Exactly why dyskinesia develops is not well understood, but researchers believe different brain chemicals, such as serotonin, glutamate and dopamine, play a role. Fluctuating levels of dopamine in particular are thought to play a role. In Parkinson’s, the brain cells that make dopamine are lost, so dopamine levels decrease. Levodopa temporarily restores dopamine, but because it has to be taken several times per day, dopamine levels rise and fall. This, combined with progressive loss of the dopamine-producing brain cells, makes it impossible to keep a constant level of dopamine in the body and brain, and these fluctuations are believed to contribute to dyskinesia.

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Management of Dyskinesia

If you experience bothersome dyskinesia, you can discuss several treatment options with your personal physician:

  • Changing your levodopa dosage and/or how often it’s taken so you get enough in each dose to control your symptoms but not too much that it causes dyskinesia.
  • Switching to an extended-release formulation or continuous infusion of levodopa, which aims to keep the level of medication and therefore dopamine in your system more constant to control symptoms and limit dyskinesia.
  • Adding a medication called amantadine to target dyskinesia. Extended-release amantadine was approved to treat dyskinesia in August 2017. (Prior to that, an immediate-release formulation of amantadine, which still may be used in some cases, was available for many years.) Read more about amantadine, levodopa and other Parkinson’s medications.
  • Undergoing deep brain stimulation (DBS), a surgical procedure. This is not an option for everyone, but for those who’ve had Parkinson’s for at least four years, still benefit from medication, and have dyskinesia and motor fluctuations (significant “off” times, when medication is not working optimally to control symptoms), DBS may be a consideration.

Ongoing Research

Much research is ongoing to understand the mechanisms of dyskinesia better and to find new and better treatments. Several drugs in the pipeline are targeting different brain chemicals and pathways, and many are aiming to keep dopamine levels more constant. Several surgical trials also are ongoing — researchers are looking to optimise deep brain stimulation and evaluate a procedure called focused ultrasound.

Article Source: The Michael J. Fox Foundation for Parkinson’s Research

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