Management of motor fluctuations and dyskinesia in Parkinson's disease

Levodopa-induced motor complications are extremely prevalent (affecting over half of all PD patients after 4-6 years of levodopa therapy), disabling, and one of the more challenging to treat of all PD symptoms. Motor fluctuations result in the re-appearance or a delay in relief of motor symptoms, following levodopa administration. Motor fluctuations occur more frequently as PD progresses and "on" periods (when motor symptoms are well-controlled) typically get shorter and "off" periods (when motor symptoms re-emerge) get longer. Levodopa-related dyskinesia can also be disturbing and disabling. There are two major types of dyskinesia - "peak dose" and "diphasic" - which are manifested by variable sequences of parkinsonism, symptom improvement, and dyskinesia. Treatment strategies for dyskinesia include adjustments in the timing and dose of levodopa, the use of amantadine (an agent with dopaminergic, NMDA receptor antagonist, norandrenergic and possibly anticholinergic activity) and deep brain stimulation surgery. Part of the Oxford American Pocket Notes series, this volume is designed for general neurologists who are often the first physicians to receive complaints of motor fluctuations and dyskinesia in PD patients. This pocket guide serves as an invaluable resource in aiding in the recognition and management of motor fluctuations and dyskinesia, and ultimately, improving the overall quality of life of persons with PD.