Levodopa‐induced dyskinesias
Top Cited Papers
- 11 April 2007
- journal article
- review article
- Published by Wiley in Movement Disorders
- Vol. 22 (10), 1379-1389
- https://doi.org/10.1002/mds.21475
Abstract
Levodopa‐induced dyskinesias (LID) are common and difficult to treat. This review focuses on three issues related to LID: clinical features, classification and rating, pathophysiology and pathogenesis, and management. The three primary clinical syndromes are OFF‐period dystonia, peak‐dose dyskinesia, and diphasic dyskinesia. Several other forms also occur, making the evaluation and choice of treatment complicated. A core component of the pathophysiology of LID is overactivity of the direct striatal output pathway. This pathway provides a direct GABAergic connection by which the striatum inhibits the output regions of the basal ganglia, i.e., the internal globus pallidus and the substantia nigra pars reticulata. Altering dopaminergic dosing and timing can abate dyskinesias, but usually impact the control of parkinsonism. Putative therapies to reduce the problem of dyskinesias could focus on the glutamatergic, GABAergic, α2 adrenergic, serotonergic (5HT1A, 5HT2A), opioid, histamine H3, adenosine A2A receptors, the monoamine transport or cannabinoid CB1 receptors systems. The only currently available drug with an evidence‐based recommendation on efficacy for dyskinesia is amantadine. Therapy goals include the prevention of dyskinesia and treatment of dyskinesias that are troublesome clinically. New rating measures to assess severity and disability related to dyskinesia are in the process of development and clinimetric testing. © 2007 Movement Disorder SocietyThis publication has 66 references indexed in Scilit:
- Drug Insight: new drugs in development for Parkinson's diseaseNature Clinical Practice Neurology, 2006
- Pergolide versus levodopa monotherapy in early Parkinson's disease patients: The PELMOPET studyMovement Disorders, 2006
- Other pharmacological treatments for motor complications and dyskinesiasMovement Disorders, 2005
- Role of surgery in the treatment of motor complicationsMovement Disorders, 2005
- Levodopa‐dyskinesia incidence by age of Parkinson's disease onsetMovement Disorders, 2005
- Stiff person syndrome with eye movement abnormality, myasthenia gravis, and thymomaJournal of Neurology, Neurosurgery & Psychiatry, 2005
- Parkinson's disease home diary: Further validation and implications for clinical trialsMovement Disorders, 2004
- Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson's disease: A prospective study using single‐dose challengesMovement Disorders, 2004
- Unilateral pallidotomy in Parkinson's disease: a randomised, single-blind, multicentre trialThe Lancet, 1999
- Conjugate eye deviations as dyskinesias induced by levodopa in Parkinson's diseaseMovement Disorders, 1998