L-Dopa dyskinesias

Juan Ramirez-Castaneda, Joseph Jankovic

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

Since its introduction in the late 1960s, levodopa (L-dopa), a dopamine (DA) precursor, has been the most widely used drug for the symptomatic therapy of Parkinson's disease (PD) and has remained the most efficacious treatment of motor manifestations of the disease. However, chronic L-dopa therapy is complicated by the development of long-term adverse effects, particularly motor fluctuations and dyskinesias, that can be disabling, difficult to treat, and may limit its utility. Levodopa-induced dyski-nesia (LID) is typically manifested by “peak-dose dyskinesia,” coinciding with the “on” response following L-dopa administration, also termed “IDI” (improvement-dyskinesia-improvement) response. This is in contrast to diphasic dyskinesia, which typically appears at the beginning of the medication effect prior to the attainment of a full “on” response and which may reappear as the medication effect starts to wear off, also termed “DID” (dyskinesia-improvement-dyskinesia) response. Chorea, stereotypy, and ballism are the most frequent forms of LIDs, especially in the IDI form. Other LIDs include off-dystonia, which is typically manifest when the dopaminergic benefit is wearing off or the patient is in an “off” state, such as early morning dystonia. LIDs tend to first appear when patients still respond well to L-dopa but begin to experience motor fluctuations, such as the wearing off response. The latency from the onset of L-dopa therapy to the onset of motor fluctuations and dyskinesia correlates with the age at onset of PD (the younger the patient, the shorter the latency), dosage, and duration of L-dopa therapy. There are, however, many other clinical, pharmacologic, and genetic factors that influence the risk and severity of motor fluctuations and LIDs. These factors will be discussed later along with LID phenomenology, molecular and pharmaco-logic mechanisms, and medical and surgical therapies. Assessment of LIDs LIDs are commonly assessed by a variety of clinical rating scales and home diaries, such as the Hauser diary. Based on a comprehensive of dyski-nesia scales, including the Unified Dyskinesia Rating Scale (UDysRS) and other scales, only the Abnormal Involuntary Movement Scale (AIMS) and the Rush Dyskinesia Rating Scale (RDRS) fulfill criteria for “recommended” use in PD populations, “albeit weakly.”

Original languageEnglish (US)
Title of host publicationMedication-Induced Movement Disorders
PublisherCambridge University Press
Pages110-130
Number of pages21
ISBN (Electronic)9781107588738
ISBN (Print)9781107066007
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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    Ramirez-Castaneda, J., & Jankovic, J. (2015). L-Dopa dyskinesias. In Medication-Induced Movement Disorders (pp. 110-130). Cambridge University Press. https://doi.org/10.1017/CBO9781107588738.012