What are dyskinesias and how can I manage them?
Dyskinesias are abnormal, involuntary movements that occur in response to repeated dopamine-replacement therapy (Brotchie 2005; Olanow 2001). Sometimes, they can be debilitating. These motor complications are typically “choreiform”. Chorea comes from the Greek word meaning “to dance”, so the dyskinesias looks similar to dance-like, constant writhing or wriggling movements of the arms, legs, trunk, and sometimes even facial muscles. However, dyskinesias can also be dystonic (prolonged twisting of body parts), or myoclonic (rapid and random twitching of isolated muscle groups) or other movement disorders, and can become progressively more severe with increasing duration of treatment (Brotchie 2005; Olanow 2001). Sometimes, with advancing disease, it becomes increasingly difficult to find a dose of levodopa that provides symptom relief while avoiding dyskinesia.
If you have severe dyskinesia(s) here are a few treatment tips we have found valuable over the years:
- Go to a Parkinson’s specialist who has a lot of experience dealing with this issue, and remember it may take multiple visits to resolve the issue.
- Remember that dyskinesia is usually driven by the dose of levodopa (sinemet) and/or agonist. Reducing the dose, and possibly taking smaller doses more frequently may be an option.
- Remember that drugs like Entacapone (Comtan) (which is also a component of Stalevo) can make dyskinesia worse.
- In severe cases, holding a dose or two of sinemet can be helpful to gain control of the situation. Remember stopping sinemet for a day or two can be dangerous so always consult your doctor for prolonged drug holidays (which are not recommended).
- In severe prolonged and disabling dyskinesia many experts will eliminate dopamine agonists, MAO-B drugs, Comtan (or Stalevo), and may switch to a sinemet only regimen. They will search for a low dose of sinemet that will allow the patient to feel “on” with minimal to no dyskinesia. They will then give this low dose frequently enough to keep them “on” for as many hours in the day as possible.
- Occasionally, patients with severe dyskinesia can be switched to liquid sinemet, although for most patients this is not a long-term viable strategy.
- Amantadine can be added to a regimen to suppress dyskinesia– for some sufferers.
- The most severe and medication resistant cases may be considered to be screened for deep brain stimulation or a duodopa pump.
Parkinson’s Treatment Tips is a blog brought to you by Dr. Michael S. Okun of the University of Florida Center for Movement Disorders and Neurorestoration
Learn more about Parkinson’s Disease.
Also, you can read more in Dr. Okun’s book, Ask the Expert about Parkinson’s Disease, Demos Publishing.