An Overview Of Dyskinesia Associated With Parkinson’s

To understand dyskinesia, we need to take a step back and understand Parkinson’s disease. Most of us are aware of Parkinson’s disease as highly prevalent, and many corporations and organizations run campaigns to increase awareness about it. It normally affects people above the age of 60, but in rare cases, it has been noticed in younger people as well. Many of us are not aware of the causes of Parkinson’s and how it impacts a person’s life.

What is Parkinson’s disease?

Substantia Nigra is a nucleus in the middle part of the brain that produces dopamine. Dopamine is a neurotransmitter that sends signals to nerve cells for any movement, reward, attention, and motivation. When nerve cells stop producing dopamine, the signals are not sent, affecting muscle movement. This inability to control movement results in Parkinson’s disease.

Tremors or stiffness, lack of coordination, speech difficulty, anxiety, fatigue, poor balance, and disturbed sleep are some symptoms. It is a progressive disease, and there is no known cure yet. It makes the patients dependent on others even for simple daily activities.

Treatment for Parkinson’s disease

• Medication that mimics or restores dopamine levels, like levodopa and dopamine agonists (for example, ropinirole, pramipexole, rotigotine)
• Deep Brain Stimulation (DBS) surgery
• Exercise and light physical activity

How does levodopa affect the body?

When levodopa is taken over the long term, the dopamine levels in the brain can surge and fall with the dosage and the continuous destruction of the dopamine-creating cells. With this fluctuation, the body starts to move involuntary, which may also lead to jerky movements. This condition is called dyskinesia. Dyskinesia as a side effect of levodopa is only one type of condition.

Impact of dyskinesia

• Involuntary movements in either one part of or the entire body
• Movements that look like fidgeting or writhing
• Bobbing of the head or swaying of the entire body
• Reduced mobility in the affected person

Treatment

Dyskinesia is a side-effect of medication taken for managing Parkinson’s. They treat every person based on how advanced Parkinson’s is, and levodopa is very effective in the management of its symptoms. As there is no other treatment for the symptoms of Parkinson’s, doctors are left with the question of whether they should stop the medication to treat dyskinesia. However, doing so will allow the symptoms of Parkinson’s to manifest. The treatment options that doctors have are as follows:

• Reduce the dosage or frequency and change the timing of the medication.
• Prescribe other forms of levodopa like extended-release or gel-infused levodopa. These can maintain the levels of dopamine over time.
• Combining other drugs like amantadine with levodopa can help reduce the possibilities of dyskinesia.
• If a person has had Parkinson’s for 4 years or more, and if there are some benefits of medication but the symptoms of dyskinesia are manifesting, they should consider going for the DBS surgical procedure. An electric stimulator is placed in the brain to activate or suppress activity in the brain, which reduces the need for dopamine medication.

Who is at risk?

We should remember that even though it is a side effect, not all those who use levodopa are at risk of developing dyskinesia. The following people face a higher risk:

• Those taking a higher dosage or indulging in long-term usage of levodopa
• Those with fewer tremors but stiff and slow movements
• Those experiencing high levels of stress

It is most likely to start on the same side of the body that Parkinson’s started, and it can range from mild to severe.