Dyskinesias are movements that you cannot control. They often happen when you try to do something on your own, like walk or talk. Dyskinesias are common in people who have Parkinson's disease (PD).1,2
While dyskinesias are associated with PD, they are not a symptom of the disease itself. Instead, they are a common adverse effect of long-term use of levodopa or other pro-dopamine drugs. Levodopa is the best drug for managing motor symptoms caused by PD.1,2
Dyskinesia is a movement disorder. With dyskinesia, parts of your body seem to move on their own, which can be quite frightening. Some people with PD never develop dyskinesia and those that do can have very different levels of severity.1,2
Why does dyskinesia occur in people with PD?
Doctors do not know exactly why dyskinesia develops. They do know that it is most often linked to the use of levodopa or other pro-dopamine drugs in people with PD. Some brain chemicals are thought to have a role. These chemicals include:2
- Dopamine
- Serotonin
- Glutamate
When you have PD, the brain cells (neurons) that make dopamine are damaged or destroyed. This decreases dopamine levels.2
Taking levodopa or other pro-dopamine PD drugs helps restore dopamine levels. But the increase in dopamine is temporary. Levodopa must be taken multiple times a day. This causes dopamine levels to fluctuate. The damage to the cells of your brain that produce dopamine means dopamine levels remain unstable.2
It is important to understand that some of the drugs used to control PD motor symptoms may result in a little dyskinesia. This is especially true late in the disease as it becomes harder to find a good balance of levodopa therapy to control symptoms without causing side effects.2
Symptoms
The involuntary movements linked to dyskinesia can range from mild to severe. These movements can affect any part of the body. Some common symptoms of dyskinesia include:1,2
- Twitching or shaking
- Jerking movements
- Rigidity
- Difficulty moving
The severity of dyskinesia can vary from day to day. It can be impossible to predict. In some cases, dyskinesia may significantly impair a person's function.1,2
Types of dyskinesia in PD
In some people, dyskinesias are most noticeable when they take levodopa. This is called peak-dose dyskinesia. As the drug starts to work and dopamine levels increase, the dyskinesias become more pronounced.1,3
Diphasic dyskinesia is a rarer form. In diphasic dyskinesia, there are 2 separate periods of involuntary movements. These happen when the levodopa first starts to work and when it is wearing off.1,3
Diagnosis
There is no single test to diagnose dyskinesia. Your doctor will likely base the diagnosis on your symptoms and how they change over time. Tests that may be used include:1,2
- Brain and nerve (neurological) exam
- Blood tests
- Brain scans, such as computed tomography (CT) scan or magnetic resonance imaging (MRI)
- Recording changes in dyskinesia with changes in levodopa or other therapy
Treatment
There is no cure for dyskinesia. But, there are alternative treatments that can help reduce the symptoms. Some common adjustments and treatments include:2
- Changing the dose or timing of levodopa
- Switching to a different formulation of levodopa, like extended release
- Adding amantadine, which works on glutamate, to help with dyskinesia
- Surgery to implant a device that delivers electrical stimulation to the brain
However, adjusting your prescriptions to lower dopamine levels may make other PD motor symptoms worse. People with PD often have to work with their doctor to find the right dose of medicines to treat all of their symptoms.
Living with dyskinesia
Living with dyskinesia can be challenging. However, there are ways to manage it. Some tips include:1,2
- Keeping a diary of your symptoms to track how they change over time
- Planning your day around when your medicine is most effective
- Taking breaks during the day to rest
- Adjusting your diet and exercise routine
Talk to your doctor about the best ways to treat dyskinesia. Following the tips above can make it easier to cope with your dyskinesia.
