Dyskinesias are abnormal, uncontrollable movements when you are trying to perform voluntary movements. Dyskinesias are often associated with Parkinson’s disease (PD). However, dyskinesias are not a symptom of PD, but rather a common side effect from long-term use of levodopa, the most effective treatment currently available for the management of motor symptoms from PD.
Dyskinesias can be a very distressing side effect to experience, as parts of your body seem to move on their own. Sometimes, it may appear as a “dance,” with the arms, legs, body, or face wiggling. Not everyone who experiences dyskinesias from levodopa therapy has the same severity, and not everyone who takes levodopa experiences dyskinesias. In their mildest form, dyskinesias may only be noticeable to the person with PD or perhaps their spouse or caregiver. However, severe dyskinesias can increase fatigue and cause exhaustion. People who experience severe dyskinesias may also experience weight loss and face an increased risk of injury.1,2
The risk of developing dyskinesias is higher in those people with young-onset PD, which is considered anyone under the age of 50. Longer-term use of levodopa, higher doses of levodopa and more severe PD also increase a person’s risk of developing dyskinesias.1
Paradox of dyskinesias and Parkinson’s disease
Dyskinesias usually appear at a turning point in the course of treating PD, when the disease is advancing. Generally, as the disease advances and symptoms worsen, there is a need to increase the dosage of levodopa. But increasing the dose of levodopa is associated with a worsening of dyskinesias. Reducing the dosage – in an effort to reduce dyskinesias – leads to poor control of PD. Some patients find they prefer the movement associated with dyskinesias to the immobility they experience when their PD symptoms aren’t well controlled.1
Currently, there is only one medication approved to treat dyskinesias: Gocovri™ (amantadine).
One of the most important steps in managing dyskinesias is working with a movement disorders specialist. Movement disorder specialists have special training and expertise in treating conditions like PD and understand the importance of dosing different medications to relieve PD symptoms and reduce the risk of side effects. Once dyskinesias have occurred, they can be challenging to treat, so preventing them, such as by working with a movement disorders specialist, is paramount.1,2
In some cases, the dosage of levodopa may be adjusted. Some people find that taking smaller doses of levodopa more frequently, using controlled-release preparations, or switching to a liquid form of medication helps relieve dyskinesias. Other options are using dopamine receptor agonists or amantadine (brand name Symmetrel® (amantadine hydrochloride)). If you are experiencing dyskinesias, talk to a movement disorders specialist about your options on changing your medications.1,2
Dyskinesias tend to worsen with stress, and people can lessen their dyskinesias with stress management, which may include learning relaxation strategies, engaging in exercise, spending time with friends and family, or practicing meditation or yoga.3
Deep brain stimulation
For those who have severe dyskinesias or whose medication is no longer controlling their PD symptoms, deep brain stimulation (DBS) may be an option. Deep brain stimulation (DBS) is a surgical procedure in which a device is implanted in the patient to deliver electrical pulses to the brain to decrease motor symptoms of PD. Many people who get DBS experience a significant reduction in their motor symptoms, and the reduction of medication lessens the side effects experienced with those medications.4,5
Thanvi B, Lo N, RobinsonT. Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment. Postgrad Med J. 2007 Jun;83(980):384-388. doi: 10.1136/pgmj.2006.054759.
Center for Movement Disorders and Neurorestoration. Accessed online on 6/28/17 at http://movementdisorders.ufhealth.org/2011/10/20/parkinsons-treatment-tips-for-dyskinesia/.
The Michael J. Fox Foundation for Parkinson’s Research. Accessed online on 6/28/17 at https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?dyskinesia.
Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H, Hallett M, Miyasaki J, Stevens J, Weiner WJ; Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 Apr 11;66(7):983-95.
Michael J. Fox Foundation for Parkinson’s Research. Accessed online on 6/28/17 at https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?deep-brain-stimulation.