Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment
Levodopa is the most effective drug for treating Parkinson’s disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson’s disease onset, disease severity, and high levodopa dose in...
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Published in | Postgraduate Medical Journal Vol. 83; no. 980; pp. 384 - 388 |
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Main Authors | , , |
Format | Journal Article Book Review |
Language | English |
Published |
London
The Fellowship of Postgraduate Medicine
01.06.2007
BMJ Oxford University Press BMJ Group |
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Abstract | Levodopa is the most effective drug for treating Parkinson’s disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson’s disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson’s disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare. |
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AbstractList | Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson's disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare. Abstract Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson's disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare. |
Author | Lo, Nelson Robinson, Tom Thanvi, Bhomraj |
AuthorAffiliation | Bhomraj Thanvi , Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK Nelson Lo , Leicester General Hospital Tom Robinson , Department of Cerebrovascular Medicine, Leicester General Hospital |
AuthorAffiliation_xml | – name: Tom Robinson , Department of Cerebrovascular Medicine, Leicester General Hospital – name: Nelson Lo , Leicester General Hospital – name: Bhomraj Thanvi , Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK |
Author_xml | – sequence: 1 givenname: Bhomraj surname: Thanvi fullname: Thanvi, Bhomraj organization: Department of Cerebrovascular Medicine, Leicester General Hospital – sequence: 2 givenname: Nelson surname: Lo fullname: Lo, Nelson organization: Department of Cerebrovascular Medicine, Leicester General Hospital – sequence: 3 givenname: Tom surname: Robinson fullname: Robinson, Tom organization: Department of Cerebrovascular Medicine, Leicester General Hospital |
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Keywords | Agonist Nervous system diseases Pathogenesis Clinical form Parkinson disease Antiparkinson agent Cerebral disorder Involuntary movement Medicine Prevention Symptomatology D2 Dopamine receptor Treatment Central nervous system disease Degenerative disease Levodopa Neurological disorder Extrapyramidal syndrome Dyskinesia |
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Notes | Correspondence to:
Dr Bhomraj Thanvi
Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester LE5 4PW, UK; bhanvi@hotmail.com ark:/67375/NVC-SWBF7WDD-T istex:2D15236066AEAFF36F68FA39468D8030A84D5CAC href:postgradmedj-83-384.pdf local:0830384 PMID:17551069 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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Snippet | Levodopa is the most effective drug for treating Parkinson’s disease. However, long-term use of levodopa is often complicated by significantly disabling... Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling... Abstract Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly... Levodopa is the most effective drug for treating Parkinson's disease. However, long‐term use of levodopa is often complicated by significantly disabling... |
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SubjectTerms | 1-methyl-4-phenyl-1 5-HT 5-hydroxytryptamine 6-tetrahydropyridine Age Antiparkinson Agents - adverse effects Biological and medical sciences catechol-O-methyl transferase Clinical medicine COMT D-I-D Dopamine Dopamine Agents - adverse effects Dyskinesia, Drug-Induced - etiology Dyskinesia, Drug-Induced - prevention & control Dyskinesia, Drug-Induced - therapy dyskinesia-improvement-dyskinesia Fos-related proteins FRA GABA General aspects Global Primate Dyskinesia Rating Scale GPDRS GPi Humans internal globus pallidum Levodopa - adverse effects levodopa-induced dyskinesias LID Medical sciences MPTP N-methyl-D-aspartate Nervous system (semeiology, syndromes) Nervous system as a whole Neurology Neurosurgical Procedures - methods NMDA Parkinson Disease - complications Parkinsons disease Pathogenesis Primates Proteins RAM rapid alternating movements Receptors, N-Methyl-D-Aspartate - drug effects Review Risk Factors Rodents STN Studies subthalamic nucleus Unified Parkinson’s Disease Rating Scale UPDRS γ-aminobutyric acid |
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Title | Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment |
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