Mechanisms underlying the onset and expression of levodopa-induced dyskinesia and their pharmacological manipulation

• Published in: Journal of Neural Transmission Vol. 118; no. 12; pp. 1661 - 1690
• Main Authors: Iravani, Mahmoud M., Jenner, Peter
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.12.2011; Springer Nature B.V
• Subjects: Adenosine receptors; Amantadine; Animals; Antiparkinson Agents - adverse effects; Basal ganglia; Basic Neurosciences; Calcium influx; Dopamine; Dopaminergic Neurons - drug effects; Dopaminergic Neurons - physiology; Drugs; Dyskinesia; Dyskinesia, Drug-Induced - drug therapy; Dyskinesia, Drug-Induced - etiology; Dyskinesia, Drug-Induced - metabolism; Dyskinesia, Drug-Induced - pathology; Genetics and Immunology - Review article; Glutamatergic transmission; Glutamic acid receptors (ionotropic); Histamine receptors; Humans; Levodopa - adverse effects; Medicine; Medicine & Public Health; Movement disorders; N-Methyl-D-aspartic acid receptors; Neurodegenerative diseases; Neurology; Neuronal Plasticity - drug effects; Neuronal Plasticity - physiology; Neurosciences; Neurotransmission; Neurotransmitter Agents - metabolism; Neurotransmitter Agents - therapeutic use; Nitric-oxide synthase; Opiates; Parkinson Disease - drug therapy; Parkinson's disease; Psychiatry; Reviews; Serotonin; Signal Transduction - drug effects; Postsynaptic mechanisms; Levodopa; Presynaptic mechanisms; Parkinson’s disease; Dyskinesia
• ISSN: 0300-9564; 1435-1463
• DOI: 10.1007/s00702-011-0698-2

A significant proportion of patients with Parkinson’s disease (PD) receiving dopamine replacement therapy in the form of levodopa develop dyskinesia that becomes a major complicating factor in treatment. Dyskinesia can only be effectively treated by a reduction in drug dose, which limits efficacy, by co-administration of the weak NMDA antagonist amantadine or by surgical treatment (pallidotomy, DBS). This raises the important question of why dyskinesia occurs in PD and how it can be avoided or suppressed by pharmacological treatment. This review assesses some of the mechanisms that underlie dyskinesia induction and expression from presynaptic changes in dopaminergic neurones to postsynaptic alterations in basal ganglia function and examines potential approaches to prevention and treatment. These include glutamatergic approaches where agents that directly or indirectly alter glutamatergic neurotransmission modify the intracellular influx of Ca 2+ and reduce the formation of nitric oxide by neuronal nitric oxide synthase that may form an integral component of the complex cascade of events leading to dyskinesia. There is increasing evidence for the role of serotoninergic neurones in dyskinesia induction related to non-physiological formation and release of dopamine and serotoninergic agonists can modify dyskinesia expression. Similarly, noradrenergic receptors may serve to alter dyskinesia intensity and α -2-adrenoceptor antagonists alter the expression of levodopa-induced dyskinesia in both experimental models of PD and in man. Finally, other potential approaches to dyskinesia treatment based on manipulation of opiate, cannabinoid, adenosine and histamine receptors are considered. The conclusion is that the cause of levodopa-induced dyskinesia remains to be fully elucidated and that new approaches to treatment through non-dopaminergic mechanisms are required to control the onset and expression of involuntary movements.