Parkinson Association
OF SOUTHWEST FLORIDA
PROMOTING QUALITY OF LIFE FOR PERSONS WITH PARKINSON DISEASE AND THEIR CARE PARTNERS
DYSKENISIA IN PARKINSON'S DISEASE
Parkinson’s disease (PD) is a progressive neurodegenerative disorder caused by a loss of dopaminergic neurons in the nigrostriatal pathway that leads to the development of severe motor difficulties including rigidity, tremor, slowness of movement, and unstable posture. To date, PD remains incurable; however, the motor symptoms can be managed by a variety of different drugs. One of these is levodopa, which is the gold standard for the treatment of motor symptoms in PD. Although initiallyeffective, dopaminergic therapies are eventually complicated by motor fluctuations including off-time–periods of return of PD symptoms when medication effect wears off–and dyskinesia–abnormal involuntary movements of the arms, legs, trunk, and head that can range from mild to very severe.These motor complications can impair quality of life and cause significant disability. These dyskinetic movements may occur as early as a few months after levodopa treatment is started, and affect themajority of patients within five years of treatment. In the long-term management of PD, dyskinesias may become sufficiently severe that they compromise the overall benefit derived from anti-Parkinsonian drugs. Risk factors include younger age at onset of PD, disease severity, higher levodopa dosage, and longer disease duration. These problems are often addressed with levodopa adjustments and the addition of additional medications. The molecular and cellular mechanisms responsible for dyskinesias with levodopa are not well-understood.Levodopa-induced dyskinesias are extremely difficult to prevent or to treat. Amantadine, one of the few drugs used for dyskinesias, is only modestly effective for a limited timeframe. Deep brain stimulation (DBS) is also used in severe cases. There are currently no medications approved for treatment of levodopa-associated dyskinesias. New pharmacological approaches are needed in the clinical management.
Unfortunately, with continued disease progression and levodopa treatment, other motor complications may arise such as freezing and end-of-dose failure. Levodopa-induced dyskinesias are extremely difficult to prevent or to treat. Amantadine, one of the few drugs used for dyskinesias, is only modestly effective for a limited timeframe. Deep brain stimulation (DBS)is also used in severe cases. There are currently no medications approved for treatment of levodopa-associated dyskinesias. New pharmacological approaches are needed in the clinical management. Unfortunately, with continued disease progression and levodopa treatment, other motor complications may arise such as freezing and end-of-dose failure. Patients often tolerate dyskinesias to avoid off-time symptoms. Difficult management decisions often develop. In my experience, dyskinesias often disturb the family and attending physicians more than the patient. Often, there are no easy solutions. Research is being conducted to evaluate the effectiveness of an investigational medication that may reduce dyskinesia and avoid dose reduction. The Movement Disorders Clinic at Collier Neurologic Specialists is participating in this research. To participate, please contact Lisa in the Research Department at 239-434-0332.
Dr. John Campbell, PASFI’s Medical Director, is Director of the Parkinson’s Disease and Movement Disorders Center at Collier Neurologic Specialists which is located at 730 Goodlette Road, Suite 100, Naples FL. The telephone number is 239-262-8971
Frequently Asked Questions
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The symptoms of Parkinson's disease, or Parkinsonism (PD), result from the degeneration of nerve cells in the mid-brain, and the corresponding loss of the neurotransmitting chemical dopamine produced by those cells.
More specifically, Parkinson's is a disorder of body movement. It is a progressive neurological disease that affects people of either sex and all ethnic groups. PD is NOT fatal. It is NOT infectious. It CANNOT be transmitted to other members of the family.
Over 1 million Americans suffer from PD, with more victims, young and old, being diagnosed daily. 40% of the victims are under the age of 60. It is estimated that PD costs the U.S. over $26 billion annually in disability costs and lost productivity. Neither the cause nor the cure for PD is known.
Because the disease is progressive, it may ultimately become debilitating. Without adequate treatment and support, people with Parkinson's may tend to become depressed and withdrawn. However, with modern drug treatment and community support, such isolation is unnecessary.
Parkinson's does not discriminate. It afflicts people regardless of gender, race, background, behavior, lifestyle or geographic area. Despite the common perception that PD is an "old person's" disease, the average age of diagnosis is 57 years, with many diagnosed in their 30's and even 20's; yet due to the debilitating nature of the disease, the Parkinson's community has been largely invisible to the public and the government.
Parkinson's disease is caused by the failure of a group of nerve cells in the brain to produce adequate amounts of a chemical called dopamine. Dopamine is necessary for smooth, coordinated movement and muscle relaxation. It is not known why the cells cease producing dopamine. However, it is likely that research will soon provide the answer.
Three main symptoms may be experienced by people with PD: Slowed movements (called bradykinesia), resting tremor (shaking in an arm or leg when it is not being moved), muscle rigidity (stiffness), and postural instability. Symptoms typically begin on one side of the body (unilateral) and progress to include both sides.
Each person's pattern of symptoms is unique. Some people have only one or two of the main symptoms. Others may have all major symptoms in varying degrees of severity
Many of the symptoms of Parkinson's Disease can be treated, even though to date there is no cure. Research has provided us with medications which are very effective over long periods of time. Physiotherapists, Nutritionists, Speech and Occupational Therapists, and Counselors can all help to maintain and improve the quality of life for people with Parkinson's.