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What is Dyskinesias, Really?

If a person has Dyskinesias, it means they experience abnormal, involuntary movements that occur in response to repeated dopamine-replacement therapy. Sometimes, this condition can be debilitating. These motor complications are typically “choreiform”. Chorea comes from the Greek word meaning “to dance”, so the dyskinesias looks similar to dance-like, constant wriggling movements of the arms, legs and sometimes even facial muscles.

However, dyskinesias can also be dystonic (prolonged twisting of body parts), or myoclonic (rapid and random twitching of isolated muscle groups) or other movement disorders, and can become progressively more severe with increasing duration of treatment. Sometimes, when the disease advances, it becomes increasingly difficult to find a dose of levodopa, the medicine that provides symptom relief while avoiding dyskinesia.

Treatment Tips

If you have severe dyskinesia(s) here are a few treatment tips we have found over the years that really do help:

  1. Go to a Parkinson’s specialist who has experience dealing with this issue, and remember it may take multiple visits to resolve the issue.
  2. Remember that dyskinesia is usually driven by the dose of levodopa (sinemet) and/or agonist.  Reducing the dose, and possibly taking smaller doses more frequently may be an option.
  3. Remember that drugs like Entacapone (Comtan) can make dyskinesia worse.
  4. In severe cases, holding a dose or two of sinemet can be helpful to gain control of the situation.  Remember stopping sinemet for a day or two can be dangerous so always consult your doctor for prolonged drug holidays (which are not recommended).
  5. In severe prolonged and disabling dyskinesia many experts will eliminate dopamine agonists, MAO-B drugs, Comtan (or Stalevo), and may switch to a sinemet only regimen.  They will search for a low dose of sinemet that will allow the patient to feel “on” with minimal to no dyskinesia.  They will then give this low dose frequently enough to keep them “on” for as many hours in the day as possible.
  6. Occasionally, patients with severe dyskinesia can be switched to liquid sinemet, although for most patients this is not a long-term viable strategy.
  7. Amantadine can be added to a regimen to suppress dyskinesia– for some sufferers.
  8. The most severe and medication resistant cases may be considered to be screened for deep brain stimulation or a duodopa pump.
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