Parkinson's Disease Dyskinesia

2. Parkinson’s Disease
Dyskinesia
Ade Wijaya, MD – September 2019

3. Outline:
• Introduction
• Predisposing factors
• Pathogenesis
• Treatment strategies
• Algorhytm
• Summary

4. Introduction
• Levodopa treatment after some time interval  motor complications
• Motor complications: motor fluctuation & dyskinesias
• Up to 50% of PD patients present dyskinesias 5 years after initiation
of levodopa
Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord 2001;16(3):448-58

5. Predisposing Factors
• Female
• Low body weight / mass index
• Younger onset
• Rigid-akinetic type of Parkinson’s disease
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease. Expert opinion on drug safety. 2015 Feb 1;14(2):281-94.

6. Clinical Features
Choreic
Combination
Dystonic
Fahn S. The spectrum of levodopainduced dyskinesias. Ann Neurol 2000;47(4 Suppl 1):S2-11

8. Pathogenesis
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease. Expert opinion on drug safety. 2015 Feb 1;14(2):281-94.

9. Treatment Strategies
Dopamine targeting
Non-dopamine targeting
Surgical
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease. Expert opinion on drug safety. 2015 Feb 1;14(2):281-94.

10. Dopamine Targeting
• Levodopa sparing
• Dopamine agonists
• Continuous dopaminergic delivery
• Antidopaminergic drugs
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease. Expert opinion on drug safety. 2015 Feb 1;14(2):281-94.

11. Non-dopamine Targeting
• Antiglutamatergic drugs
• Serotoninergic drugs
• Drugs acting on GABA transmission
• Others
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease. Expert opinion on drug safety. 2015 Feb 1;14(2):281-94.

13. Algorhytm

14. Summary
• Dyskinesias are a frequent complication of levodopa therapy and produce
negative impact on patients’ quality of life
• The onset and severity of dyskinesias is related not only to the exposure to
levodopa, but also to the degree on neurodegenerative process
• Monotherapy with dopamine agonists may delay, but not avoid, the onset
of dyskinesias, and is not feasible in the long term
• Amantadine
• Advanced therapies, such as dopamine infusion and deep brain
stimulation, provide significant improvement of dyskinesias, but are not
suitable for all patients and have potential severe complications

15. THANK YOU