Parkinson Disease Dyskinesia
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Parkinson's disease patients often develop dyskinesias after long-term levodopa treatment, which are abnormal involuntary movements that negatively impact quality of life. Dyskinesias are more common in females, those with lower body weight or younger onset of Parkinson's, and those with the rigid-akinetic form of the disease. While dopamine agonists can delay dyskinesias, levodopa is still necessary over the long term. Treatment strategies include optimizing levodopa dosage, adding non-dopamine drugs, and advanced therapies like deep brain stimulation for severe cases.
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Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
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Year of first presented in Class: 2018
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- 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