Treatment can be complicated. It might seem logical to reduce the amount of levodopa taken, or avoid it for as long as possible, since dyskinesia seems to be a side effect of this medication, but this may mean that other symptoms, such as tremor, rigidity and slow movement, are no longer controlled. A reduced amount of levodopa can also result in ‘off’ periods - when symptoms are least controlled - occurring sooner and lasting longer.
It is therefore important to achieve a good balance between improved mobility and episodes of dyskinesia. Each person will need to decide on the balance they prefer: having more ‘on’ time when most symptoms are controlled but dyskinesia is experienced, or more ‘off’ time when dyskinesia is controlled but other symptoms reappear. This is a personal choice that only you can make.
The following options may be suggested by your doctor according to the balance you feel is right for you:
- a controlled release form of levodopa to level out the response to this medication. This should reduce the peak levels that occur with other forms of levodopa, which in turn should reduce the likelihood of dyskinesia being experienced
- to divide the total daily dose of levodopa into more frequent, smaller single doses
- to combine levodopa with medications that slow down the breakdown of the drug so as to prolong its action
- increasing the dosage of a dopamine agonist to the maximum and at the same time reduce the dosage of levodopa to the minimum you can tolerate. Some people also notice an improvement if they switch from one dopamine agonist to another
- Duodopa, a gel containing levodopa and carbidopa. This is administered continuously and directly to the upper part of the small intestine where it can be absorbed evenly throughout the day to stabilise levels of dopamine in the blood consequently providing smoother control of movement symptoms
- If medication does not help and dyskinesia is affecting quality of life then surgery may be suggested but this is not suitable for everyone and must be discussed with a Parkinson’s specialist doctor. Pallidotomy, thalamotomy and deep brain stimulation have been shown to help control motor fluctuations in some people. For further information on these techniques please see the section on surgery.
Who can help?
Your doctor will be your first point of contact or, depending on the
country in which you live, a Parkinson’s Disease Nurse Specialist.
They will probably adjust your medication, sometimes trying several
combinations, to see if this eases your dyskinesia. They may also
refer you to a doctor who specialises in movement disorders.
