Dyskinesias and Parkinson's disease: how to reduce them?


Dyskinesias, which result in involuntary movements of the limbs and trunk, are the late consequence of taking levodopa in Parkinson’s disease, which is the most frequently prescribed and most effective treatment. The explanations of Dr. Thomas de Broucker, neurologist at Pierre Delafontaine Hospital in Saint-Denis.

Parkinson dyskinesia

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Any medicine can induce unwanted side effects. Those who treat Parkinson’s disease are no exception. The levodopa treatment (Modopar®, Sinemet®, Stalevo®) can cause, after several years, up to more than 10 years or more, dyskinesias who are sudden involuntary movements similar to those we see in chorea.

«The symptoms of Parkinson’s disease – slow movements, muscular stiffness, trembling at rest – always appear asymmetrically, explains Dr. Thomas de Broucker. The dyskinesias start, too, so asymmetric : the hand, then the arm, the leg, first touching the first areas of the body affected by Parkinson’s disease. ”

Dyskinesias are accepted by patients

The dyskinesias accompany the unlocking the body“They are not painful and are often quite well accepted by patients who have been warned of the side effects of drugs,” says the neurologist. They are more likely to annoy the entourage, because they are tiring to see. ”

Absent at the beginning of the illness, “the dyskinesias occur afterA more or less long period of evolution under treatment, when the duration of action of the levodopa and his efficiency decrease in the brain justifying the increase in doses and frequency of taking in order toimprove motor symptoms “Says Dr. de Broucker.

” The levodopa is essential because it allows a better quality of life of the patient, says the doctor. Delay at all costs its prescription for fear of side effects provides a marginal benefit, saving only about 3 months on the time of onset of dyskinesia. Giving early levodopa has been shown to be the best therapeutic strategy for maintaining a better quality of life. Over time, the occurrence of fluctuations in effect requires a modulation of doses and times of catch. ”

Dyskinesias: what solutions to avoid them?

Theamantadine (Mantadix®) is a medicine originally used as antiviral then, currently, to treat the Parkinson’s patients with dyskinesia due to levodopa.

“We can also use dopamine agonist drugs, even at apomorphine pump, that allow to smooth the dopaminergic stimulation along the nycthémère even for the pump, to deliver throughout the day the minimum effective dose to reduce dyskinesias, “informs the neurologist. This pump is in the form of a portable and programmable electric syringe.

Another solution: “One can obtain a continuous flow of L-dopa through a digestive probe placed directly in the small intestine, says Dr. De Broucker. This mode of administration may be interesting when the dyskinesias resist the therapeutic arrangements and can hinder walking or cause falls. ”

And finally, “the last possibility is to resort to the deep brain stimulation “Says the neurologist. This is an intervention to implant electrodes in the brain to reduce drug intake.

These so-called second-line treatments are, however, only indicated in less than 5% of patients with Parkinson’s disease. Their implementation is done in a super-specialized center; their contraindications are numerous because intolerances are frequent.