title: Severe evening dyskinesias in advanced Parkinson's disease: clinical description, relation to plasma levodopa, and treatment.
abstract: We report four patients with Parkinson's disease who had an unusual pattern of severe chorea and dystonia in the evenings only. The temporal pattern of abnormal movements and simultaneous monitoring of plasma levodopa and clinical state were consistent with dyskinesias associated with subtherapeutic (low dopa dyskinesias) rather than peak concentrations of levodopa (high dopa dyskinesias). In two patients, addition of a direct-acting dopamine receptor agonist was helpful in ameliorating this complication of antiparkinson therapy.
authors.affiliation: Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903.
authors.forename: T R
authors.initials: TR
authors.lastname: Zimmerman
authors.forename: J I
authors.initials: JI
authors.lastname: Sage
authors.forename: A E
authors.initials: AE
authors.lastname: Lang
authors.forename: M H
authors.initials: MH
authors.lastname: Mark
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D001971:Bromocriptine / Q000008:administration & dosage; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002819:Chorea / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D002940:Circadian Rhythm / Q000187:drug effects*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D004421:Dystonia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000978:Antiparkinson Agents; D003692:Delayed-Action Preparations; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D001971:Bromocriptine; D007980:Levodopa; D002230:Carbidopa