title: [Motor complications of treatment with levodopa in Parkinson's disease].
abstract: BACKGROUND
  Motor complications of treatment with levodopa affect more than 50% of patients after several years' treatment. This has a marked effect on patients with Parkinson's disease since these side effects are undesirable, affect the natural course of the disorder and complicate treatment.
  
  
  METHODS
  In this review we describe the main epidemiological, physiopathological and therapeutic aspects of the motor complications of levodopa. According to most epidemiological studies, starting treatment at an early age and more severe degree of the disorder are the main risk factors. The physiopathology of motor complications is varied. It has been thought to be due to loss of the buffer effect of the brain on plasma levels of levodopa, alterations in the functional state of the postsynaptic receptors and chronic intermittent use of levodopa. Management includes division and/or reduction of the dose of levodopa, use of slow-release preparations and association of dopaminergic agonists with COMT inhibitors which are the latest drugs to be tried. Various surgical possibilities in specialist centres may also be considered for serious cases of motor complications which do not respond to medical treatment.
  
  
  CONCLUSIONS
  Recent advances in understanding the physiopathology and in the medical and surgical treatment permit improved control of the motor complications of chronic treatment with levodopa.
authors.affiliation: Unidad de Neurología, Hospital de Sagunto, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: García-Escrig
authors.forename: F
authors.initials: F
authors.lastname: Bermejo-Pareja
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000209:etiology*; D005684:Gait / Q000187:drug effects; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
vernacular_title: Complicaciones motoras del tratamiento con levodopa en la enfermedad de Parkinson.