title: Levodopa-induced dyskinesia in Parkinson's disease: clinical features, pathogenesis, prevention and treatment.
abstract: Levodopa is the most effective drug for treating Parkinson's disease. However, long-term use of levodopa is often complicated by significantly disabling fluctuations and dyskinesias negating its beneficial effects. Younger age of Parkinson's disease onset, disease severity, and high levodopa dose increase the risk of development of levodopa-induced dyskinesias (LID). The underlying mechanisms for LID are unclear though recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in their pathogenesis. The non-human primates with MPTP-induced parkinsonism serve as a useful model to study dyskinesia. Once established, LID are difficult to treat and therefore efforts should be made to prevent them. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson's disease, amantadine, atypical neuroleptics, and neurosurgery. LID can adversely affect the quality of life and increase the cost of healthcare.
authors.affiliation: Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. bhanvi@hotmail.com
authors.forename: Bhomraj
authors.initials: B
authors.lastname: Thanvi
authors.forename: Nelson
authors.initials: N
authors.lastname: Lo
authors.forename: Tom
authors.initials: T
authors.lastname: Robinson
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects*; D015259:Dopamine Agents / Q000009:adverse effects*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D019635:Neurosurgical Procedures / Q000379:methods; D010300:Parkinson Disease / Q000150:complications*; D016194:Receptors, N-Methyl-D-Aspartate / Q000187:drug effects; D012307:Risk Factors
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents; D016194:Receptors, N-Methyl-D-Aspartate; D007980:Levodopa