title: Drug-induced dyskinesia in Parkinson's disease. Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia?
abstract: BACKGROUND
  Dyskinesia, a major complication in the treatment of Parkinson's disease (PD), can require prolonged monitoring and complex medical management.
  
  
  CONCLUSIONS
  The current paper proposes a new way to view the management of dyskinesia in an integrated fashion. We suggest that dyskinesia be considered as a factor in a signal-to-noise ratio (SNR) equation where the signal is the voluntary movement and the noise is PD symptomatology, including dyskinesia. The goal of clinicians should be to ensure a high SNR in order to maintain or enhance the motor repertoire of patients. To understand why such an approach would be beneficial, we first review mechanisms of dyskinesia, as well as their impact on the quality of life of patients and on the health-care system. Theoretical and practical bases for the SNR approach are then discussed.
  
  
  CONCLUSIONS
  Clinicians should not only consider the level of motor symptomatology when assessing the efficacy of their treatment strategy, but also breadth of the motor repertoire available to patients.
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Daneault
authors.forename: Benoit
authors.initials: B
authors.lastname: Carignan
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Sadikot
authors.forename: Michel
authors.initials: M
authors.lastname: Panisset
authors.forename: Christian
authors.initials: C
authors.lastname: Duval
mesh_terms: D000818:Animals; D019468:Disease Management; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D009048:Motor Skills / Q000187:drug effects / Q000502:physiology*; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D020127:Recovery of Function / Q000502:physiology*; D059629:Signal-To-Noise Ratio
chemical_list: D007980:Levodopa