title: Therapeutic strategies to prevent and manage dyskinesias in Parkinson's disease.
abstract: BACKGROUND
  Chronic treatment with levodopa is associated with the development of motor fluctuations and dyskinesias particularly in young Parkinson patients. In some cases, dyskinesias become so severe that they interfere with normal movement and negatively impact quality of life.
  
  
  METHODS
  In this review, we discuss benefits and limits of available therapeutic approaches aimed at delaying or managing dyskinesias as well as new strategies that are currently under investigation.
  
  
  CONCLUSIONS
  Among available treatments, monotherapy with dopamine agonists in the early phases of the disease reduces the risk for dyskinesias compared with levodopa. Nevertheless, dopamine agonists are unable to prevent dyskinesias once levodopa is added, which is always required once disease severity progresses. Convincing evidence of dyskinesia improvement has been shown only for deep brain stimulation and to some extent also for duodenal levodopa infusion and subcutaneous apomorphine. These approaches are expensive, have restrictive inclusion criteria and can cause potentially serious side effects. Alternative therapies include drugs targeting nondopaminergic neurotransmitter systems. Amantadine improves dyskinesias but its long-term effect is often unsatisfactory. Glutamatergic and gabaergic compounds have been tested in clinical trials, with promising results. By contrast, adrenergic drugs, fipamezole and idazoxan, did not show antidyskinetic effect.
authors.affiliation: Parkinson Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo" - I.R.C.C.S , Via Alberoni 7030126 Venice , Italy , +39 41 2207554 , angelo.antonini@ospedalesancamillo.net.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pilleri
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
mesh_terms: D046690:Deep Brain Stimulation; D018491:Dopamine Agonists / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D004409:Dyskinesia, Drug-Induced / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control* / Q000628:therapy; D018683:Excitatory Amino Acid Agents / Q000627:therapeutic use; D018756:GABA Antagonists / Q000627:therapeutic use; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D012702:Serotonin Antagonists / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
chemical_list: D018491:Dopamine Agonists; D018683:Excitatory Amino Acid Agents; D018756:GABA Antagonists; D012702:Serotonin Antagonists; D017366:Serotonin Receptor Agonists; D007980:Levodopa
keywords: Parkinson’s disease; dyskinesias; motor complications; therapy