How do you treat motor complications in Parkinson's disease: medicine, surgery, or both?
Abstract
The motor complications associated with levodopa therapy, namely, fluctuations in motor response and dyskinesias, occur in the majority of Parkinson's disease patients. These complications can impair a patient's quality of life and even cause pronounced disability. "Off" states that result in freezing of gait and falling are disabling for many patients. Dyskinesias most commonly occur at peak dose and typically alternate with the wearing-off state. Once these problems appear, they usually persist, and the physician needs to make continual adjustments in medications to minimize these problems. Medical treatments should be attempted before treatments such as deep brain stimulation are considered because of the potential adverse effects that are associated with surgery. The timing of surgery, however, is also important because younger patients and less advanced patients tend to have a better outcome. There is thus a need for experienced and knowledgeable physicians and surgeons who are able to handle these motor complications. This review discusses available medications and surgical approaches, and their outcomes.
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Dyskinesias occur in most patients after repeated L-DOPA exposure and can be troublesome or disabling.
“These excessive abnormal involuntary movements (AIMs), which occur in the majority of patients with repeated exposure to L-DOPA, can be very troublesome and even disabling (Fahn, 2008;Schapira et al., 2009).”
From Nicotinic receptor-mediated reduction in l-DOPA-induced dyskinesias may occur via desensitization (2010) · cites this paper as Fahn, 2008
Few drugs are currently available to reduce dyskinesias.
“Few drugs are currently available to attenuate dyskinesias (Fahn, 2008;Schapira et al., 2009).”
From Nicotinic receptor-mediated reduction in l-DOPA-induced dyskinesias may occur via desensitization (2010) · cites this paper as Fahn, 2008
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Nicotinic receptor-mediated reduction in l-DOPA-induced dyskinesias may occur via desensitization
Bordia, T., Campos, C., McIntosh, J. M., & Quik, M. (2010) · The Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.109.162396 · Cited by 82 · see citing works
Targeting G protein coupled receptor-related pathways as emerging molecular therapies
Ghanemi, A. (2015) · Saudi Pharmaceutical Journal · doi:10.1016/j.jsps.2013.07.007 · Cited by 53 · see citing works
- Authors
- Fahn, S.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Fahn, Stanley
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2009-01-06
- Volume
- 64
- Issue
- S2
- Pages
- S56-S64
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- OpenAlex
- W1979668360
- Cited by
- 66
- References
- 103
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 1 · 2016: 3 · 2015: 8 · 2014: 3 · 2013: 7 · 2012: 4
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- Parkinson's disease, motor complications, levodopa, dyskinesia, wearing-off phenomenon, off periods, freezing of gait, deep brain stimulation, surgical treatment, medical treatment, timing of surgery, medication adjustment
- MeSH terms
- Dyskinesia, Drug-Induced, Humans, Levodopa, Parkinson Disease, Quality of Life, Risk Factors, Treatment Outcome, Dopamine Agonists, Neurosurgical Procedures, Deep Brain Stimulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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