Motor Fluctuations

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Clinical spectrum of levodopa-induced complications

By Camila Catherine Aquino MD, MSc and Susan H. Fox MRCP (UK), PhD*

ABSTRACT
The first years of Parkinson disease (PD) treatment are marked by good and sustained responses to dopaminergic therapy. With disease progression and longer exposure to levodopa (L-dopa), patients develop a range of L-dopa–induced complications that include motor and non-motor symptoms. Motor complications include motor fluctuations, characterized by periods of reduced benefit from the medication, and L-dopa–induced dyskinesia, characterized by emergence of hyperkinetic involuntary movements. Dyskinesia can occur at peak effect of L-dopa, at the beginning and end of dose, or between doses. These motor complications are often associated with fluctuations in non-motor symptoms, particularly fluctuations in neuropsychiatric, autonomic, and sensory symptoms. Recognizing such complications and understanding their relationship with the timing of L-dopa doses is essential for adequate diagnosis and management. © 2014 International Parkinson and Movement Disorder Society

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