The long-term management of Parkinson disease is commonly accompanied by the development of motor fluctuations and drug-induced dyskinesias. These motor complications present a major challenge in the effective management of this disease. In this clinical article, Dr. Gancher of Oregon Health Sciences University discusses a number of recent studies that clarify the understanding of changes in basal ganglia metabolism underlying these motor effects. In addition, a number of recent treatment advances, including updated information on a recent trial comparing different deep brain stimulation targets and surgical treatment options are outlined.
In most patients, long-term treatment of Parkinson disease with levodopa is complicated by the gradual emergence of dyskinesias and motor fluctuations.
Medical treatment options for dyskinesias and fluctuations are aimed at producing a more stable delivery of drugs to the brain. These include readjustment of levodopa doses and timing, drugs that inhibit levodopa or dopamine metabolism (COMT and MAO-B inhibitors), dopamine agonists, and restriction of dietary protein.
In patients with severe dyskinesias or motor fluctuations, deep brain stimulation is generally more effective than medication adjustments.
Pallidal and subthalamic stimulation produce roughly equal benefits in motor function, dyskinesias, and quality of life.