Levodopa-induced dyskinesia in Parkinson disease: Current and evolving concepts.

Espay, Alberto J; Morgante, Francesca; Merola, Aristide; Fasano, Alfonso; Marsili, Luca; Fox, Susan H; Bezard, Erwan; Picconi, Barbara et al. · Ann Neurol · 2018

review · Level V

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Abstract

Levodopa-induced dyskinesia is a common complication in Parkinson disease. Pathogenic mechanisms include phasic stimulation of dopamine receptors, nonphysiological levodopa-to-dopamine conversion in serotonergic neurons, hyperactivity of corticostriatal glutamatergic transmission, and overstimulation of nicotinic acetylcholine receptors on dopamine-releasing axons. Delay in initiating levodopa is no longer recommended, as dyskinesia development is a function of disease duration rather than cumulative levodopa exposure. We review current and in-development treatments for peak-dose dyskinesia but suggest that improvements in levodopa delivery alone may reduce its future prevalence. Ann Neurol 2018;84:797-811.

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