Abstract
After more than 40 years of clinical use, levodopa (LD) still remains the gold standard for symptomatic efficacy in Parkinson’s disease (PD). However, long-term treatment with LD is often complicated by the development of various types of motor response oscillations as well as drug-induced dyskinesias. These treatment-related motor complications evolve in approximately one-third of patients after only 2 years of LD exposure and, once established, they are difficult to treat and significantly contribute to overall disability and disease burden. Although first described soon after the introduction of LD, the pathophysiology of motor complications is still not completely understood. In fact, it is most likely that non-physiological pulsatile stimulation of dopamine receptors, which is followed by various downstream alterations, plays a key role in the development of LD-induced motor response oscillations and dyskinesias. This review outlines the various types of motor complications and will also address underlying mechanisms, treatment options, as well as impact on clinical disability and quality of life (QoL).
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Conflict of interest
Klaus Seppi has received honoraria for speaking and consulting from Novartis, Boehringer Ingelheim, Lundbeck, Schwarz Pharma, UCB Pharma, and GlaxoSmithKline. Werner Poewe served as a consultant for Boehringer Ingelheim, Esai Ltd., Novartis, Sovay, and Teva. He was in the advisory panel for Boehringer Ingelheim, Esai Ltd., Genzyme, Novartis, Schering Plough, Sovay, Teva, and Valeant. He received research support from Boehringer Ingelheim and Astra Zeneca. He serves as a review editor for the Journal of Neurology and as a member of the editorial advisory board for the European Journal of Neurology. E. Hametner has no conflicts of interest.
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Hametner, E., Seppi, K. & Poewe, W. The clinical spectrum of levodopa-induced motor complications. J Neurol 257 (Suppl 2), 268–275 (2010). https://doi.org/10.1007/s00415-010-5719-9
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DOI: https://doi.org/10.1007/s00415-010-5719-9