Parkinson’s Disease: Diphasic Dyskinesia

  • Roongroj Bhidayasiri
  • Daniel Tarsy
Part of the Current Clinical Neurology book series (CCNEU)


Diphasic dyskinesia (DD) is a complex pattern of levodopa (LD) dyskinesia in patients with Parkinson’s disease (PD) in which involuntary movements occur during both peak and trough LD effects. End of dose dyskinesia is usually more severe and often differs in appearance from peak-dose dyskinesia. It commonly causes ballistic flexion-extension, kicking, or bicycling leg movements which often force the patient into a reclining position. There may be associated dystonic postures, mental distress, and autonomic manifestations. DD often occurs toward the end of the day and may sometimes occur only once daily following the final dose of LD when it has been called “evening dyskinesia.”


Deep Brain Stimulation Mental Distress Involuntary Movement Dystonic Posture Recline Position 
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Supplementary material

PD-Diphasic dyskinesia.mp4 (MP4 16,904KB)

The patient is reclining on a couch with continuous jerky dystonic posturing in her upper limbs and trunk and repetitive kicking movements of the right leg.


  1. 1.
    Apetauerova D, Ryan R, Ro SI, et al. End of day dyskinesia in advanced Parkinson’s disease can be eliminated by bilateral STN or GPi deep brain stimulation. Mov Disord. 2006;21:1277–9.PubMedCrossRefGoogle Scholar
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    Zimmerman TR, Sage JL, Lang AE, Mark MH. Severe evening dyskinesias in advanced Parkinson’s disease: clinical description, relation to plasma levodopa, and treatment. Mov Disord. 1994;9:173–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Roongroj Bhidayasiri
    • 1
    • 2
  • Daniel Tarsy
    • 3
  1. 1.Chulalongkorn Center of Excellence on Parkinson’s Disease and Related DisordersChulalongkorn University HospitalBangkokThailand
  2. 2.Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of NeurologyHarvard Medical School Beth Israel Deaconess Medical CenterBostonUSA

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