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Levodopa-induced dyskinesia: clinical features, incidence, and risk factors

  • Neurology and Preclinical Neurological Studies - Review Article
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Abstract

Symptoms of Parkinson’s disease have been controlled with levodopa for many years; however, motor complications consisting of wearing off of medication effect and dyskinesias tend to occur within a few years of starting levodopa. Motor complications can begin a few months after taking levodopa, with the average time to onset estimated to be 6.5 years. Dyskinesias can be troublesome and require intervention. Levodopa-induced dyskinesia can be composed of a variety of movement disorders including chorea, dystonia, ballism, myoclonus, and akathisia. Based on the clinical pattern, the most common dyskinesia is chorea and choreoathetosis. The clinical manifestations can be divided into three main categories based on their clinical movement patterns and the temporal correlation between the occurrence of dyskinesia and the levodopa dosing: on or peak-dose dyskinesias, biphasic dyskinesias, and Off dyskinesias. Severe cases of dyskinesia have been reported, with the extreme being dyskinesia–hyperpyrexia syndrome. The prevalence of LID has been reported in many studies, but the reported incidence varies. The rate of LID development is from 3 to 94%. The prevalence of LID mainly depends on age at onset, disease duration, and severity, and duration of levodopa therapy. Some of the risk factors for the development of dyskinesia are modifiable. Modifiable risk factors include levodopa dose and body weight. Non-modifiable risk factors include age, gender, duration of disease, clinical subtype, disease progression, disease severity, and genetic factors.

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Authors and Affiliations

  1. Neurology Department, University Medical Center, Ho Chi Minh City, Vietnam

    Tai N. Tran

  2. Neurology Department, International Neurosurgery Hospital, Ho Chi Minh City, Vietnam

    Trang N. N. Vo

  3. Loma Linda University, Loma Linda, CA, 92354, USA

    Karen Frei

  4. The Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, 92708, USA

    Daniel D. Truong

  5. Department of Psychiatry and Neuroscience, UC Riverside, Riverside, CA, USA

    Daniel D. Truong

Authors
  1. Tai N. Tran
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  2. Trang N. N. Vo
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  3. Karen Frei
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  4. Daniel D. Truong
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Correspondence to Daniel D. Truong.

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Conflict of interest

Drs. Frei, Tran, and Vo have no conflicts of interest to declare. Daniel Truong reports research Grants from Ipsen, Merz, Auspex, Daiichi Sankyo Pharma, AbbVie, National Institute of Neurological Disorders, and Stroke, Kyowa, Neurocrine, Sunovion Pharmaceuticals, Acadia, Accorda, Cynapsus, Neuroderm, Prexton Therapeutics, and Intec. He reports receiving honoraria from Teva Pharmaceutical Industries, Alexza Pharmaceuticals, Inc., Adamas Pharmaceuticals, Revance Therapeutics, and US WorldMeds.

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Tran, T.N., Vo, T.N.N., Frei, K. et al. Levodopa-induced dyskinesia: clinical features, incidence, and risk factors. J Neural Transm 125, 1109–1117 (2018). https://doi.org/10.1007/s00702-018-1900-6

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  • DOI: https://doi.org/10.1007/s00702-018-1900-6

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