Annals of Indian Academy of Neurology
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MINI SERIES
Year : 2017  |  Volume : 20  |  Issue : 3  |  Page : 190-198

Levodopa-induced dyskinesia: Clinical features, pathophysiology, and medical management


1 Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
2 Department of Medicine, Division of Neurology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand

Correspondence Address:
Sanjay Pandey
Department of Neurology, Academic Block, Room No 507, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_239_17

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Levodopa-induced dyskinesia (LID) is commonly seen in Parkinson's disease patients treated with levodopa. This side effect is usually encountered after long duration of treatment, but occasionally, this may be seen even after few days or months of treatment. LID is broadly classified as peak-dose dyskinesia, wearing-off or off-period dyskinesia, and diphasic dyskinesia. Pathogenesis of LID is complex, and different neurotransmitters such as dopamine, glutamine, adenosine, and gamma-aminobutyric acid play important role altering the normal physiology of direct and indirect pathway of cortico-basal ganglia-thalamic loop responsible for fine motor control. Treatment of LID requires careful history taking and clinical examination to find the type of dyskinesia as different approach is required for different types. Changes in dopaminergic medication including continuous dopaminergic stimulation are very helpful in the management of peak-dose dyskinesia. Different types of surgical approaches including unilateral pallidotomy and deep brain stimulation have given very good result in patients, who cannot be managed by medications alone. The surgical management of LID is dealt with in detail in another review in this series.


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