Teaching Video NeuroImages: The underrecognized diphasic dyskinesia of Parkinson disease

Dyskinesia is a common motor complication in levodopa-treated Parkinson disease (PD), associated with higher doses, greater disease severity, and longer disease duration.1 Often assumed to be a peak-dose phenomenon, the diphasic (beginning-of-dose or end-of-dose) variant may be ignored, as exemplified by a patient with PD whose dyskinesia was initially interpreted as peak-dose (video at Neurology.org). Rapid improvement with apomorphine, a short-acting levodopa-equipotent dopamine agonist, confirmed its diphasic nature.2 Recognition of dyskinesia subtype based on the relationship with levodopa dose cycles (figure) facilitates their differing management in PD: while dopaminergic stimulation needs reduction in peak-dose dyskinesia, it should be increased in diphasic.
Source: Neurology - Category: Neurology Authors: Tags: Parkinson's disease/Parkinsonism, Chorea RESIDENT AND FELLOW SECTION Source Type: research

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The treatment of Parkinson ’s disease is often complicated by levodopa-induced dyskinesia (LID). Nicotinic acetylcholine receptor agonists can alleviate LID in animal models but may be less effective in conditi...
Source: BMC Neuroscience - Category: Neuroscience Authors: Tags: Research article Source Type: research
Publication date: Available online 20 November 2018Source: NeuroImageAuthor(s): David Meder, Damian Marc Herz, James Benedict Rowe, Stéphane Lehéricy, Hartwig Roman SiebnerAbstractParkinson's disease causes a characteristic combination of motor symptoms due to progressive neurodegeneration of dopaminergic neurons in the substantia nigra pars compacta. The core impairment of dopaminergic neurotransmission has motivated the use of functional magnetic resonance imaging (fMRI) in patients with Parkinson's disease to elucidate the role of dopamine in motor control and cognition in humans. Here we review the main i...
Source: NeuroImage - Category: Neuroscience Source Type: research
Background and purposeWeight loss (WL) is a frequent yet under ‐recognized complication of levodopa/carbidopa intestinal gel (LCIG) infusion, as well as a milestone of Parkinson's disease (PD) disability progression. The complex association between WL, poor nutritional status, motor complications and PD progression, however, remains unclear.MethodsConsecutive consenting patients with PD treated with LCIG (n = 44; PD duration, 18.3 ± 6.5 years) were enrolled in an open‐label observational study assessing the extent of WL occurring during LCIG treatment. As secondary aims, we correlated th...
Source: European Journal of Neurology - Category: Neurology Authors: Tags: Original Article Source Type: research
uot P Abstract Virtually every patient affected by Parkinson's disease (PD) eventually requires treatment with L-3,4-dihydroxyphenylalanine (L-DOPA), which leads to complications such as dyskinesia and psychosis. Whereas blockade of serotonin 2A (5-HT2A) receptors appears to be an effective way to reduce both dyskinesia and psychosis, whether it has the potential to eliminate the two phenomena remains to be determined. In a previous study, we showed that highly selective 5-HT2A receptor blockade with EMD-281,014, at plasma levels comparable to those achieved in the clinic, reduced dyskinesia and psychosis-like beh...
Source: Experimental Brain Research - Category: Neuroscience Authors: Tags: Exp Brain Res Source Type: research
Authors: Dragašević-Mišković N, Petrović I, Stanković I, Kostić VS Abstract INTRODUCTION: Levodopa-induced dyskinesias (LID) appears in more than 50% of Parkinson's disease patients after 5 years of treatment and clinicians always have to ensure that there is a balance between the beneficial effect of the treatment and the potential complications. Areas covered: In this review, the authors discuss the treatment of LID. Treatment can be divided into strategies for preventing their occurrence, modification of dopaminergic therapy, and providing more continuous dopaminergic stimulation as well ...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
Despite the effectiveness of levodopa for treatment of Parkinson ’s disease (PD), prolonged usage leads to development of motor complications, most notably levodopa-induced dyskinesia (LID). Persons with PD and...
Source: Journal of NeuroEngineering and Rehabilitation - Category: Rehabilitation Authors: Tags: Research Source Type: research
CONCLUSIONS: Self-selected speed Lokomat training in PD patients can provide clinical enhancements, but is not superior to self-selected speed overground gait training; the influence of VR on motor performance seems to be related to non-motor aspects. CLINICAL REHABILITATION IMPACT: Regarding self-selected speed gait training, there seems to be no difference between RAGT and conventional overground gait training. Other parameter settings for RAGT need to be carefully investigated for a tailored use of RAGT in PD. PMID: 30370751 [PubMed - as supplied by publisher]
Source: European Journal of Physical and Rehabilitation Medicine - Category: Rehabilitation Authors: Tags: Eur J Phys Rehabil Med Source Type: research
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Source: Annals of Neurology - Category: Neurology Authors: Tags: Review Source Type: research
ConclusionsPIGD are characterized by more severe disease manifestations at diagnosis and greater cognitive progression, more frequent hallucinations, psychosis as well as features of DDS than TD patients. We interpret these findings as expression of greater cortical and subcortical involvement in PIGD already at onset. Since PIGD/TD classification is very unstable at onset, our analysis based on stricter definition criteria provides important insight for clinical trial stratification and definition of related outcome measures.
Source: Neurological Sciences - Category: Neurology Source Type: research
This article attempts to identify different patient profiles and matches them with suggested advanced therapies for PD. There is limited literature providing guidance to a busy neurologist to match the most appropriate advanced therapy to the right patient profile. This article attempts to fill that void. Expert commentary: When matching patient profiles to therapy, several features must be considered: age, frailty, cognitive status, phenotype (predominant tremor vs. akinetic rigid), side effect or complication profile (dyskinesia, hallucinations, dysautonomia), and patient's comfort with invasive therapy options. PMID:...
Source: Expert Review of Neurotherapeutics - Category: Neurology Tags: Expert Rev Neurother Source Type: research
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