Conjugate eye deviations as dyskinesias induced by levodopa in Parkinson's disease

Abstract

Involuntary upward and lateral eye movements are described in two Parkinson's disease patients who also experience levodopa-induced choreoathetoid limb movements simultaneously. These brief deviations of gaze represent a rare ocular manifestation of dyskinesia and are similar to oculogyric movements resulting from other causes.

Parkinson's Disease Presenting with Oculogyric Crisis in the Off Period

“…Although OGC caused by sporadic PD has been reported in a few cases, it usually occurs in the peak-dose period of levodopa therapy (4,6). This case is quite unusual in that the OGC occurred in the off period of levodopa treatment.…”

“…OGC is classically caused by postencephalitic parkinsonism or pharmacological effects, including those of antipsychotic agents (2,3). However, there are only a few reports of OGC in patients with Parkinson's disease (PD) (4)(5)(6). Furthermore, in previous reports with case descriptions, OGC in sporadic PD was observed during the peak-dose period (4,6).…”

“…However, there are only a few reports of OGC in patients with Parkinson's disease (PD) (4)(5)(6). Furthermore, in previous reports with case descriptions, OGC in sporadic PD was observed during the peak-dose period (4,6). No studies have found an association between the incidence of OGC in sporadic PD and the off-period phenomenon.…”

Facing the Unique Challenges of Dyskinesias In Parkinson‘s Disease

“…Dystonic movements manifest most commonly as distorted posturing, but can also include mobile dystonia, craniocervical dystonia and blepharospasm [2]. Less commonly, dyskinesia may be seen in the form of stereotypies, myoclonus and respiratory or ocular movements [2][3][4][5]. Whereas occasionally authors have also included akathisia, restlessness and a worsening of baseline tremor in the spectrum future science group of dyskinesia, these movement disorders are not considered dyskinesias in this discussion [6].…”

“…Dystonic dyskinesia often affects the foot, but can also involve the neck and trunk. Cases of ocular dyskinesia have been reported with either large amplitude oscillations of gaze or conjugate upward and lateral gaze deviations [4]. Respiratory dyskinesia is another rare form of dyskinesia and consists of symptomatic dyspnea related to irregular tachypnea alternating with brief episodic apnea experienced after a dose of levodopa [5,7].…”