Motor Complications of Dopaminergic Medications in Parkinson's Disease

Abstract

Motor complications are a consequence of chronic treatment of Parkinson’s disease (PD) and include motor fluctuations (wearing-off phenomenon) and levodopa-induced dyskinesia. Both can have a significant impact on functionality and quality of life and thus proper recognition and management is essential. The phenomenology and temporal relationship of motor complications to the schedule of levodopa dosing can be helpful in characterizing them. There are several therapeutic approaches to motor complications, including pharmacological and surgical options. The current review summarizes the different types of motor complications according to phenomenology and the currently available medical treatments, including ongoing trials for management of this condition.

The influence of SLC6A3 and DRD2 polymorphisms on levodopa-therapy in patients with sporadic Parkinson's disease

“…No significant association was observed between motor fluctuation and the TaqIA polymorphism in a multivariate analysis, although there was an increased risk for the development of motor fluctuations related to the daily dose of levodopa, corroborating with data found by Freitas et al …”

“…In the present study, as previously suggested by Sharma et al the risk of dyskinesia was a consequence of an interaction among intrinsic factors, such as age, gender and genetics (patient-related) and extrinsic factors such as the use of dopamine agonists, L-DOPA dose, COMT and MAO inhibitors (medication-related). [8,9] Furthermore, in this study, an additional association was observed with the degree of disease severity. Regarding the DRD2/ANKK1 rs1800497 no significant difference was verified in relation to the development of motor fluctuation or dyskinesia in both univariate and multivariate analyses, similar to the results observed by Rieck et al [35] On the other hand, Wang et al [14] found an association with the TaqIA A1/A1 genotype with the development of motor fluctuation in a Chinese population.…”

“…In the present study, as previously suggested by Sharma et al . the risk of dyskinesia was a consequence of an interaction among intrinsic factors, such as age, gender and genetics (patient‐related) and extrinsic factors such as the use of dopamine agonists, L‐DOPA dose, COMT and MAO inhibitors (medication‐related) . Furthermore, in this study, an additional association was observed with the degree of disease severity.…”

“…[4] Moreover, some studies have reported that PD patients treated with levodopa and/or other antiparkinsonian drugs over a long period of time may experience side effects, such as dyskinesia and motor fluctuation, which are present in 40% of all patients with PD. [6][7][8][9] In addition, previous studies have reported that these side effects may emergence due to an interindividual heterogeneity in the response to the pharmacological treatment adopted over the course of PD. [9,10] These different responses may, at least in part, can be explained by intrinsic and extrinsic factors.…”

“…[6][7][8][9] In addition, previous studies have reported that these side effects may emergence due to an interindividual heterogeneity in the response to the pharmacological treatment adopted over the course of PD. [9,10] These different responses may, at least in part, can be explained by intrinsic and extrinsic factors. [10][11][12] Some genes related to the therapeutic response to treatment to levodopa have been investigated in PD.…”