The meaning of dyskinesia comes from dys, referring to “not correct”, and kinesia referring to “movement”. Dyskinesia is characterized by abnormal, involuntary wriggling movements that some describe as random dance-like motions. It tends to happen most frequently when other Parkinson’s disease (PD) symptoms are under control (Michael J. Fox Foundation, n.d.). These movements are different from the common Parkinson’s disease tremor. Dyskinesia can affect part of the body or the entire body, including the legs, arms, trunk, head, face, mouth, and tongue. Some people with Parkinson’s report that it is more troubling than the disease itself (Michael J. Fox Foundation, n.d.).

 

Causes of Dyskinesia

It is important to note that not all people living with PD will experience dyskinesia. Although dyskinesia is not a direct symptom of Parkinson’s disease, it can be a side effect of medication prescribed to treat PD, commonly levodopa/carbidopa. However, it can occur as a result of any medication that stimulates dopamine’s effect at its receptor site, including dopamine agonists, monoamine oxidase type B (MAO B) inhibitors, and catechol-O-methyl transferase (COMT) inhibitors (Liang, 2023).

Dyskinesia occurs most commonly during the peak effects of the medication, called peak-dose dyskinesia. It can also occur at the start of a dose when it is beginning to take effect (wearing “on”), and similarly at the end of the dose, when the effects of the medication are starting to wear off (wearing “off”). As Parkinson’s disease progresses further, the time when levodopa works well can become much shorter (Michael J. Fox Foundation, n.d.). Its effect may begin to wear off in just three to four hours (Liang, 2023). People might go quickly from feeling the effects of the medication (“on”) to experiencing a decrease in its effectiveness (“off”), and this swift change is called “on-off fluctuations” (Aradi & Hauser, 2020). Dyskinesia may also fluctuate in an individual due to stress or excitement (Michael J. Fox Foundation, n.d.).

While the connection between levodopa and dyskinesia typically depends on the dosage, the threshold for experiencing dyskinesia varies significantly among individuals with PD. For example, some patients may develop dyskinesia even at relatively low doses of levodopa (at 100 mg per dose). Additionally, dyskinesia is more prevalent among individuals with early-onset Parkinson’s, and tends to be less troublesome in those with later-onset disease (over 80 years of age) (Liang, 2023).

However, as Parkinson’s disease advances, the brain cells that help control movement start to break down. Levodopa converts into dopamine in the brain to help with movement, but as the disease progresses, the body has a harder time storing and releasing levodopa. This means that the effects of the medication don’t last as long as they should, and the ups and downs of its effectiveness become more noticeable (Liang, 2023). Ultimately, over time, most people with PD are likely to experience dyskinesia no matter how long they have been on treatment. In fact, studies have shown that the majority of people diagnosed with Parkinson’s will develop levodopa-induced dyskinesia approximately 15 to 20 years following their diagnosis (Aradi & Hauser, 2020). If you are experiencing dyskinesia, be sure to record when it occurs during your medication cycle, as this information can be helpful for your healthcare team.

 

Managing Dyskinesia

It is best to discuss the options for managing dyskinesia with your medical team. They will work to minimize your movement problems to get the most “on” time without dyskinesia. It can be a lengthy process to determine the correct dose, timing, and type of medication, as each individual is different and treatment needs can change over time.

Some people with PD choose to live with mild dyskinesia, as they are not bothered by it and feel that treating it may be more disruptive to the treatment of other, more serious symptoms. It is best for the healthcare team, family, and friends to ask the person with Parkinson’s what their preference is, so medication and lifestyle can be managed accordingly.

There are ways to manage dyskinesia through the use or modification of medications, including (Michael J. Fox Foundation, n.d.):

  • Adjusting the amount and/or schedule of levodopa to find the right balance: making sure you receive adequate doses to manage your symptoms without taking too much, which might lead to dyskinesia.
  • Trying extended-release levodopa.
  • Using the drug amantadine, which is an antidyskinetic medicine: this medication works on a neurotransmitter in the brain called glutamate and can help control dyskinesia.
  • Speaking to your doctor about Deep Brain Stimulation (DBS) surgery: DBS may be an option for those who experience dyskinesia or substantial “off” periods.

 

Sources

Aradi, S.D., Hauser, R.A. Medical Management and Prevention of Motor Complications in Parkinson’s Disease. Neurotherapeutics 17, 1339–1365 (2020). https://doi.org/10.1007/s13311-020-00889-4

Liang, T (2023). Medical management of motor fluctuations and dyskinesia in Parkinson disease. https://www.uptodate.com/contents/medical-management-of-motor-fluctuations-and-dyskinesia-in-parkinson-disease

Michael J. Fox Foundation (n.d.). Dyskinesia. https://www.michaeljfox.org/news/dyskinesia

Okun, M. S. & Fernandez, H. H. (2010). Ask the doctor: Parkinson’s disease. New York, NY. Demos Medical Publishing.

Weiner, W. J., Shulman, L. M. & Lang A. E. (2001). Parkinson’s disease: A complete guide for patients & families. Baltimore, MD: The John Hopkins University Press.

Wile, Daryl (2018). Personal communication.


Last updated: January 10, 2024