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Off spells and dyskinesias: pharmacologic management of motor complications.
Cleve Clin J Med. 2012 Jul; 79 Suppl 2:S8-13.CC

Abstract

There are two major causes of disability in patients with Parkinson disease: motor fluctuations that occur when a dose of levodopa becomes ineffective, leading to a "wearing off," and hyperkinetic movements (dyskinesias) caused by excessive levels of dopamine. The utility of continuous levodopa treatment is therefore limited by motor complications. Pharmacologic options to treat wearing off include adding (or increasing the dosage of) levodopa, adding (or increasing the dosage of) a dopamine agonist, or adjunctive treatment with a monoamine oxidase inhibitor or catechol-O-methyltransferase inhibitor. Dyskinesias will respond to a reduction in levodopa dosage at the expense of worsening parkinsonism and an increase in the number of "off" episodes. Continuous dopamine stimulation may overcome the pulsatile stimulation of postsynaptic dopamine receptors produced by standard oral formulations of levodopa that lead to motor complications.

Authors+Show Affiliations

Movement Disorders Program, Cleveland Clinic Florida, Weston, FL 33331, USA. khant@ccf.org

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22761271

Citation

Khan, Tarannum S.. "Off Spells and Dyskinesias: Pharmacologic Management of Motor Complications." Cleveland Clinic Journal of Medicine, vol. 79 Suppl 2, 2012, pp. S8-13.
Khan TS. Off spells and dyskinesias: pharmacologic management of motor complications. Cleve Clin J Med. 2012;79 Suppl 2:S8-13.
Khan, T. S. (2012). Off spells and dyskinesias: pharmacologic management of motor complications. Cleveland Clinic Journal of Medicine, 79 Suppl 2, S8-13. https://doi.org/10.3949/ccjm.79.s2a.02
Khan TS. Off Spells and Dyskinesias: Pharmacologic Management of Motor Complications. Cleve Clin J Med. 2012;79 Suppl 2:S8-13. PubMed PMID: 22761271.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off spells and dyskinesias: pharmacologic management of motor complications. A1 - Khan,Tarannum S, PY - 2012/7/5/entrez PY - 2012/7/13/pubmed PY - 2012/11/7/medline SP - S8 EP - 13 JF - Cleveland Clinic journal of medicine JO - Cleve Clin J Med VL - 79 Suppl 2 N2 - There are two major causes of disability in patients with Parkinson disease: motor fluctuations that occur when a dose of levodopa becomes ineffective, leading to a "wearing off," and hyperkinetic movements (dyskinesias) caused by excessive levels of dopamine. The utility of continuous levodopa treatment is therefore limited by motor complications. Pharmacologic options to treat wearing off include adding (or increasing the dosage of) levodopa, adding (or increasing the dosage of) a dopamine agonist, or adjunctive treatment with a monoamine oxidase inhibitor or catechol-O-methyltransferase inhibitor. Dyskinesias will respond to a reduction in levodopa dosage at the expense of worsening parkinsonism and an increase in the number of "off" episodes. Continuous dopamine stimulation may overcome the pulsatile stimulation of postsynaptic dopamine receptors produced by standard oral formulations of levodopa that lead to motor complications. SN - 1939-2869 UR - https://www.unboundmedicine.com/medline/citation/22761271/Off_spells_and_dyskinesias:_pharmacologic_management_of_motor_complications_ L2 - https://www.ccjm.org/cgi/pmidlookup?view=long&pmid=22761271 DB - PRIME DP - Unbound Medicine ER -