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Therapeutic strategies to prevent and manage dyskinesias in Parkinson's disease.
Expert Opin Drug Saf. 2015 Feb; 14(2):281-94.EO

Abstract

INTRODUCTION

Chronic treatment with levodopa is associated with the development of motor fluctuations and dyskinesias particularly in young Parkinson patients. In some cases, dyskinesias become so severe that they interfere with normal movement and negatively impact quality of life.

AREAS COVERED

In this review, we discuss benefits and limits of available therapeutic approaches aimed at delaying or managing dyskinesias as well as new strategies that are currently under investigation.

EXPERT OPINION

Among available treatments, monotherapy with dopamine agonists in the early phases of the disease reduces the risk for dyskinesias compared with levodopa. Nevertheless, dopamine agonists are unable to prevent dyskinesias once levodopa is added, which is always required once disease severity progresses. Convincing evidence of dyskinesia improvement has been shown only for deep brain stimulation and to some extent also for duodenal levodopa infusion and subcutaneous apomorphine. These approaches are expensive, have restrictive inclusion criteria and can cause potentially serious side effects. Alternative therapies include drugs targeting nondopaminergic neurotransmitter systems. Amantadine improves dyskinesias but its long-term effect is often unsatisfactory. Glutamatergic and gabaergic compounds have been tested in clinical trials, with promising results. By contrast, adrenergic drugs, fipamezole and idazoxan, did not show antidyskinetic effect.

Authors+Show Affiliations

Parkinson Disease and Movement Disorders Unit, "Fondazione Ospedale San Camillo" - I.R.C.C.S , Via Alberoni 7030126 Venice , Italy , +39 41 2207554 , angelo.antonini@ospedalesancamillo.net.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25483147

Citation

Pilleri, Manuela, and Angelo Antonini. "Therapeutic Strategies to Prevent and Manage Dyskinesias in Parkinson's Disease." Expert Opinion On Drug Safety, vol. 14, no. 2, 2015, pp. 281-94.
Pilleri M, Antonini A. Therapeutic strategies to prevent and manage dyskinesias in Parkinson's disease. Expert Opin Drug Saf. 2015;14(2):281-94.
Pilleri, M., & Antonini, A. (2015). Therapeutic strategies to prevent and manage dyskinesias in Parkinson's disease. Expert Opinion On Drug Safety, 14(2), 281-94. https://doi.org/10.1517/14740338.2015.988137
Pilleri M, Antonini A. Therapeutic Strategies to Prevent and Manage Dyskinesias in Parkinson's Disease. Expert Opin Drug Saf. 2015;14(2):281-94. PubMed PMID: 25483147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic strategies to prevent and manage dyskinesias in Parkinson's disease. AU - Pilleri,Manuela, AU - Antonini,Angelo, Y1 - 2014/12/06/ PY - 2014/12/9/entrez PY - 2014/12/9/pubmed PY - 2015/9/15/medline KW - Parkinson’s disease KW - dyskinesias KW - motor complications KW - therapy SP - 281 EP - 94 JF - Expert opinion on drug safety JO - Expert Opin Drug Saf VL - 14 IS - 2 N2 - INTRODUCTION: Chronic treatment with levodopa is associated with the development of motor fluctuations and dyskinesias particularly in young Parkinson patients. In some cases, dyskinesias become so severe that they interfere with normal movement and negatively impact quality of life. AREAS COVERED: In this review, we discuss benefits and limits of available therapeutic approaches aimed at delaying or managing dyskinesias as well as new strategies that are currently under investigation. EXPERT OPINION: Among available treatments, monotherapy with dopamine agonists in the early phases of the disease reduces the risk for dyskinesias compared with levodopa. Nevertheless, dopamine agonists are unable to prevent dyskinesias once levodopa is added, which is always required once disease severity progresses. Convincing evidence of dyskinesia improvement has been shown only for deep brain stimulation and to some extent also for duodenal levodopa infusion and subcutaneous apomorphine. These approaches are expensive, have restrictive inclusion criteria and can cause potentially serious side effects. Alternative therapies include drugs targeting nondopaminergic neurotransmitter systems. Amantadine improves dyskinesias but its long-term effect is often unsatisfactory. Glutamatergic and gabaergic compounds have been tested in clinical trials, with promising results. By contrast, adrenergic drugs, fipamezole and idazoxan, did not show antidyskinetic effect. SN - 1744-764X UR - https://www.unboundmedicine.com/medline/citation/25483147/Therapeutic_strategies_to_prevent_and_manage_dyskinesias_in_Parkinson's_disease_ L2 - https://www.tandfonline.com/doi/full/10.1517/14740338.2015.988137 DB - PRIME DP - Unbound Medicine ER -