Therapy for dyskinesias in Parkinsons disease patients

Alessandro Stefani, Mariangela Pierantozzi, Giacomo Koch, Salvatore Galati, Paolo Stanzione

Research output: Contribution to journalArticlepeer-review

Abstract

Dyskinesia hampers the quality of life for most Parkinsons disease patients following several years of therapy. However, the severity of L-Dopa-induced dyskinesia (LID) varies between patients, being quite tolerable in late-onset patients. Understanding the pathogenesis of LID has contributed to the development of a set of therapeutic strategies, including the choice, in early stages, of the least pulsatile regimen of dopamine-receptor activation. In cases where LIDs are already disabling, there is only a limited number of options: the optimization of ongoing DOPA-centered treatment, the utilization of glutamate antagonists and the exploration of the benefits of antipsychotic agents. More radical solutions are provided by deep brain stimulation in the subthalamic nucleus (or internal pallidus). This approach has proved efficacious in reducing LID, largely because it allows a reduction in dopaminergic daily doses. Stereotactic neurosurgery has fuelled several lines of investigation regarding the crosstalk between the basal ganglia and motor cortex. Here, we will present interesting evidence highlighting the potential for repetitive transcranial stimulation in reducing the occurrence of LID. The future may disclose important new avenues for the treatment of LIDs, given the current development of promising agents that might target different facets of dyskinesia, such as the impairment of striatal plasticity and non-Dopaminergic contributors such as adenosine, nitric oxide and the nucleotide cascade.

Original languageEnglish
Pages (from-to)277-299
Number of pages23
JournalFuture Neurology
Volume5
Issue number2
DOIs
Publication statusPublished - Mar 2010

Keywords

  • Basal ganglia plasticity
  • Continuous dopaminergic stimulation
  • Cortical plasticity
  • Deep brain stimulation
  • Involuntary movements
  • Levodopa
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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