Complications of levodopa therapy in Parkinson’s disease

ABSTRACT

Introduction: Levodopa remains the most effective treatment for the motor symptoms of Parkinson’s disease (PD). However, with chronic treatment, PD patients develop motor complications, which consist of motor fluctuations and dyskinesia. Many new treatments, both medical and interventional, have been developed for the treatment of motor complications but there continues to be an unmet medical need for further treatments.

Areas covered: This manuscript summarizes the phenomenology, pathophysiology, prevalence and current and future treatments of motor complications in PD patients based on a PubMed literature search from 1950s to present.

Expert opinion: Motor complications are prevalent in PD and risk factors for developing these complications are well-known and well characterized. There are many effective medical and interventional treatments for both motor fluctuations and dyskinesia in PD patients. Despite these treatments, many patients still suffer from many hours of ‘Off’ time or dyskinesia that have a profound negative impact on quality of life. There are many exciting treatments under development for motor complications that may provide additional benefit for PD patients.

KEYWORDS:

• Parkinson’s disease
• motor complications
• dyskinesia
• wearing off
• levodopa

Article highlights

• ;Levodopa is the most effective treatment for PD but results in the development of long-term motor complications

• Motor complications are common and occur in almost all PD patients with long-term treatment

• Most data suggests pulsatile stimulation of the dopamine receptor induces motor complications

• Various treatments for motor complications are approved around the world and have a great impact on motor fluctuations and dyskinesia; however, some patient still need interventional procedures to control their motor fluctuations

• Many new treatments are in development for the treatment of motor complications

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.