Severe evening dyskinesias in advanced Parkinson's disease: Clinical description, relation to plasma levodopa, and treatment

Authors

  • Thomas R. Zimmerman Jr.,

    1. Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.
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  • Jacob I. Sage,

    1. Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.
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  • Anthony E. Lang,

    1. Division of Neurology and the Playfair Neurosciences Unit, University of Toronto, The Toronto Hospital, Toronto, Ontario, Canada
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  • Dr. Margery H. Mark

    Corresponding author
    1. Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.
    • Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, CN-19, New Brunswick, NJ 08903, U.S.A.
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Abstract

We report four patients with Parkinson's disease who had an unusual pattern of severe chorea and dystonia in the evenings only. The temporal pattern of abnormal movements and simultaneous monitoring of plasma levodopa and clinical state were consistent with dyskinesias associated with subtherapeutic (low dopa dyskinesias) rather than peak concentrations of levodopa (high dopa dyskinesias). In two patients, addition of a direct-acting dopamine receptor agonist was helpful in ameliorating this complication of anitparkinson therapy.

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