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Features and Mechanisms of Diphasic Dyskinesia in Parkinson’s Disease

  • Marcelo Merello
  • Inés Trigo Damas
  • José A. Obeso
Chapter

Abstract

Levodopa-induced dyskinesia is normally assessed based on the course of the appearance of their symptoms. Diphasic dyskinesia (DD) usually appears at the beginning and at the end, but not at the peak, of the levodopa effect in long-term treated Parkinson’s disease patients. The most commonly affected subjects with this form of dyskinesia are those who have an early onset of the disease, approaching 20 % of globally treated parkinsonian patients. Typically, they are present in the lower limbs and exhibit rhythmic and sometime stereotypic movement patterns. In the past, DD were a serious management problem and often associated with severe dysautonomic manifestations. Current pharmacological trends to avoid high levodopa use have reduced the incidence of very troublesome DD. When severe, surgical approach may be considered, since pallidotomy typically resolves the movements. In a broader sense, the net predominance of the lower limb in DD is a fascinating mystery of which resolution could lead to important advances in the functional anatomy of the basal ganglia and Parkinson’s disease.

Keywords

Diphasic dyskinesia Low dose levodopa Graft induced dyskinesia Serotonin Dystonia improvement dystonia Stereotyped lower limb dyskinesia 

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Marcelo Merello
    • 1
    • 2
  • Inés Trigo Damas
    • 3
  • José A. Obeso
    • 3
  1. 1.Raul Carrea Institute for Neurological Research (FLENI), Universidad Católica Argentina, CONICETBuenos Aires (1428)Argentina
  2. 2.Raul Carrea Institute for Neurological ResearchBuenos AiresArgentina
  3. 3.Movement Disorders Laboratory, Neuroscience DepartmentCenter for Applied Medical Research (CIMA), University of NavarraPamplonaSpain

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