Sanjay Jaiswal
Jaiswal Hospital and Neuro Institute, India
Title: Dyskinesia associated with old and new therapies in Parkinson’s disease
Biography
Biography: Sanjay Jaiswal
Abstract
Parkinson’s disease is a neurodegenerative disorder that affects approximately 1% of people over the age of 60 years. Levodopa is standard, and often initial, therapy for patients with this condition. However, with continued treatment and as the disease progresses, up to 80% of patients experience ‘wearing-off’ symptoms, dyskinesia and other motor complications. Younger age of Parkinson’s disease onset, disease severity, and high levodopa doses increase the risk of development of levodopaâ€induced dyskinesia (LID). Recent studies indicate the importance of pulsatile stimulation of striatal postsynaptic receptors in pathogenesis of LID. The nonâ€human primates with MPTPâ€induced Parkinsonism serve as a useful model to study dyskinesia. Once established, LID is difficult to treat and, therefore, efforts should be made to prevent it. The therapeutic and preventative strategies for LID include using a lower dosage of levodopa, employing dopamine agonists as initial therapy in Parkinson’s disease such as amantadine, use of atypical neuroleptics and neurosurgery. In recent studies, among 124 patients with Parkinson’s disease, 87 (70%) had received a levodopa preparation. Among these 87 patients, 28% were experiencing treatment-induced dyskinesias and 40% showed response fluctuations. The newer, non-ergoline dopamine agonists such as pramipexole and ropinirole have undergone extensive studies to evaluate their efficacy as monotherapy in early Parkinson’s disease. Amantadine is a non-competitive NMDA receptor antagonist shown to lower dyskinesia scores and improve motor complications in patients with Parkinson’s disease when given adjunctively with levodopa. These newer agonists are ideal initial symptomatic medications, primarily because they delay the onset of levodopa-induced motor fluctuations. So, it can be concluded that there is less chances of developing dyskinesia when patient is on newer anti parkinsonian drugs as compared to older agents.