Parkinson’s medications like levodopa can cause motor symptoms known as dyskinesia. Another set of motor symptoms, dystonia, can also develop as a side effect of Parkinson’s medications, or as a direct symptom of Parkinson’s or another movement disorder.
Parkinson’s disease is a neurological disorder characterized by a lack of the neurotransmitter dopamine in the brain. This chemical messenger is responsible for controlling muscle movements. When dopamine levels are low, signaling is disrupted, leading to the development of movement disorders. Parkinson’s is treated with dopaminergic treatments to increase dopamine levels or mimic the chemical to improve symptoms.
Movement disorders such as Parkinson’s disease are associated with the symptoms of dyskinesia and dystonia.
Dyskinesia is a set of motor symptoms that affects about half of people with Parkinson’s disease who use levodopa. These symptoms include jerky, involuntary movements of the face, arms, legs, or trunk. Women and those diagnosed with Parkinson’s before the age of 60 are more likely to develop dyskinesia. Dyskinesia is a side effect of some medications used to treat Parkinson’s disease.
Read more about dyskinesia and its impact on MyParkinsonsTeam members.
Dystonia is another disorder that causes excessive, involuntary muscle contractions that are repetitive and patterned. However, the main difference between dyskinesia and dystonia is that dystonia can be a symptom of Parkinson’s disease itself. It can affect many parts of the body, including the face, jaw, neck, eyelids (blepharospasm), vocal cords, hands, arms, legs, and feet.
Some common symptoms of dystonia include:
Dyskinesia is a common side effect of the Parkinson’s drug levodopa. This drug is used to help increase the level of dopamine in the brain, alleviating symptoms of the disease. However, levodopa is taken intermittently throughout the day, causing dopamine levels to rise and fall over time. These fluctuations are thought to be the cause of dyskinesia. There are two types of dyskinesia:
While dystonia can be a symptom of Parkinson’s disease itself, it can also be caused by levodopa treatment, similar to dyskinesia. Dystonia symptoms occur when there is a decrease in brain dopamine levels, which can occur before medication is taken in the mornings or as it is wearing off during the day. This “off” and “on” dystonia can be addressed by taking an extended-release form of levodopa, or increasing the number of doses taken per day.
Dystonic dyskinesia can occur when the movements caused by levodopa are more sustained and twisting than in typical dyskinesia. When this occurs, it is important to determine the cause — whether the movement occurs at peak-dose levels of dopamine or it is “off” and “on” dystonia.
There are many types of dystonia unrelated to Parkinson’s disease. Many forms of dystonia occur with no known cause. Some causes of dystonia are hereditary, while brain injury (from trauma or stroke) can also cause dystonia.
Huntington’s disease is a rare, genetic condition in which nerve cells in the brain degenerate over time. This disease causes movement disorders similar to Parkinson’s, including chorea and dystonia.
Multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are other rare, degenerative disorders that affect muscle movements. Dyskinesia can occur when people with MSA or PSP are treated with levodopa, and untreated MSA or PSP can lead to the development of dystonia.
Your neurologist may suggest adding a new medication, switching the form of levodopa you take, or even having a surgical implant to help you manage dyskinesia.
Dopamine receptor agonists are another type of drug used to treat Parkinson’s disease. These function by mimicking the action of dopamine and interacting with neurons in the brain to relieve symptoms. Dopamine receptor agonists can be used alone or added to levodopa to help control dyskinesia. Examples of these drugs include Requip (ropinirole), Mirapex (pramipexole), Apokyn (apomorphine), and Neupro (rotigotine).
Gocovri (amantadine) is another clinically available drug that can reduce dyskinesia and help Parkinson’s symptoms. Gocovri works by increasing the amount of dopamine in the brain, which alleviates movement symptoms associated with the disease.
Another way to combat dyskinesia is to lower the dose of levodopa or change the time of day in which it is taken. There is also an extended-release form of levodopa available, which steadily releases the drug over a longer period of time. This helps prevent peak-dose or diphasic dyskinesia.
Deep brain stimulation (DBS) is a surgical procedure used to help control motor symptoms and dyskinesia caused by taking levodopa. During one surgery, thin electrodes are inserted into areas of the brain responsible for controlling movement. A small impulse generator is implanted during another surgery later. Once the DBS system is in place, the electrodes send tiny electrical pulses to these brain areas to stimulate them. DBS helps the brain maintain normal movement activity while lowering the dose of levodopa required to alleviate symptoms.
Dystonia can be treated in many of the same ways as dyskinesia, such as with dopaminergic medications and DBS. However, there are other ways to manage this condition, including Botox (botulinum toxin), physical therapy to work the dystonic muscles, or anticholinergic medications.
Botox (botulinum toxin) is most well known for its cosmetic uses, such as for decreasing wrinkles. However, it can also be used to manage dystonia. This toxin comes from the bacteria Clostridium botulinum, which interferes with the chemical acetylcholine, used by nerve endings in muscles to send messages. When this communication is interrupted, the muscles are weakened, which can alleviate certain symptoms of Parkinson’s.
Similar to botulinum toxin, anticholinergic medications can be used to interfere with acetylcholine signaling between the nerves and muscles. These include Artane (trihexyphenidyl), Parsitan (ethopropazine), and Cogentin (benztropine mesylate).
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