From the Guidelines
Levodopa-induced dyskinesia can be managed by adjusting the patient's diet and medication regimen, particularly by redistributing protein intake throughout the day and considering a reduction in levodopa doses if necessary.
Treatment Options
- Protein redistribution diet: This involves consuming a low-protein breakfast and lunch, and eating a larger portion of protein at dinner, which can help improve motor function and reduce dyskinesias 1.
- Reducing levodopa doses: If patients experience onset or worsening of dyskinesias, reducing levodopa doses may be necessary to alleviate symptoms 1.
Key Considerations
- Monitoring and individualization: Patients should undergo active monitoring, and their dietary and medication regimens should be tailored to their individual needs and responses to treatment 1.
- Avoiding complications: Patients should be aware of potential complications, such as weight loss, micronutrient deficits, and hunger, and take steps to mitigate these effects 1.
Evidence-Based Recommendations
The ESPEN guideline recommends advising patients with Parkinson's disease (PD) to take levodopa medications at least 30 minutes before meals and to try a protein-redistribution dietary regimen to maximize levodopa absorption and efficacy 1. Additionally, medical nutrition therapy can improve well-being and quality of life in PD patients, and should be tailored to individual requirements 1.
From the FDA Drug Label
Dyskinesia Levodopa alone, as well as carbidopa and levodopa orally disintegrating tablets, is associated with dyskinesias The occurrence of dyskinesias may require dosage reduction. The treatment for Levodopa (L-Dopa) induced dyskinesia is dosage reduction 2.
From the Research
Treatment Options for Levodopa-Induced Dyskinesia
The treatment for Levodopa-induced dyskinesia (LID) includes several options, such as:
- Adjusting Parkinson's disease (PD) medications to maximize "on" time without troublesome dyskinesia 3
- Using amantadine, a glutamate antagonist, which may be the most effective, easily available, and inexpensive medical treatment for LID 4, 3
- Employing dopamine agonists as initial therapy in PD 5
- Using atypical neuroleptics 5
- Considering neurosurgery, such as deep brain stimulation of the subthalamic nucleus or globus pallidus interna, which appears to be the most effective treatment for LID 4, 3
- Targeting pathways other than the dopaminergic pathway to treat LID, such as using drugs targeting 5-hydroxytryptamine receptors 6
Prevention Strategies
Prevention strategies for LID include:
- Using a lower dosage of levodopa 5
- Employing dopamine agonists as initial therapy in PD 5
- Avoiding high levodopa doses, especially in younger patients with PD 5
Challenges in Treatment
Once established, LID can be difficult to treat, and efforts should be made to prevent them 5. The exact etiology of LID is unknown, but there is evidence that abnormal pulsatile stimulation of dopamine receptors may be contributory 3.