motor fluctuation

Frequent on-off periods, freezing & dyskinesias associated with Parkinson's disease & its treatment. Pathology: - dyskinesias usually result from peak levels of L-dopa, 1 hour after Sinemet dose, but may be biphasic Management: 1) identify when symptoms occur; patient diary 2) frequent low-dose Sinemet 3) adjunct use of dopamine agonist 4) entacapone to increase t1/2 of L-dopa 5) amantadine can be helpful 6) clozapine may be useful in severe cases (frequent blood monitoring) 7) surgery when all else fails

References

Bronstein J, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004