Recommended medications and surgeries for dyskinesia treatment

Involuntary, erratic, and writhing movement of the muscles is termed as dyskinesia. While 60% to 70% of all patients suffer from mild to moderate cases of dyskinesia, only 3% suffer from severe cases of the disease. Patients suffering from mental conditions like schizophrenia and bipolar disorder are usually at risk of suffering from this disease. It has also been observed that patients who take medications to manage Parkinson’s disease also suffer from dyskinesia as a side effect. This article sheds light on two popular treatment options that can help one manage dyskinesia.

Medications
Dyskinesia treatment can be complex; if the disease is because of Parkinson’s disease’s medications, doctors might change dosage levels to manage the side-effects. As the first line of treatment, doctors typically change the dosage of Levodopa, which is an amino acid that specifically manages symptoms of Parkinson’s disease. However, changing the dosage could also result in other side effects like rigidity, tremors, and slow movements. It has also been observed that changing the dosage of this medicine can also induce dyskinesia. This condition is termed as levodopa-induced dyskinesia. Hence, it is important to find the perfect balance between the medicine dosage and its associated side effects.

Apart from this, doctors also increase the dosage of dopamine agonists and decrease Levodopa dosage. FDA-approved dopamine agonists can be orally and intravenously administered. Increasing the dosage of these medications helps better manage side effects like dyskinesia. Switching the type of dopamine agonist can also improve dyskinesia symptoms. Some experts also suggest logging the time, duration, and frequency of episodes of dyskinesia symptoms into a diary. This helps determine a link between dyskinesia symptoms and medications as well as help the doctors assess the effectiveness of medications accordingly and adjust dosages.

Since most cases of dyskinesia are mild to moderate, they can be controlled through medications. However, surgical therapies might be needed for severe cases of dyskinesia.

Surgical intervention
Since severe cases of dyskinesia are rare, there are fewer surgical therapies compared to medications. One such device-assisted surgical therapy is continuous levodopa-carbidopa intestinal gel (LCIG) infusion. It involves the continuous and percutaneous infusion of levodopa into the intestine through a small feeding tube. This helps in maintaining motor movements and reducing dyskinesia symptoms. Continuous subcutaneous apomorphine infusion (CSAI) involves administering apomorphine subcutaneously. This therapy has the same effect as LCIG as it helps in better controlling motor function. CSAI and LCIG may be used in conjunction with other medications for severe cases of dyskinesia.

Device-assisted surgical therapies like deep brain stimulation (DBS) can be used for treating severe cases of dyskinesia. It involves implanting a small pacemaker-like device in the brain to send signals and manipulate movements. The areas in the brain that are involved include the internal globus pallidus and the subthalamic nucleus (STN). The signals sent from the pacemaker stop the brain’s messages from relaying the disabling motor messages for better symptom control. The pacemaker-like device needs to be controlled by a specialist programmer. However, DBS is one of those treatments that are not suitable for every dyskinesia patient.

It is necessary to be aware of the side-effects associated with surgical interventions like LCGI, CSAI, and DBS. While these surgical therapies improve dyskinesia symptoms, some patients might also experience changes in personality as well as episodes of confusion, apathy, mania, and even depression. So, it is important to consult a doctor and talk about the side effects associated with dyskinesia before agreeing to undergo surgical therapies.

It is observed that dyskinesia treatments are not effective in patients with a high-protein diet as this nutrient makes absorbing the medications difficult for the body. So, it is necessary to consult a dietician for planning a balanced, low-protein diet.