Dyskinesia, or involuntary and uncontrolled movement, can range in its severity and may look like fidgeting or swaying. For many people, living with dyskinesia is easier than dealing with the symptoms of Parkinson’s, says Alex Pantelyat, MD, an assistant professor of neurology at the Johns Hopkins School of Medicine, in Baltimore. But for others, it can be painful and can interfere with their social activities. The goal is to find a treatment regimen that minimizes your side effects and allows you to live a full life with Parkinson’s disease. Here are eight ways to manage dyskinesia.
1. Talk to your doctor about changing your medication dosage.
Levodopa is more likely to cause side effects like dyskinesia when it’s taken in higher doses. “More than 600 milligrams a day in the long run is associated with a greater incidence of dyskinesia,” says Dr. Pantelyat. That’s why it’s important to find the lowest dose that will still control your symptoms. Your doctor will work to do this by starting you on a low dose and gradually increasing it as needed.
2. Tweak the timing of your medication.
The timing of medication is also a consideration, because of “wearing off” phenomenon, in which some patients feel that the effects of the medication end about four hours after a dose. Your doctor may decide to split your daily medication into smaller, more frequent doses. Doing so may deliver a steadier amount of medication to the body, according to a 2016 research review in the European Medical Journal. Your doctor may also suggest a switch to extended-release pills, which work in a similar manner. The downside to these formulations, however, is that they tend to require more of the drug to achieve the same result.
3. Take additional medication for your Parkinson’s disease.
Taking a medication called a dopamine agonist can allow your doctor to reduce your levodopa dosage, which may help ease the symptoms of dyskinesia. (Unlike levodopa, which is converted to dopamine in the brain, dopamine agonists mimic the actions of naturally occurring dopamine, according to the American Parkinson Disease Association.) However, according to the 2016 review, these drugs can cause similar side effects as those of levodopa for some people and may require you to adjust your dose of levodopa. Adding amantadine (Gocovri, Osmolex ER) to your treatment regimen may also provide relief of dyskinesia symptoms.
4. Talk to your doctor about continuous drug infusion.
One way to potentially avoid fluctuations in medication delivery and dopamine levels is through a continuous drug delivery system such as duodenal infusion, in which the medication travels through a tube directly into the intestine. Another option is continuous subcutaneous apomorphine infusion, in which a small device similar to an insulin pump is clipped to the clothing, according to the Parkinson’s Foundation. A wire then enters the skin to deliver a steady dose of the medication apomorphine (Apokyn), a dopamine agonist, which may reduce the “off” periods, when levodopa stops working, and may minimize dyskinesia symptoms.
5. Consider deep brain stimulation.
For severe symptoms that don’t improve with medicine, your doctor may recommend a surgical treatment, such as deep brain stimulation. This type of procedure, which involves attaching thin wires onto specific parts of the brain that control movement and delivering electronic pulses through the wires, has been shown to reduce dyskinesia by more than 80 percent, according to the 2016 review. After the surgery, most people are able reduce their need for medications, which may be related to the improvement in dyskinesia. It’s also possible that the stimulation itself helps counteract dyskinesia. “Deep brain surgery has the greatest promise on an individual level,” says Pantelyat. But there are also risks. “Depending on the experience of the surgeon,” he says, “there’s a risk of bleeding or trauma to the brain, as well as a slight hit to verbal memory — for example, the ability to remember names of animals or words starting with the letter f may be impaired for a while. Usually it’s a short-term problem, but in some people it can be a long-term one.”
6. Adjust your diet.
No specific diet helps treat dyskinesia, but there are dietary changes you can make that can affect how your body absorbs and uses levodopa. Because levodopa is a building block of protein, your body absorbs it along with dietary protein, according to the Michael J. Fox Foundation. That means if you eat a protein-rich meal along with your levodopa pill, your body can’t absorb the medication as completely. (Your body can only absorb so much at one time, after all.) That’s a problem because it may mean taking a higher dose to get the same effect — and a higher dose means a higher risk of dyskinesia. The Michael J. Fox Foundation suggests tweaking your diet to avoid significant protein sources at the time you take your medication. If your stomach can handle it, you may consider taking levodopa either 30 minutes before or 60 minutes after eating. If you struggle with nausea, it may help to take the medication with some (low protein) crackers or other carbohydrate-based snack.
7. Lower your stress.
Since dyskinesia can have a tendency to worsen during periods of stress, learning to manage stress effectively may help minimize your symptoms. Consider practicing deep-breathing exercises or meditation or just spending time with family or friends. Even music may be beneficial, says Pantelyat, whose 2016 study published in the journal Movement Disorders Clinical Practice demonstrated the positive effect of music lessons on quality of life among people with Parkinson’s.
8. Exercise aerobically.
Early in the course of Parkinson’s disease, people typically experience a lack of pep, says Pantelyat. It’s stressful, you may feel fatigued, and everyday tasks may feel physically demanding. Says Pantelyat, “The way I talk to patients about starting levodopa is that it’s going to give you back some of that pep, and you want to take that increased energy and focus it on aerobic exercise.” While no drug has yet been proven to slow the progression of Parkinson’s, physical exercise — anything that gets you to break a sweat and boosts your heart rate — can truly slow the disease, says Pantelyat. Swimming, rowing, and cycling on a recumbent bicycle are all great ways to get moving. Tai chi has also been shown to be beneficial, says Pantelyat, and there are even boxing classes designed specifically for people with Parkinson’s.
