Reduction of Levodopa Therapy

With ongoing Levodopa therapy for months or more commonly, a few years of treatment, two major types of motor complications tend to arise: motor fluctuations and dyskinesias. Motor fluctuations are variations in mobility associated with the effectiveness of levodopa when patients can tell when their medications kick in and wear off (the short duration response to levodopa). As the disease progresses, the beneficial effect of each individual dose of levodopa may become shorter and shorter. Levodopa may have to be dosed more frequently (4, 5, or even 6 times a day) compared to 3 times a day when initially started. The term “on” is used to describe the period during which medications are working and mobility is good while the term “off” is used to describe episodes in which medication is working poorly and mobility is poor. Dyskinesias refer to excess involuntary squirming and rocking-type movements which may occur as an adverse effect of chronic levodopa. These usually occur during the “on” state. They can be mild and not troublesome, but can also be severe and interfere with day-to-day activities. One way to prevent dyskinesia is to lower the dose of Levodopa; however, the challenge is to make sure the dose is adequately adjusted to avoid negative side effects and ensure that Parkinson’s symptoms are still controlled.  One of the main concerns with lowering Levodopa, is the increase of OFF episodes. In these cases, patients may benefit from the addition of other adjunctive medications to rescue them from sudden and unpredictable “off” periods. The main limiting factor to all adjunctive medications is they may even worsen dyskinesia and non-motor symptoms.  It is best to discuss these options with your Neurologist or Movement Disorder Specialist to determine the best individualized approach based on your characteristics and lifestyle.