Tremor is among the most well-known symptoms of Parkinson's disease, but it's not the only thing that can cause involuntary movements in patients. Dyskinesia induces twitching, writhing, jerking, fidgety, or rocking movements that most commonly affect the arms, legs, and torso. It can range from mild to severe, and often strikes when the other motor symptoms of Parkinson's are under control — partly because dyskinesia is associated with the medication levodopa.
1. Dyskinesia and levodopa: What are your options?
Because dyskinesia tends to occur in Parkinson's patients who have been using medications, especially levodopa, for a long period of time and particularly in larger doses, people who are first diagnosed with Parkinson's disease will always be prescribed the lowest possible dose — one that reduces their symptoms sufficiently while minimizing side effects.
Over time, however, dyskinesia can still set in. It is most likely to happen when your levodopa dose has reached a "peak", meaning your dopamine levels are highest. Some patients will also, meanwhile, experience as their dose of medication is about to "run out". To counter these phenomena, your doctor may advise you to take smaller doses of levodopa more often, or offer you a slow-release version.
2. Other medications
With dyskinesia being a well-known potential side effect of levodopa, some people with Parkinson's disease are worried about it before they even develop it — and may be reluctant to start taking levodopa. It is important to weigh the advantages and risks of any medication, but some patients are indeed prescribed COMT inhibitors or MAO-B inhibitors before they begin using levodopa.
Once dyskinesia becomes an issue, your doctor may prescribe a dopamine agonist or up the dose of the one you were already taking — and reduce the dose of levodopa at the same time. If dyskinesia is still a problem, it may also be possible to try another dopamine agonist instead of the one you are currently on. Amantadine (Gocovri, Osmolex ER), an antiviral and Parkinson's medication in one, can also help you control dyskinesia.
3. Exploring ways to reduce stress
Stress can worsen many of the symptoms of Parkinson's disease, including dyskinesia. Because Parkinson's, as a progressive disease, also does its fair share to cause you stress, finding ways to reduce stress may seem like an impossible task. There are, however, many possible steps you can take:
- Organize your daily life with your symptom severity in mind — if you feel best in the morning, for instance, do your most physically demanding tasks then.
- Look into mind-body disciplines such as yoga and Tai Chi, which will relax your mind and body at the same time.
- Try massage therapy.
- Look into home adaptations that will make your daily life physically easier.
- Try to ensure that your social needs are met — being around friends and family can be a great source of relaxation, and Parkinson's support groups may allow you to find people in a unique position to understand the challenges you face.
Exercise is very important for people living with Parkinson's — not only can it help you get stronger, become more flexible, reduce rigidity and improve your balance, some research suggests regular physical activity may also reduce tremors and dyskinesia. Parkinson's patients can engage in almost any kind of exercise, especially in the earlier stages, but walking, swimming, and cycling using a stationary bike (smaller odds of falling that way!) are all great choices.
5. Dietary adjustments
A varied and healthy diet is important for everyone, and people with Parkinson's disease are no exception. Did you know, however, that meals rich in protein can impact levodopa absorption, thereby leading to symptom fluctuations? This doesn't mean you should say good bye to meat, beans, eggs, and other sources of protein, of course — but it does mean they should time their meals right. Take your levodopa around half an hour before mealtime, or have some plain bread or crackers (nothing too protein-rich) if you feel nauseous when taking your medication without food.
6. Are you getting enough sleep?
Parkinson's patients often find it difficult to get a good night's sleep, with some data suggesting that many don't get much more than five hours. As you know, most people need between seven and nine hours a night. Being sleep deprived could be making your symptoms worse. To try to get more and better sleep, the following steps should help you:
- Stick to a schedule — go to bed and wake up at the same time each day.
- Take a nap if you like, but only one a day, and again on a regular schedule, to allow you to sleep better at night.
- Engage in a relaxing activity like reading or listening to soothing music in the 40 or so minutes before you plan on going to bed.
- Banish electronics from your bedroom.
7. Might deep brain stimulation (DBS) be an option for you?
Parkinson's disease patients who don't suffer from dementia, who have been diagnosed years ago, and whose medication no longer provides adequate symptom control may benefit from a surgery called deep brain stimulation or DBS. This surgery involves the implantation of electrodes in the brain controlled by a device, and it can greatly reduce motor symptoms.
One study found that DBS reduces up to 80 percent of dyskinesia. The reason may be twofold — deep brain stimulation allows many patients to reduce the dose of levodopa they take, and the surgery itself may also have a positive effect on the involuntary movements.