Peak-Dose Dyskinesia – Pulsatile Stimulation — SCE Neurology MCQ

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HardMovement DisordersPeak-Dose Dyskinesia – Pulsatile StimulationSCE Neurology

A patient with Parkinson’s disease has troublesome peak-dose choreiform dyskinesia despite smaller, more frequent levodopa doses and withdrawal of an unnecessary COMT inhibitor. Off-time remains acceptable and cognition is intact. Which add-on is specifically recommended next for dyskinesia?

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Correct answer: A — Amantadine

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

A is not recommended for people with motor fluctuations or dyskinesia because of cognitive, urinary and falls toxicity. B treats nausea. C treats Parkinson dementia. D is correct: NICE advises considering amantadine when dyskinesia remains inadequately controlled after modification of existing therapy. E usually prolongs levodopa exposure and may worsen peak-dose dyskinesia unless the regimen is deliberately rebalanced.

Reference: NICE NG71: Parkinson’s disease in adults: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations