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Levodopa Dyskinesias — RACP Adult Medicine MCQ

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ModerateNeurologyLevodopa DyskinesiasRACP Adult Medicine

A 60-year-old man with advanced Parkinson's disease on levodopa/carbidopa develops disabling dyskinesias (involuntary movements) at peak plasma levels of levodopa. What is the most appropriate management strategy?

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Correct answer: D — Reduce individual levodopa doses and increase frequency

Peak-dose dyskinesias in Parkinson's disease result from pulsatile dopaminergic stimulation with levodopa. The strategy is to reduce individual doses (reducing peak levels) while increasing dosing frequency (maintaining therapeutic coverage). Adding a COMT inhibitor (entacapone) or MAO-B inhibitor can smooth out fluctuations. Amantadine is the only drug with direct antidyskinetic properties. Deep brain stimulation is considered for refractory motor complications.

Reference: eTG – 2025 – Neurology; MDS – 2023 – PD Treatment Guidelines