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Levodopa-induced dyskinesia — SCE Neurology MCQ

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EasyMovement DisordersLevodopa-induced dyskinesiaSCE Neurology

A 63-year-old man presented with choreiform movements occurring at peak dose in advanced Parkinson's disease. On examination, there was underlying bradykinesia and wearing-off before the next dose. Initial investigations showed: symptom diary linked dyskinesia to medication peaks. What is the most likely diagnosis?

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Correct answer: E — Levodopa-induced dyskinesia

Levodopa-induced dyskinesia is the best answer because the vignette describes Levodopa-induced dyskinesia: peak-dose choreiform movement in treated PD is levodopa-induced dyskinesia. Progressive supranuclear palsy is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Hemifacial spasm and Cervical dystonia are less appropriate because they would require different localisation, timing or test findings; Multiple system atrophy would fit a different syndrome. Clinical pearl: tardive dyskinesia requires dopamine antagonist exposure.

Reference: NICE NG71; Movement Disorder Society consensus criteria