Clinical spectrum of levodopa-induced complications

The first years of Parkinson disease (PD) treatment are marked by good and sustained responses to dopaminergic therapy. With disease progression and longer exposure to levodopa (l‐dopa), patients develop a range of l‐dopa–induced complications that include motor and non‐motor symptoms. Motor complications include motor fluctuations, characterized by periods of reduced benefit from the medication, and l‐dopa–induced dyskinesia, characterized by emergence of hyperkinetic involuntary movements. Dyskinesia can occur at peak effect of l‐dopa, at the beginning and end of dose, or between doses. These motor complications are often associated with fluctuations in non‐motor symptoms, particularly fluctuations in neuropsychiatric, autonomic, and sensory symptoms. Recognizing such complications and understanding their relationship with the timing of l‐dopa doses is essential for adequate diagnosis and management. © 2014 International Parkinson and Movement Disorder Society