Propofol Withdrawal Dyskinesia in a Parkinson’s Disease Patient with Levodopa-Induced Dyskinesia

A 67-year-old man with a 30-year history of PD was admitted to our hospital as a possible candidate for subthalamic DBS. Previous reports suggest that the functional changes of the GABAergic-glutamatergic system may play an important role in peak dose propofol-induced dyskinesia in PD.3 Therefore, these neurotransmitters may also be implicated in the pathophysiology of propofol-induced end-of-dose dyskinesia in PD. Altered cholinergic signaling has been shown to be another important factor in the development of dyskinesia. Drugs targeting various types of nicotine acetylcholine receptors as well as muscarine acetylcholine receptors are thought to be effective interventions to alleviate dyskinesia.9 Some of these receptors are expressed in GABA interneurons and glutamatergic terminals. [...]considering the effects of propofol on the GABAergic-glutamatergic system, withdrawal of anticholinergic medication may play a role in propofol-induced dyskinesia.