Objective: The aim of this study was to assess the level of drug-induced dyskinesia (DID), the presence of other motor symptoms of PD, and the performance of patients during activities of daily living (ADL), this before and after changing medication to manage DID.

Background: Reducing levodopa dosage and adding other medication like dopamine agonists to manage DID in patients with PD is the main strategy used by clinicians before surgery is contemplated. However, reducing levodopa dosage could enhance residual motor symptoms of PD already present in these patients, and therefore, could be counterproductive in maintaining a good mobility in patients.

Methods: Eight patients diagnosed with PD and needing an adjustment of medication to reduce their level of DID were tested prior to, and approximately six weeks after medication regimen modification. Patients were tested both times in the afternoon, after buildup of medication. They were asked to eat the same meal before each testing session. Patients were asked to perform a series of ADL consisting in reading, counting money, cutting-eating a piece of apple, eating soup, taking medication, drinking water, picking-up an object off the floor, sitting-standing, walking, walking while carrying a glass of water, walking and stepping over an obstacle. Levels of DID, tremor, bradykinesia and freezing of gait were assessed using 17 inertial measurement units positioned on each body limb. Rigidity and postural instability were assessed using clinical evaluations. Multiple measurements of ADL performance and symptomatology assessment were done; the ones used in the analysis were those closest to the period at which DID had the highest amplitude (peak-dose). Levels symptomatology, including amplitude of DID and performance during ADL (number of errors and time required to perform ADL) were compared between testing sessions using Wilcoxon signed-rank tests.

Results: The level of DID was significantly reduced after changing medication. We also noticed an increase in the level of bradykinesia, tremor, and freezing of gait, albeit not statistically significant. Performance related to the amount of time required to perform ADL and number of errors didn’t change. We nonetheless observed a slight increase in the time required to perform ADL and a decrease in the number of errors after medication regimen modification, but it did not reach statistical significance.

Conclusions: The strategy used by clinicians to reduce DID was efficient but did not improve the performance of patients. The trend towards increased underlying symptomatology may have played a role in the lack of improvement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-altering-medication-to-avoid-dyskinesia-positively-alters-the-breadth-of-the-motor-repertoire-of-patients-with-parkinsons-disease-a-pilot-study/