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Open Access Opinion

Drug-induced dyskinesia in Parkinson's disease. Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia?

Jean-François Daneault12, Benoit Carignan23, Abbas F Sadikot1, Michel Panisset4 and Christian Duval25*

Author affiliations

1 Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University street, Montreal, Quebec, H3A 2B4, Canada

2 Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 Chemin Queen-Mary, Montréal, Québec, H3W 1W4, Canada

3 Département des Sciences Biologiques, Université du Québec à Montréal, 141 Avenue Président-Kennedy, Montréal, Québec, H2X 1Y4, Canada

4 Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montréal, Québec, H2L 4M1, Canada

5 Département de Kinanthropologie, Université du Québec à Montréal, 141 Avenue Président-Kennedy, Montréal, Québec, H2X 1Y4, Canada

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Citation and License

BMC Medicine 2013, 11:76  doi:10.1186/1741-7015-11-76

Published: 20 March 2013

Abstract

Background

Dyskinesia, a major complication in the treatment of Parkinson's disease (PD), can require prolonged monitoring and complex medical management.

Discussion

The current paper proposes a new way to view the management of dyskinesia in an integrated fashion. We suggest that dyskinesia be considered as a factor in a signal-to-noise ratio (SNR) equation where the signal is the voluntary movement and the noise is PD symptomatology, including dyskinesia. The goal of clinicians should be to ensure a high SNR in order to maintain or enhance the motor repertoire of patients. To understand why such an approach would be beneficial, we first review mechanisms of dyskinesia, as well as their impact on the quality of life of patients and on the health-care system. Theoretical and practical bases for the SNR approach are then discussed.

Summary

Clinicians should not only consider the level of motor symptomatology when assessing the efficacy of their treatment strategy, but also breadth of the motor repertoire available to patients.

Keywords:
LID; DID; Levodopa; Deep brain stimulation; DBS; Treatment; Quality of life; Motor complication; Motor fluctuations; Algorithm