Levodopa-induced choreiform movement
by Kalyan B Bhattacharyya, Kalyan Satish V

Atlas of Neurology—A Case-based Approach

by Satish V Khadilkar, Kalyan B Bhattacharyya
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The long-term motor complications of levodopa include dyskinesias which may be choreic, athetotic and dystonic. These occur usually in young-onset Parkinson’s disease after five years of treatment in 80% of patients and is thought to be due to alterations in the pre- and post-synaptic signal transduction in the nigrostriatal pathway in the dorsal striatum. Use of non-physiological pulsatile small doses of laevodopa administered over a long time has also been thought to be a contributing factor. The role of dietary proteins, D3 receptors, glutamate receptors, buffering capacity of the remaining and negligible number of nigral neurons in the ventral tier of the pars compacta of Baxter and Olszewski of the substantia nigra, and genetic factors have been implicated in their pathogenesis. There is potentiation of GABA-ergic efferent fibers, particularly glutamate receptors and amelioration of chorea and other movements with the use of amantadine, a glutamate-antagonist, attests such a hypothesis. Abnormalities in non-dopaminergic transmission like, alpha-2 adrenergic, serotonergic, cannabinoid and opioid mechanisms have also been suggested.

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