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Levodopa-induced dyskinesias in Parkinson’s disease: emerging treatments

Authors Bargiotas P, Konitsiotis S

Received 26 July 2013

Accepted for publication 2 September 2013

Published 22 October 2013 Volume 2013:9 Pages 1605—1617

DOI https://doi.org/10.2147/NDT.S36693

Checked for plagiarism Yes

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Panagiotis Bargiotas, Spyridon Konitsiotis

Department of Neurology, University of Ioannina, Ioannina, Greece

Abstract: Parkinson’s disease therapy is still focused on the use of l-3,4-dihydroxyphenylalanine (levodopa or l-dopa) for the symptomatic treatment of the main clinical features of the disease, despite intensive pharmacological research in the last few decades. However, regardless of its effectiveness, the long-term use of levodopa causes, in combination with disease progression, the development of motor complications termed levodopa-induced dyskinesias (LIDs). LIDs are the result of profound modifications in the functional organization of the basal ganglia circuitry, possibly related to the chronic and pulsatile stimulation of striatal dopaminergic receptors by levodopa. Hence, for decades the key feature of a potentially effective agent against LIDs has been its ability to ensure more continuous dopaminergic stimulation in the brain. The growing knowledge regarding the pathophysiology of LIDs and the increasing evidence on involvement of nondopaminergic systems raises the possibility of more promising therapeutic approaches in the future. In the current review, we focus on novel therapies for LIDs in Parkinson’s disease, based mainly on agents that interfere with glutamatergic, serotonergic, adenosine, adrenergic, and cholinergic neurotransmission that are currently in testing or clinical development.

Keywords: motor fluctuations, dopaminergic/nondopaminergic systems, pharmacotherapy

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