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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: tardive dyskinesia & parkinsonForum: Neurology Forum
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dear dr. my mother has long standing parkinson.she is right now on sinemet cr 50/200 qid & sinemet 25/100tid/prn for 3yrs.she is also taking artane 2mg hailf tab tid& klonopin .5mg half tid.she has thermoregulation problem & excessive salivation,& faciomandibular dyskinesia.the dyskinesia is the most distressing symptom for my mom.she has past history of phenothiazines which she took on & off for several yrs.i wonder if the dyskinesia is because of long intake of phenothiazines but again she is not taking it for nearly ten yrs.if its because of sinemet what can be done becuase when we lower the drug her parkinson worsen but it does'nt improve the dyskinesia even after lowering the drug. thanking you in anticipation. Dr.Nuzhat Nisar. = Determining the source of dyskinesia (tardive vs levodopa induced) is usually a matter of careful history taking. I suspect your mother's dyskinesia is related to the Sinemet, though oro-mandibular dyskinesia in the setting of intermittent use of phenothiazines is certainly suspicious for tardive dyskinesia. Management of dyskinesia is one of the challenges of modern movement disorders practice. As far as anyone knows, dyskinesia appears to be an inevitable occurrence in Parkinson's disease. There is the concern that use of levodopa may accelerate the appearance of dyskinesia, but nothing is really proven. We typically use a combination of levodopa (Sinemet) and dopamine agonists (the newest are Mirapex and Requip; Permax remains quite useful) and try to balance the mix in favor of the long-acting agonists. There is some suggestion now that amantadine may be helpful. I think the only way she can be helped is to visit a movement disorders specialist in person. These are complicated situations, and each patient is managed differently. As you may be aware by now, the treatment of Parkinson's disease is highly individualized. Further, PD is a moving target. The optimum treatment one day may be no longer helpful six months from now. You are welcome to call 800 223-2273 and ask for neurology appointments at 4-5559. If you are unable to use 800 toll-free numbers, call 216 444-5559. I hope this helps. CCF MD mdf.
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