AN ANALYSIS OF TREATMENT OPTIONS AND OUTCOME IN PATIENTS WITH PARKINSONS-DISEASE AND SEVERE DYSKINESIAS

Forty-one patients with Parkinson's disease and severe dyskinesias wer e analyzed retrospectively to determine if some general principles wou ld emerge to aid physicians handling this complication of treatment. D yskinesia type (high dopa chorea [HDC], low dopa chorea [LDC], high do pa dystonia [HDD], and low dopa dystonia [LDD]) predicted response to treatment and whether or not levodopa dose reduction would benefit dys kinesias without producing unacceptable ''offs.'' High dopa chorea imp roved best but at the expense of increased ''off' time, followed by LD D, HDD, and LDC. Levodopa reduction was an acceptable strategy in amel iorating HDC and LDD only. Adjunctive therapy benefited all dyskinesia types, although the majority of patients (12/17) helped by selegiline had LDD or LDC. Generally, low doses of dopamine agonists were helpfu l (bromocriptine < 20 mg/day; pergolide < 2 mg/day). When adding adjun ctive therapy (except for selegiline or controlled-release carbidopa/l evodopa), concomitant reduction in daily dose of levodopa was not an e ffective strategy to decrease dyskinesias. Serial trials of multiple d rug regimens are useful in these patients.