## Breadcrumb - [Home](/) - [Understanding Parkinson's](/understanding-parkinsons) - [Movement Symptoms](/understanding-parkinsons/movement-symptoms) ## Breadcrumb - [Home](/) - [Understanding Parkinson's](/understanding-parkinsons) - [Movement Symptoms](/understanding-parkinsons/movement-symptoms) # Dyskinesia ## 💡 Quick Summary - Dyskinesias are involuntary, erratic movements caused by some Parkinson’s medications, usually [levodopa](/living-with-parkinsons/treatment/prescription-medications/levodopa "Levodopa"), not by Parkinson’s disease itself. They can be mild or severe, affecting the face, arms, legs, or trunk. - Common types include peak-dose [dyskinesia](/understanding-parkinsons/movement-symptoms/dyskinesia "Dyskinesia") (occurs when medication is strongest) and diphasic dyskinesia (occurs as medication starts or wears off). - Management involves adjusting [medication timing](/library/podcast/109 "Episode 109: Medication Timing") or dose, and medications like amantadine (including extended-release Gocovri) can help reduce dyskinesias without worsening “off” periods. ![Man sitting on couch with pained expression and holding his back with both hands](/sites/default/files/styles/no_sizing/public/images/dyskinesia.jpg?itok=duMy_Sxx) **Dyskinesias** are involuntary, erratic, writhing movements of the face, arms, legs or trunk. They are often fluid and dance-like, but they may also cause rapid jerking or slow and extended muscle spasms. They are not a symptom of Parkinson's disease (PD) itself. Rather, they are a complication from some Parkinson's medications. Dyskinesias are a possible side effect of long-term [levodopa](/living-with-parkinsons/treatment/prescription-medications/levodopa "Levodopa") use, the most commonly prescribed PD medicine. They are more likely to occur as Parkinson’s progresses and more dopamine-producing brain cells are lost. As cells are lost, the brain has a harder time handling changes in dopamine levels. This leads to dyskinesias during “on” time. Research shows that waiting to start levodopa does not prevent dyskinesias. Instead, the progression of PD is a major factor in their development. Dyskinesias can often be improved by adjusting levodopa or other dopaminergic medications (those that influence dopamine-producing parts of the brain). Younger people with PD are thought to develop earlier ["off" time](/library/fact-sheets/managing-off-time "Managing "Off" Time in Parkinson's") and dyskinesias in response to levodopa. ## Types of Dyskinesias - ### Peak Dose Dyskinesia The most common kind of dyskinesias are called “peak dose.” These occur when the concentration of levodopa in the blood is at its highest — usually one to two hours after you take it. This typically matches up with when the medications are working best to control motor symptoms. In the earliest stages of Parkinson’s, they are usually not bothersome, and you may not even notice these extra movements. - ### Diphasic Dyskinesia Sometimes, instead of at peak dose, dyskinesias can occur as you are just beginning your “on” period and again as you begin to turn “off.” This is known as diphasic dyskinesia, or the dyskinesia-improvement-dyskinesia (D-I-D) syndrome. Diphasic dyskinesias are associated with relatively low doses of levodopa and, unlike peak-dose dyskinesias, tend to improve with higher doses of levodopa. ## Managing Dyskinesia The “therapeutic window” describes the period of time when a medication is effective. There is enough medication in your body to control your symptoms, but not too much so that side effects occur. Good medication response occurs within the window — outside the window, you might get motor fluctuations (not enough medication) or dyskinesias (too much). Levodopa therapy is typically the cause of dyskinesias, but other drugs such as dopamine agonists, [**COMT (catechol-o-methyl transferase) inhibitors**](/living-with-parkinsons/treatment/prescription-medications/comt-inhibitors "COMT Inhibitors") and [**MAO-B (monoamine oxidase B)**](/living-with-parkinsons/treatment/prescription-medications/mao-b-inhibitors "MAO-B Inhibitors") inhibitors can worsen dyskinesias. Because dyskinesias tend to occur at peak concentrations of levodopa, one management strategy is to reduce dopamine levels. This can be done with small decreases in levodopa dosage or by removing other dopaminergic medications (such as dopamine agonists, COMT inhibitors or MAO-B inhibitors). However, as Parkinson’s progresses, if you reduce the levodopa dose, your Parkinson’s symptoms will not be well-controlled. There are currently two medications available to treat dyskinesia, and several in development. - [**Amantadine**](/living-with-parkinsons/treatment/prescription-medications/amantadine "Amantadine") may be added to your medication regimen to reduce dyskinesias without worsening “off” periods. - The U.S. Food and Drug Administration has approved an extended-release formulation of amantadine (brand name Gocovri) specifically for the treatment of levodopa-induced dyskinesia in people with PD. Other amantadine formulations are sometimes used off-label for dyskinesia. ![shirley_bealor](/sites/default/files/styles/535x680/public/images/shirley_bealor.jpg?h=1eaf43a3&itok=UyV7mP5H) MY PD STORY: Shirley Bealor "While Shirley saw improvements after DBS, she still lives with a myriad of PD symptoms. Shirley also has dyskinesia and lately, a decrease in energy, but she’s doesn’t let any of it slow her down." [ READ Shirley's STORY ](/living-with-parkinsons/stories/shirley-bealor) ### Learn More Read Managing Parkinson’s Mid-Stride: A Treatment Guide to Parkinson’s for more information about dyskinesia, the therapeutic window and motor fluctuations. [READ NOW](https://secure3.convio.net/prkorg/site/Ecommerce/299056634?VIEW_PRODUCT=true&product_id=1621&store_id=4003) *Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson's Foundation Center of Excellence, and Dr. Sneha Mantri, MD, MS, FAAN, Chief Medical Officer for the Parkinson’s Foundation and Movement Disorders Specialist at Duke Health.* ## Related Materials Fact Sheets ### [ Pain in Parkinson's Disease ](/library/fact-sheets/pain) [Read Now](/library/fact-sheets/pain) Fact Sheets ### [ Occupational Therapy & Parkinson's ](/library/fact-sheets/occupational-therapy) [Read Now](/library/fact-sheets/occupational-therapy) Fact Sheets ### [ Managing "Off" Time in Parkinson's ](/library/fact-sheets/managing-off-time) [Read Now](/library/fact-sheets/managing-off-time) ## Related Blog Posts ![Kathy Steece-Collier headshot](/sites/default/files/styles/500x360/public/images/kathysteececollier-preview.jpg?h=9105c3fe&itok=uLnZ_dnw) Advancing Research ### [ Understanding 'Gene Silencing' and Its Role in Parkinson’s and Dyskinesia ](/blog/research/gene-silencing) READ NOW ![Cells](/sites/default/files/styles/500x360/public/images/lidnews-blogprev.png?h=ed9ce7df&itok=ymGgajD-) Science News ### [ Levodopa-Induced Dyskinesias Reversed in Gene Therapy Study ](/blog/science-news/dyskinesias) READ NOW ![lots of pill boxes](/sites/default/files/styles/500x360/public/images/newdruglevo-blogprev.png?h=ed9ce7df&itok=Kjr_vxcZ) Science News ### [ New Drug Shows Promise for Levodopa-Induced Dyskinesia ](/blog/science-news/new-drug-dyskinesia) READ NOW ### Find Local Support Find your nearest Parkinson's Foundation chapter for local events, support groups, care facilities and more. 10 Miles 25 Miles 50 Miles 100 Miles 250 Miles ### Parkinson's Foundation Helpline Contact 1-800-4PD-INFO or Helpline@Parkinson.org for answers to your Parkinson’s questions. 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