What is your approach to bothersome dyskinesias in Parkinson disease patients?  

This is an interesting recent article in which a meta-analysis of various anti-Parkinson medications and surgical interventions was looked at for their effect on controlling dyskinesias as compared to placebo. The meta-analysis showed that DBS of the GPI (globus pallidus interna) was more effective ...

This meta-analysis does not influence my practice. I worry that this meta-analysis may lead people to premature surgical treatment. My approach to treating bothersome dyskinesias, meaning dyskinesias that are interfering with daily function, is as follows: Adjust carbidopa/levodopa dosing. ...

Managing bothersome dyskinesia in Parkinson's disease can be an extremely complex task, so I believe it is best to start by asking what is causing the dyskinesia. If dyskinesia only occurs at predictable times after dosing of carbidopa/levodopa, it is most appropriate to start by adjusting the regim...