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 than DBS of the STN (subthalamic nucleus) in controlling dyskinesias. Among medications, amantadine was the most effective anti-dyskinetic medication. In my experience, both DBS GPI and DBS STN surger...

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 regimen to minimize peaks and troughs through either fractionating the dose or by switching to a formulation that accomplishes the same thing, as noted by Dr. Dent. If dyskinesia occurs inseparably from an...

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:

1. Adjust carbidopa/levodopa dosing. Often, reducing levodopa will diminish dyskinesias. May need to increase frequency of dosing or add a slower release version (carbidopa/levodopa CR, ER, SA) or dopamine agonist to the regimen.
2. Eliminate COMT ...