<unk>  <unk>  is a form of<unk>  associated with<unk>  (l-DOPA), used to treat Parkinson's disease. It often involves hyperkinetic movements, including chorea, dystonia, and athetosis. In the context of Parkinson's disease (PD),<unk>  is often the result of long-term dopamine therapy. These motor fluctuations occur in up to 80% of PD patients after 5–10 years of l-DOPA treatment, with the percentage of affected patients increasing over time. Based on the relationship with<unk>  dosing,<unk>  most commonly occurs at the time of peak l-DOPA plasma concentrations and is thus referred to as peak-dose<unk>  (PDD). As patients advance, they may present with symptoms of diphasic<unk>  (DD), which occurs when the drug concentration rises or falls. If<unk>  becomes too severe or impairs the patient's quality of life, a reduction in l-Dopa might be necessary, however this may be accompanied by a worsening of motor performance. Therefore, once established,<unk>  is difficult to treat. Amongst pharmacological treatments, N-methyl-D-aspartate (NMDA) antagonist, (a glutamate receptor), amantadine, has been proven to be clinically effective in a small number of placebo controlled randomized controlled trials, while many others have only shown promise in animal models. Attempts to moderate<unk>  by the use of other treatments such as bromocriptine (Parlodel), a dopamine agonist, appears to be ineffective. In order to avoid<unk> , patients with the young-onset form of the disease or young-onset Parkinson's disease (YOPD) are often hesitant to commence l-DOPA therapy until absolutely necessary for fear of suffering severe<unk>  later on. Alternatives include the use of DA agonists (i.e. ropinirole or pramipexole) in lieu of early l-DOPA treatment which delays the use of l-DOPA. Additionally, a review shows that highly soluble l-DOPA prodrugs may be effective in avoiding the in vivo blood concentration swings that potentially lead to motor fluctuations and<unk> .
Levodopa-induced dyskinesia
Dopamine-responsive dystonia
Post-encephalitic parkinsonism
Paroxysmal exercise-induced dystonia
Parkinson-plus syndrome
Hyperkalemic periodic paralysis
Tardive dyskinesia
Cerebellar cognitive affective syndrome