Drug-induced dyskinesia in Parkinson's disease. Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia?

BMC Medicine

Christian Duval¹  Michel Panisset³  Abbas F Sadikot⁵  Benoit Carignan⁴  Jean-François Daneault² 

[1] Département de Kinanthropologie, Université du Québec à Montréal, 141 Avenue Président-Kennedy, Montréal, Québec, H2X 1Y4, Canada;Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4545 Chemin Queen-Mary, Montréal, Québec, H3W 1W4, Canada;Unité des troubles du mouvement André-Barbeau, Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montréal, Québec, H2L 4M1, Canada;Département des Sciences Biologiques, Université du Québec à Montréal, 141 Avenue Président-Kennedy, Montréal, Québec, H2X 1Y4, Canada;Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University street, Montreal, Quebec, H3A 2B4, Canada

关键词: Algorithm;    Motor fluctuations;    Motor complication;    Quality of life;    Treatment;    DBS;    Deep brain stimulation;    Levodopa;    DID;    LID;   

Others  :  857135
DOI  :  10.1186/1741-7015-11-76

 received in 2012-07-05, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Background

Dyskinesia, a major complication in the treatment of Parkinson's disease (PD), can require prolonged monitoring and complex medical management.

Discussion

The current paper proposes a new way to view the management of dyskinesia in an integrated fashion. We suggest that dyskinesia be considered as a factor in a signal-to-noise ratio (SNR) equation where the signal is the voluntary movement and the noise is PD symptomatology, including dyskinesia. The goal of clinicians should be to ensure a high SNR in order to maintain or enhance the motor repertoire of patients. To understand why such an approach would be beneficial, we first review mechanisms of dyskinesia, as well as their impact on the quality of life of patients and on the health-care system. Theoretical and practical bases for the SNR approach are then discussed.

Summary

Clinicians should not only consider the level of motor symptomatology when assessing the efficacy of their treatment strategy, but also breadth of the motor repertoire available to patients.

【 授权许可】

   
2013 Daneault et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

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