I am going to turn to the research to highlight how very little is known about Levodopa Induced Dyskinesia (LID). This recent study indicates that genetics and our exposure to tobacco influences our likelihood of developing dyskinesia. People who have never smoked and who have an alteration impacting their D2 receptors are more likely to get dyskinesia and to see it appear earlier.

Just as an aside, most research on dyskinesia seems to center on the dopamine receptors and the timing of synaptic stimulation. Note: Dyskinesia is nearly non-existant in Duodopa patients. Dyskinesia is less to do with levodopa, and much more to do with delivery and maintaining consistent therapeutic plasma levels. When there is too much circulating in us at once, we get the wiggles. BTW, it's funny that the focus is on the extra movement, for me, I feel so wiped out by it, I can take half a day to get back on the 'normal' train.

Since there is a strong correlation between receptors and LID, and agonists work solely with our receptors, it would seem logical that if taken with levodopa, we might get a little more dyskinetic. I once mistakenly took 2 doses of Sinemet while only using that drug. I had a reaction, but it was not dyskinesia.

Further, when neuros try to make the case that levodopa be avoided or delayed, they really have nothing to base it on save a few studies that show you may delay levodopa therapy for a few years. What they don't tell you that is longitudinally, after 5-6 years of diagnosis, patients will have roughly same med needs with Sinemet and experience the same level of dyskinesia and those first years, those patients had to live with inferior symptom control or were undermedicated. I really don't know how someone could even tolerate the side effects of an agonist if you have to go beyond the barely therapeutic dosages. At lower dosages I already had behavior problems. At the levels we would need go to sustain clinical benefit, I could not imagine what might happen. The notion that levodopa therapy should be delayed dates back to 1978! Current recommendation of the AAN is to use what improves quality of life most for patient in balance with long term need for levodopa.

I understand why they want to delay dyskinesia, but now genetics may play a role in that too? Yeesh, at this point, I'd be most impressed with a doctor who promoted daily exercise over all else as the most important treatment early on; it costs nothing, and has the best side effect profile.

Laura