Involuntary movements in Parkinson's disease
Dyskinesia is a common side effect of long-term levodopa treatment for Parkinson’s disease. It can cause involuntary, uncontrolled movements including writhing, twisting or fidgeting.
It can usually be managed by adjusting medications, dose timing or overall dosage. However, many patients who have developed dyskinesia may be best served by transitioning to a 'smart' therapy, such as deep brain stimulation surgery or a continuous dopaminergic infusion delivered via a pump under the skin or into the stomach.
Key points
- Dyskinesia is distinct from tremor and usually relates to the response to levodopa medication in patients with a longer disease duration.
- It typically appears after years of levodopa use, often when medication levels are at their highest (peak-dose dyskinesia), and there are fewer dopamine cells in the brain that can buffer what the patient requires.
- Common areas affected include the face, neck, trunk and limbs, with movements that look writhing, twisting or restless. These can interfere with daily activities like eating, speaking or dressing.
- Similar movements can occur with other medications or conditions so a specialist review is worthwhile if symptoms are new or unclear.
Next steps:
Involuntary movements aren't unique to Parkinson's medication effects. They can include:
- tardive dyskinesia, from long-term use of dopamine-blocking medications such as antipsychotics or anti-nausea drugs, typically producing repetitive movements of the face, mouth and tongue
- chorea (brief, irregular, dance-like movements) or dystonia (sustained contractions causing abnormal postures), which can occur for unrelated reasons
- certain metabolic disturbances or structural brain changes
- anxiety-related restlessness, occasionally mistaken for mild dyskinesia.
As management differs by cause, a doctor should assess any change rather than assuming it's routine.
When to consider specialist review
Speak with your neurologist or GP if movements are:
- affecting daily life or safety
- new
- unclear in their relationship to your medication
- worsening.
Timing changes are best made with specialist guidance rather than on your own.
When to seek urgent help
Seek urgent medical attention for severe movements that:
- are accompanied by high fever, confusion or sudden loss of consciousness
- cause falls or injuries
- interfere with breathing or swallowing.