Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor and Online Editor, JAMA.
Author Affiliation: Dr Tarsy is the director of the Parkinson Disease and Movement Disorders Center and the National Parkinson Foundation Center of Excellence Parkinson Disease Center at Beth Israel Deaconess Medical Center.
In early stages, Parkinson disease typically begins with asymmetric or unilateral motor symptoms due to combinations of mild bradykinesia, rigidity, and tremor. In most cases, with progression, signs of more generalized bradykinesia appear, which include facial masking, reduced voice volume, and slowing of activities of daily living. In more advanced Parkinson disease, other disabling manifestations may follow, such as impaired balance, gait freezing, falls, speech disturbance, and cognitive impairment. Levodopa is the most effective medical treatment for Parkinson disease. However, motor complications uniquely related to levodopa treatment may emerge that may be difficult to manage. These include fluctuating levodopa responses and involuntary movements and postures known as dyskinesia and dystonia. Medication adjustments are usually effective, but in some cases surgical intervention with deep brain stimulation becomes necessary to alleviate motor complications. The case of Mr L, a man with an 11-year history of Parkinson disease, illustrates these emerging motor complications and the manner in which they may be managed both medically and surgically.
Tarsy D. Treatment of Parkinson DiseaseA 64-Year-Old Man With Motor Complications of Advanced Parkinson Disease. JAMA. 2012;307(21):2305-2314. doi:10.1001/jama.2012.4829