Complications of levodopa therapy in Parkinson's disease

Introduction: Levodopa remains the most effective treatment for the motor symptoms of Parkinson's disease (PD). However, with chronic treatment, PD patients develop motor complications, which consist of motor fluctuations and dyskinesia. Many new treatments, both medical and interventional, have been developed for the treatment of motor complications but there continues to be an unmet medical need for further treatments. Areas covered: This manuscript summarizes the phenomenology, pathophysiology, prevalence and current and future treatments of motor complications in PD patients based on a PubMed literature search from 1950s to present. Expert opinion: Motor complications are prevalent in PD and risk factors for developing these complications are well-known and well characterized. There are many effective medical and interventional treatments for both motor fluctuations and dyskinesia in PD patients. Despite these treatments, many patients still suffer from many hours of 'Off' time or dyskinesia that have a profound negative impact on quality of life. There are many exciting treatments under development for motor complications that may provide additional benefit for PD patients.