Movement Disorders

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2 experts are featured in this series.

Panelists discuss how treatment decisions for complex cases like the 66-year-old man with severe dyskinesia and 4 hours of daily OFF time require individualized approaches based on patient tolerance, with options including delayed-release/extended-release amantadine (starting at lower doses in older patients due to hallucination risk), extended-release carbidopa-levodopa formulations, infusion pumps for potential deep priming effects, or deep brain stimulation for patients seeking rapid improvement, emphasizing the importance of engaging patients in discussions about their patience for dose adjustments, risk tolerance for adverse effects, and desired timeline for symptom control to guide optimal treatment selection.

2 experts are featured in this series.

Panelists discuss how a 66-year-old man with 8 years of Parkinson disease progression presenting with severe peak-dose dyskinesia affecting basic functions like eating and speaking, plus 4 hours of daily OFF time despite frequent dosing, represents a patient who should not have been allowed to progress to such advanced motor complications, emphasizing that the preferred approach is early intervention to treat motor fluctuations and dyskinesia as they develop rather than waiting until patients reach this severely impaired state with complex symptoms requiring more intensive management strategies.