Opinion
Video
A Case of a 54-Year-Old Woman With Parkinson Disease and Dyskinesia
Panelists discuss how a 54-year-old woman with early-onset Parkinson disease presenting with troublesome peak-dose dyskinesia affecting her work performance illustrates the challenge of managing patients who have both dyskinesia and likely "off" episodes, requiring careful assessment of functional impacts through targeted questioning about daily activities, work performance, and social interactions, since patients often minimize or remain unaware of their dyskinesia's true impact while caregivers may provide crucial insights into how the involuntary movements affect not only the patient but also family dynamics and professional relationships.
This segment presents a clinical case of a 54-year-old woman diagnosed with early-onset Parkinson disease at age 45, who now presents with troublesome peak-dose dyskinesia primarily affecting her upper body and head. Her symptoms significantly interfere with her work performance, particularly during typing and virtual meetings, leading to social withdrawal and mild anxiety. She demonstrates several key risk factors for dyskinesia development, including female gender, early-onset Parkinson disease, and her thin body habitus. After 10 years with the diagnosis, her current medication regimen includes carbidopa-levodopa immediate release taken 5 times daily, along with ropinirole and rasagiline, representing a typical treatment approach for someone at this disease stage.
The clinical assessment emphasizes the critical importance of evaluating both dyskinesia and “off” time episodes, as these 2 complications typically coexist. Before determining treatment strategies, clinicians must thoroughly assess whether the patient experiences off periods, as this significantly impacts therapeutic decision-making. If the patient has minimal “off” time, reducing medications such as ropinirole or rasagiline could help improve dyskinesia. However, if significant off time exists, medication reduction becomes challenging since it could worsen motor fluctuations and functional capacity, particularly affecting work performance when patients become slow and unable to type efficiently between doses.
The discussion highlights important clinical challenges in dyskinesia management, including the tendency for physicians to prioritize treating off time over dyskinesia due to having more available treatment options for the former. Patients often minimize or remain unaware of their dyskinesia's impact, requiring clinicians to ask targeted questions about work performance, hobbies, sleep, and fall risk rather than directly asking about dyskinesia symptoms. The involvement of caregivers or family members in appointments is crucial, as they often provide valuable insights about functional impacts that patients may not recognize, including effects on grandchildren who might be frightened by abnormal movements or social situations that patients avoid due to embarrassment.
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