Although distinguishing between Parkinson’s dyskinesia and parkinsonian tremor can be difficult, recognizing the differences can significantly impact both treatment and quality of life for a person with Parkinson’s. Here, we’ll highlight some of the differences and similarities and share how treatments vary depending on the diagnosis.
What Is Dyskinesia?
Literally meaning “abnormal movement,” dyskinesia is an uncontrolled, involuntary muscle movement that is irregular in motion. Although it can be a stand-alone condition, in people with Parkinson’s, it is most often associated with long-term use of levodopa or other Parkinson’s medications that increase levels of dopamine in the brain. This type of levodopa-induced dyskinesia involves symptoms ranging from writhing or wriggling to dramatic rocking and head bobbing. Severe dyskinesia, also referred to as troublesome dyskinesia, can significantly interfere with daily life and compromise gait and balance, limiting the person’s engagement in activities such as running errands, participating in hobbies, meeting with family and friends, and eating in public.
How is dyskinesia diagnosed?
Parkinson’s dyskinesia is most often diagnosed via a physical examination and clinical history review. Movement disorder specialists and neurologists are best equipped to make this diagnosis. To help confirm the diagnosis more objectively, your doctor may also suggest that you video yourself when you’re at home or use a wearable device that can detect movements over time.
What is parkinsonian tremor?
Like dyskinesia, a parkinsonian tremor involves involuntary muscle movements. Unlike dyskinesia, however, a tremor is characterized by regular, rhythmic movements.
A tremor can affect one or more parts of the body, with the most common being a person’s hands. In the early stages of Parkinson’s, tremor is typically seen on one side of the body often starting in a hand; however, as Parkinson’s progresses, tremor may impact both sides and affect more body regions.
Typically, Parkinson’s tremors, often referred to as a rest tremor, occur when the person is at rest or under emotional or physical stress. During sleep and other relaxed states, and when the affected part of the body is actively moving, tremors often subside.
Regardless of the body parts they affect, tremors can interfere with routine activities such as writing, shaving, getting dressed, tying shoelaces, cutting, and other tasks that require fine motor coordination.
How is parkinsonian tremor diagnosed?
Doctors often diagnose tremors through physical and neurological examinations and a medical history review. During the physical evaluation, a doctor will assess the tremor to see if it occurs when your muscles are at rest or in action, where they are located on your body, if they occur on one or both sides, and their frequency and amplitude. They will also assess other neurological functions such as walking, balance, speech, muscle tone, and mobility.
What is the difference in treatment?
At times, it can be difficult to distinguish between dyskinesia and tremor, so it is essential to find a doctor with enough expertise to do so. Making the correct diagnosis is critically important, as it can profoundly alter treatment decisions.
If a person with Parkinson’s is having dyskinesias that are bothersome and/or present most of the time, one option is to reduce the levodopa dose or other related Parkinson’s medications. However, if doing so would adversely affect the control of your chief Parkinson’s symptoms, your doctor may prescribe treatment to specifically target the dyskinesia. An extended-release formulation of amantadine (GOCOVRI) has been approved by the FDA specifically for the treatment of levodopa-induced dyskinesia in people with Parkinson’s and has been demonstrated to also reduce OFF time, when Parkinson’s symptoms re-emerge. Another option is to consider other forms of amantadine, which are approved to treat Parkinson’s – and may be prescribed off-label to treat dyskinesia.
However, if a person with Parkinson’s is experiencing a parkinsonian tremor, you would do the exact opposite and increase the dosage of levodopa or related Parkinson medications. As the most common medication used to control movement symptoms of Parkinson’s, levodopa typically helps relieve tremors in people with Parkinson’s. Other medications, such as anticholinergics, are sometimes used to control tremors, but because these can cause significant mental and physical side effects, be sure to discuss all options with your doctor carefully. Propranolol, a drug used for hypertension, heart disease, and migraine headaches, is occasionally helpful for managing parkinsonian tremors, as is Clozapine, a drug used for treating schizophrenia. Although it may be effective for controlling tremor, Clozapine requires those taking it to adhere to strict monitoring of blood work for the first year and a half of use.
In short, making the wrong decision such as increasing levodopa when the person with Parkinson’s actually has bothersome dyskinesias or decreasing the dose when the person with Parkinson’s actually has tremor, can significantly compromise normal movement and quality of life.
For people with Parkinson’s who are good candidates and willing to undergo surgery, deep brain stimulation (DBS) can be a successful treatment option for controlling Parkinson’s dyskinesia and parkinsonian tremor.
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This post was written by the Davis Phinney Foundation.
This blog series is sponsored by Adamas Pharmaceuticals Inc.