Medical Management and Prevention of Motor Complications in Parkinson's Disease

Neurotherapeutics. 2020 Oct;17(4):1339-1365. doi: 10.1007/s13311-020-00889-4.


Levodopa is the most effective medication for the treatment of the motor symptoms of Parkinson's disease. However, over time, the clinical response to levodopa becomes complicated by a reduction in the duration and reliability of motor improvement (motor fluctuations) and the emergence of involuntary movements (levodopa-induced dyskinesia). Strategies that have been attempted in an effort to delay the development of these motor complications include levodopa sparing and continuous dopaminergic therapy. Once motor complications occur, a wide array of medical treatments is available to maximize motor function through the day while limiting dyskinesia. Here, we review the clinical features, epidemiology, and risk factors for the development of motor complications, as well as strategies for their prevention and medical management.

Keywords: Parkinson’s disease; continuous dopaminergic stimulation; levodopa; levodopa-induced dyskinesia; motor fluctuations; treatment.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / administration & dosage*
  • Carbidopa / administration & dosage*
  • Catechol O-Methyltransferase Inhibitors / administration & dosage*
  • Delayed-Action Preparations / administration & dosage
  • Disease Management
  • Dyskinesias / drug therapy*
  • Dyskinesias / etiology
  • Dyskinesias / physiopathology
  • Humans
  • Levodopa / administration & dosage*
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / physiopathology


  • Antiparkinson Agents
  • Catechol O-Methyltransferase Inhibitors
  • Delayed-Action Preparations
  • Levodopa
  • Carbidopa