Longterm problems

After 3-5 years of levodopa treatment side effects may appear in about one half of patients: 5

• involuntary movements—dyskinesia (use lower dose + pergolide)

• end of dose failure (reduced duration of effect to 2-3 hours only)

• 'on-off phenomenon (sudden inability to move with recovery in 30-90 minutes)

• early morning dystonia, e.g. clawing of toes (due to disease—not a side effect); management of motor problems summarised in Table 29.6 .

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