People with Parkinson’s disease may not notice their dyskinesia, and even when they do, they may prefer to experience some extra movement as opposed to feeling “locked up.” However, the symptoms of dyskinesia can sometimes cause caregivers and family members to feel embarrassed or uncomfortable. Here are six common causes of dyskinesia, plus strategies to keep the symptom from worsening.
Dyskinesia Cause #1: Stress
In general, stress can trigger many reactions, but in people with Parkinson’s disease, stress can also trigger dyskinesia. Stress is defined as pressure or strain, and when viewed in this light, many daily activities can increase stress and therefore the likelihood of developing dyskinesia. For someone with Parkinson’s, dealing with symptoms like stiffness and slowness, getting dressed, preparing and eating meals, and even walking can be a challenge. “Even a cold or a long walk could be stressful,” says Kathleen Poston, MD, an associate professor of neurology at Stanford University Medical Center in Palo Alto, California. Careful planning and scheduling plenty of time for the day’s activities can help reduce stress. When possible, reframing or removing someone with Parkinson’s from a stressful situation can also help get things back on track.
Dyskinesia Cause #2: Anger
When someone with Parkinson’s becomes angry or frustrated — for example, after they had a difficult conversation with a caregiver — they may experience more severe dyskinesia, says Poston. “Anything that prompts the release of adrenaline is likely to make dyskinesia worse.” Parkinson’s is a challenge for not only for people who have the condition but also for caregivers and families. Communication is key in avoiding misunderstandings and conflicts, says Cathi A. Thomas, RN, CNRN, the program director of the Parkinson’s Disease and Movement Disorders Center at Boston University Medical Campus.“We have a lot of programs for newly diagnosed people [with Parkinson’s], and we offer support groups to help them cope better,” she says.
Dyskinesia Cause #3: Happiness
Moments of joy and happiness, especially laughter, can bring on dyskinesia. “Dyskinesia is influenced by what’s going on in your environment, so whether you’re happy, sad, or anxious, you can definitely see an increase in movement,” says Thomas. It’s important to remember, especially in this case, that even though dyskinesia can make bystanders feel uncomfortable, the needs of the person with Parkinson’s are what matter the most. For most people with Parkinson’s, dyskinesia isn’t a problem, says Alexander Pantelyat, MD, the director of the Johns Hopkins Atypical Parkinsonism Center in Baltimore. However, he says, dyskinesia can cause embarrassment for the person’s friends and family members. In the case of happiness and laughter, it’s good to be aware why dyskinesia might be worsening, even if (in this case) you don’t want to take measures to prevent it.
Dyskinesia Cause #4: Too Little Sleep
Symptoms like stiffness and cramping that accompany Parkinson’s can make it difficult to get a good night’s sleep. According to the American Parkinson Disease Association (APDA), people with the disease average just over five hours of sleep a night and wake up twice as many times as those who don’t have Parkinson’s. Keeping a regular sleep-wake schedule and only taking one short nap a day can help improve your shut-eye at night, according to the APDA.
Dyskinesia Cause #5: A High-Protein Snack
“Knowing when, and how, to take medication [with] food can help reduce dyskinesia,” says Thomas. First, you’ll need to know how levodopa works in the body and how the medication interacts with food: The amino acids found in protein are used in the body and the brain, but first, these acids must pass through the blood-brain barrier — the same pathway that’s used by levodopa, says Dr. Poston. Because of this so-called traffic congestion, a high-protein meal can interfere with the way the medication is absorbed, worsening the “on-off” fluctuations that can come with levodopa therapy. By working with a doctor and a dietitian, who can help you plan meals and snacks that have the right amount of protein, as well as tracking when the symptoms of dyskinesia start to worsen, it’s possible to reduce some of these unwanted movements.
Dyskinesia Cause #6: Too Much Medication
Each person with Parkinson’s experiences symptoms a little differently than the next. The challenge for the physician is finding the dose and formulation of levodopa that provides the right balance of symptom relief while avoiding dyskinesia, says Todd Herrington, MD, PhD, a neurologist at Massachusetts General Hospital in Boston and an instructor in neurology at Harvard Medical School in Cambridge, Massachusetts. Too much levodopa can trigger dyskinesia and possibly make other Parkinson’s symptoms worse, he says. But if people don’t take enough medication, it can leave them feeling slow, stiff, and even trapped in their own body. So be sure to work with your doctor on the right treatment regimen for you.
