Movement problems are common from long-term levodopa use. Most people who take levodopa develop some of these problems within 5 to 10 years. The main types of levodopa-related movement problems include motor (movement) fluctuations and dyskinesias.
- Motor fluctuations .
These are changes in the ability to move throughout the day. They may be called "on" and "off" times. When the medicine is working and movement is easy, it is "on." When it's harder to move and symptoms cause more problems, it is "off."
Wearing off happens when the effects of a dose of levodopa don't last as long as they used to. Symptoms come back before the next dose of levodopa. These changes can be predicted based on the timing of each dose.
"On" and "off" periods can also occur without warning. They can be hard to predict. An "off" period can occur suddenly, over seconds or minutes, and the person may freeze. Sometimes, long muscle spasms cause movement that can't be controlled. This can happen during on or off times.
Dyskinesias are sudden, random, uncontrollable, often jerky or twisting movements caused by the medicine. They may affect the head, neck, arms, and legs or other parts of the body.
Changing the dosage or when it is taken may help movement problems. Or other medicines may be added to help with these movement problems. Examples are amantadine, dopamine agonists, COMT inhibitors, MAO-B inhibitors, and apomorphine.