December 27, 2025

@michaelokun

Should we use 'early amantadine' to tame dyskinesia before it starts? Dyskinesia refers to involuntary extra movements that can appear after disease progression and levodopa exposure in Parkinson’s disease. Rascol and colleagues describe in a new paper in Movement Disorders how adding immediate release amantadine early to levodopa therapy may reduce the manifestation of dyskinesia in Parkinson’s disease. Key Points: - Early amantadine plus levodopa cut the rate of new dyskinesia roughly in half over 18 months when compared w/ placebo. - Folks receiving amantadine needed smaller increases in daily levodopa doses over time. - Modest benefits were also seen in freezing of gait, fatigue and quality of life, while safety remained consistent w/ prior experience. My take: This is a thoughtful study that asks whether timing matters. Starting the right therapy earlier may shape how Parkinson’s symptoms evolve rather than just reacting after problems appear. Here are 5 points that resonated w/ me: 1- Dyskinesia may no always be inevitable and perhaps early strategies may lower risk for some folks. 2- Using amantadine earlier may allow health care providers to rely on slightly lower levodopa doses over time. 3- Benefits extended beyond dyskinesia and touched symptoms like fatigue and freezing that have been traditionally hard to treat. 4- The approach did not prove disease modifying, however it suggested the possibility that prevention minded care was worth studying. 5- These data support more personalized conversations between folks and their health care providers about when to add therapies and not just what to add. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.70120 #michaelokun #fixelinstitute #parkinson #amantadine #dyskinesia