Can New Parkinson’s Treatments Really Help with Dyskinesia?

For people living with Parkinson’s disease, managing symptoms is a careful balancing act. One of the trickiest parts? Treating the motor symptoms—like stiffness and slowness—without triggering dyskinesia, the involuntary movements that can come as a side effect of medication. It’s a classic “robbing Peter to pay Paul” situation: reduce the “off” time when medication isn’t working, and you might increase the troublesome movements when it is. But there’s growing interest in a concept called “good on time”—this is the sweet spot where medication is working well (you’re “on”) but without those bothersome dyskinesias. The latest question for researchers and doctors is: can newer Parkinson’s therapies help us reach that sweet spot more reliably? Why Dyskinesia Happens in the First Place There’s a theory behind how dyskinesia develops: it’s not just about how much dopamine you have, but how it’s delivered to the brain. Traditional Parkinson’s meds—especially immediate-release tablets like levodopa—cause a kind of on-off, pulsing effect in the brain. This “pulsatile stimulation” is thought to increase the risk of dyskinesia over time. The idea is that smoother, more continuous dopamine delivery could potentially reduce that risk or even prevent dyskinesia from starting in the first place. That’s where newer formulations and infusion therapies come in—like extended-release pills or wearable pumps that give you a steady flow of medication. The catch? These therapies are often complicated to use, especially early in the disease. They can involve surgery, devices, or strict routines. And while the theory sounds promising, we don’t yet have long-term studies proving that starting continuous therapies earlier actually stops dyskinesia from developing. Unfortunately, the clinical trials needed to prove this are long, expensive, and not a top priority for most pharmaceutical companies. What If You Already Have Dyskinesia? That’s the big question for many people: can these newer treatments actually reduce dyskinesia once it’s already a problem? The answer so far is... mixed. Large studies (called phase 3 trials) of new Parkinson’s therapies have shown that they do reduce “off” time and increase “good on time”—that’s promising. But they haven’t shown a clear drop in troublesome dyskinesia. So, while your meds may work better, the involuntary movements often remain about the same. However, smaller studies are offering a glimmer of hope. For example: Dr. Angelo Antonini in Italy saw significant reductions in dyskinesia over 6 months with enteral levodopa infusion (a type of pump that delivers medication through the gut). Dr. Regina Katzenschlager in Europe found that subcutaneous apomorphine infusion (a pump delivering medication just under the skin) also helped reduce dyskinesia over 6 months. These results suggest that longer-term continuous therapy may gradually retrain the brain, reducing dyskinesia over time—a process some are calling “deep priming.” Where Do We Go from Here? The takeaway? There’s no magic bullet—yet—but newer therapies are moving in the right direction. They may not erase dyskinesia overnight, but they offer the potential for better balance and longer stretches of “good on time” without as many side effects. And while early use of continuous therapies might one day prevent dyskinesia, the tools (and funding) just aren’t quite there yet. In the meantime, research continues—and these new infusion treatments are worth watching closely. For people with Parkinson’s and their doctors, it’s about finding the right combination of treatments to strike the balance: better movement, fewer side effects, and, hopefully, more good days.