LEVODOPA-INDUCED DYSKINESIAS: TRANSITION FROM HYPOKINESIA TO HYPERKINESIA IN PARKINSON’S DISEASE

Abstract

Parkinson’s disease is a neurodegenerative disorder characterized primarily by motor alterations resulting from the degeneration of dopaminergic neurons. Levodopa remains the most effective treatment for the control of motor symptoms; however, its long-term use is associated with the development of levodopa-induced dyskinesias, characterized by involuntary movements and motor fluctuations that impair patients’ quality of life. The present study aimed to analyze the pathophysiological mechanisms and clinical outcomes associated with the transition from hypokinesia to hyperkinesia in patients with Parkinson’s disease undergoing levodopa treatment. This study consists of a qualitative narrative literature review conducted using the PubMed database, including studies published between 2017 and 2025 in Portuguese, English, Spanish, and French. After applying the inclusion and exclusion criteria, 11 articles comprised the final sample. The results demonstrated that dyskinesias are associated with the progressive degeneration of the nigrostriatal pathway, pulsatile dopaminergic stimulation, alterations in synaptic plasticity, and the involvement of serotonergic, glutamatergic, and inflammatory pathways. Clinically, a predominance of involuntary movements, motor fluctuations, and progressive functional impairment was observed. It is concluded that levodopa-induced dyskinesias represent an important therapeutic challenge in Parkinson’s disease, requiring more individualized management strategies and therapeutic approaches capable of reducing the functional impact of disease progression.