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l-3,4-Dihydroxyphenylalanine (l-dopa)-induced dyskinesia affects virtually every patient with Parkinson disease (PD) after chronic administration.1 The pathophysiology of dyskinesia is complex, and several nondopaminergic systems are involved.2 The serotonin (5-HT) system has received much attention over the past years as a critical player underlying dyskinesia and as a potentially efficacious therapeutic target. 5-HT neurons contain the required enzymes to synthesize dopamine from l-dopa3 but without the regulatory mechanisms required for dopaminergic transmission, resulting in dysregulated, nonphysiologic dopamine release, which underlies the dyskinetic state.4 However, if this aberrant dopamine release by 5-HT fibers is the culprit in dyskinesia, it is also responsible, at least partly, for the antiparkinsonian action of l-dopa.5 As a result, it has proven difficult to achieve an antidyskinetic benefit with agonists of the 5-HT1A receptors, which act by dampening this aberrant dopamine release by 5-HT terminals, without hindering the therapeutic effect of l-dopa in both preclinical and clinical settings.6,7
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See page 853
- © 2015 American Academy of Neurology
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