Most people who begin levodopa treatment for Parkinson’s disease can get several years of near-complete relief from symptoms with few side effects. After several years on levodopa, however, it’s common for symptoms to become harder to manage and more medication to become necessary.

As levodopa loses its effectiveness and dopamine levels rise and fall, some people living with Parkinson’s notice “off” times when medication isn’t working, as well as motor fluctuations — changes in their ability to move. In some people, motor fluctuations are accompanied by dyskinesia, a complication of dopamine agonist therapy that causes involuntary and abnormal movements such as twisting, writhing, and jerking.

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