Early Morning Off-Medication Dyskinesias, Dystonia, and Choreic Subtypes

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Abstract
DYSKINESIAS in patients with Parkinson disease (PD) have various forms, related in part to the underlying dopaminergic denervation and to drugs.1 Dyskinesias are usually classified into 2 categories, off-period dyskinesias and on-period dyskinesias, based on the patient's clinical state (on or off) and relationship with the medication intake (before the first dose of morning medication, at peak medication intake, and at the end of the dose). On-period dyskinesias, such as levodopa peak-dose dyskinesias, occur during the period of maximal relief of parkinsonian symptoms and are predominantly choreic, usually involving the upper more than the lower limbs, the face, and the trunk.2,3 Peak-dose on-period dystonia may also occur.