9 Ways to Manage Dyskinesia in Advanced Parkinson’s Disease
Updated on August 3, 2026
Parkinson’s disease is associated with a number of symptoms, including tremor, slowed movement, stiffness, and balance problems. But one symptom of advanced Parkinson’s disease — dyskinesia — is actually a complication of levodopa, the medication most commonly used to treat Parkinson’s.
Dyskinesias, a type of involuntary movement, typically begin after several years of living with Parkinson’s disease. They tend to have a writhing, fluid, dance-like quality, but they may also cause rapid jerking or slow and extended muscle spasms. Although dyskinesia is a side effect of levodopa, it’s important to remember that this isn’t a sign that levodopa has stopped working; rather, it’s working too well and the brain is struggling to smooth out its effects.
For many people, living with dyskinesia is easier than dealing with the other symptoms of Parkinson’s, such as stiffness, says Alex Pantelyat, MD, an associate professor of neurology at the Johns Hopkins School of Medicine in Baltimore. But for others, it can be painful and can interfere with social activities. Here are nine ways to manage dyskinesia and feel your personal best.
1. Talk to Your Doctor About Changing Your Medication Dosage
Tweaking your dosage of levodopa or other dopaminergic medications (drugs that affect the dopamine-producing parts of the brain) can often help improve dyskinesias.
Levodopa, in particular, is more likely to cause dyskinesia when it’s taken in higher doses. “More than 600 milligrams a day in the long run is associated with a greater incidence of dyskinesia,” says Dr. Pantelyat.
To manage dyskinesias, your doctor may suggest making small decreases in levodopa, but still taking enough to control your other Parkinson’s symptoms. They may also suggest removing other dopaminergic medications, such as dopamine agonists, catechol-o-methyl transferase (COMT) inhibitors, or monoamine oxidase B (MAO-B) inhibitors.
2. Tweak the Timing of Your Medication
Common types of dyskinesia include peak-dose dyskinesia (which occurs when medication is strongest) and diphasic dyskinesia (which happens when medication kicks in or wears off). This means that adjusting the timing of your medication can be an important strategy for managing dyskinesias.
Your doctor may decide to split your daily medication into smaller, more frequent doses in order to deliver a steadier amount of medication to the body and reduce the risk of dyskinesias.
Your care team may also suggest switching to extended-release levodopa, which has been shown to provide a greater reduction of “off” times (when the medication wears off, which can increase symptoms) and a greater increase in “on” times (when the medication response is good, which improves symptoms) without extra dyskinesias, when compared with the standard formulation.
3. Start or Stop Taking Other Medications for Your Parkinson’s Disease
In addition to levodopa, other drugs, such as dopamine agonists, COMT inhibitors, and MAO-B inhibitors, can also worsen dyskinesias. To manage dyskinesias, your doctor may suggest removing these medications from your regimen.
Your doctor may also recommend taking other medications (in addition to levodopa) to manage dyskinesias. These drugs include:
- An antiviral and antidyskinetic medication called amantadine (Gocovri, Symmetrel) may be prescribed to help reduce dyskinesias without worsening “off” periods.
- An extended-release formulation of amantadine (Gocovri) is used specifically for the treatment of levodopa-induced dyskinesia in people with Parkinson’s disease.
- Other amantadine formulations are also sometimes used off-label for dyskinesia.
4. Ask Your Doctor About Continuous Drug Delivery
One way to potentially avoid fluctuations in medication delivery and dopamine levels (and potentially reduce dyskinesias) is through a continuous drug delivery system such as Duopa.
Levodopa is almost always combined with a medication called carbidopa to help improve uptake. Duopa therapy is a form of carbidopa-levodopa that treats the same movement symptoms, but it's also designed to improve absorption and reduce “off” times by delivering the drug through a tube directly into the small intestine, rather than being taken as a pill.
Before you can start Duopa, you must have surgery to make a small hole (called a stoma) in your abdomen in order to place a tube in your intestine. A pump then delivers Duopa directly to your intestine through this tube.
Another option is a continuous subcutaneous (under the skin) infusion, in which a small device similar to an insulin pump is clipped to the clothing. In late 2024, the U.S. Food and Drug Administration approved foscarbidopa and foslevodopa (Vyalev) as the first and currently only subcutaneous 24-hour infusion of levodopa-based therapy for the treatment of motor fluctuations in adults with advanced Parkinson’s disease.
Vyalev uses a pump device that you wear at all times, except when you shower, bathe, or swim. By delivering medication continuously through the day and night, it’s meant to provide more “on” times and help smooth out “off” times when symptoms return, including dyskinesia.
Another continuous subcutaneous infusion option is one that delivers a steady dose of the medication apomorphine (Apokyn), a dopamine agonist, which may reduce “off” times, increase “on” times, and minimize dyskinesia symptoms.
5. Consider Deep Brain Stimulation
Deep brain stimulation (DBS) is a type of surgery that can help control movement symptoms such as dyskinesia when medications alone are not enough, or between doses.
During the surgery, a small opening is made in the skull to place thin wires in specific areas of the brain. These wires are connected to a small device implanted under the skin near the collarbone, which sends electrical signals that can help reduce movement symptoms.
DBS may be considered when medications no longer control Parkinson’s symptoms or cause side effects (such as dyskinesia) that are hard to manage.
After surgery, many people take less medication than they did before, which may also help with dyskinesia by reducing medication doses.
“Deep brain surgery has the greatest promise on an individual level,” says Pantelyat. But there are also risks. “Depending on the experience of the surgeon,” he says, “there’s a risk of bleeding or trauma to the brain, as well as a slight hit to verbal memory — for example, the ability to remember names of animals or words starting with the letter ‘f’ may be impaired for a while. Usually it’s a short-term problem, but in some people it can be a long-term one.”
6. Adjust Your Diet
No specific diet helps treat dyskinesia, but there are dietary changes you can make that can affect how your body absorbs and uses levodopa.
Levodopa is a building block of protein, so your body absorbs it along with dietary protein. This means that if you eat a protein-rich meal along with your levodopa pill, your body cant absorb the medication as completely, because it can only absorb so much at one time.
That’s a problem because it may mean taking a higher dose to get the same effect — and a higher dose means a higher risk of dyskinesia.
Doctors often recommend a low-protein diet or a protein redistribution diet (eating most of your daily protein at dinnertime) to improve levodopa bioavailability.
If levodopa doesn’t seem to be working its best, or if it’s wearing off before it’s time for your next dose, your doctor may also recommend taking the medication on an empty stomach — 30 minutes before or 60 minutes after a meal.
Iron supplements can decrease the absorption of levodopa, so if you take those, experts recommend doing so at least two hours before or after taking levodopa.
7. Lower Your Stress
Stress is associated with dyskinesias. A survey of 5,000 patients with Parkinson’s disease found that stress worsened all symptoms of the disease, including dyskinesia.
However, the survey also found that stress-reducing interventions such as mindfulness helped improve symptoms, including dyskinesia. Participants also used exercise (walking, cycling, swimming, sports, yoga, Pilates, or tai chi) as another way to reduce stress, which in turn improved their symptoms.
8. Find New Ways to Exercise
Research shows that exercise can also help reduce dyskinesias in those with Parkinson’s disease.
People with advanced Parkinson’s disease who exercise also show greater positive effects on health-related quality of life in general.
While you can (and should) exercise at any stage of Parkinson’s, you may need to find new ways to do so as the disease progresses. In the advanced stages, you may consider simple stretching with caregiver assistance, light strengthening, or deep breathing.
Walking with walking poles, seated exercise routines at home or exercises from bed (for both strength training and cardiovascular training) can also be beneficial in the advanced stages of the disease.
9. Get Enough Sleep
Not getting adequate sleep at night is associated with dyskinesia.
However, Parkinson’s symptoms like stiffness and cramping can make it challenging to get a good night’s sleep. People with Parkinson’s average just over five hours of sleep a night and wake up twice as many times as those who don’t have the disease, according to the American Parkinson Disease Association (APDA).
To get better sleep at night and potentially reduce dyskinesias, try sleep hygiene hacks like keeping a regular sleep-wake schedule and taking no more than one short nap a day, according to the APDA.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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