Table 1

Practical suggestions for pharmacological management of LID

(1) The optimal therapeutic approach for LID is to try avoiding their development
(2) Start PD treatment with an agonist if possible, particularly in young onset patients
(3) Save levodopa as long as you can hold the patient’s requirements for daily life activities
(4) Adjust the drug schedule: reduce total daily doses and/or shorten the intake intervals
(5) Add amantadine 200–400 mg/day
(6) Low doses of quetiapine or clozapine may be helpful
(7) Propose continuous drug delivery devices: duodenal levodopa/carbidopa gel or subcutaneous apomorphine
(8) For refractory cases, when indication is set by an expert and the risks are assumable by the patient, surgery is the treatment of choice