American Board of Internal Medicine (ABIM) Certification Practice Exam

What approach can be taken for patients with Parkinson's who experience dyskinesia?

1. Increasing Levodopa dosage

2. Administering botulinum toxin

3. Adding amantadine

4. Prescribing stronger antipsychotics

The correct answer is: Adding amantadine

In patients with Parkinson's disease who experience dyskinesia, the most effective approach is to add amantadine. Amantadine is an antiviral medication that has been found to reduce dyskinesia in patients treated with levodopa. It works by increasing the release of dopamine and blocking the reuptake of dopamine, which is beneficial in managing the motor symptoms of Parkinson's disease, especially dyskinesias that manifest as involuntary movements. Utilizing amantadine can help improve the patient's quality of life by decreasing the intensity and frequency of dyskinetic episodes, allowing for better control of their motor symptoms without necessarily increasing the dosage of levodopa, which could lead to a worsening of dyskinesia. Other approaches such as increasing levodopa dosage may exacerbate dyskinesia rather than alleviate it, and botulinum toxin is more suitable for treating specific types of dystonia rather than general dyskinesias associated with Parkinson's. Stronger antipsychotics might address unrelated symptoms or side effects but do not target dyskinesia directly and can have adverse effects in Parkinson's patients. Hence, the addition of amantadine stands out as a preferred management strategy for dyskinesia in this patient population