{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:40Z","timestamp":1787017060839,"version":"build-2736575974"},"reference-count":14,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,9]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>Parkinson\u2019s disease (PD) is characterised by motor complications that can become difficult to manage with disease progression. Certain medications used to treat PD, such as levodopa-carbidopa, can also cause motor complications. The timing and type of motor complication occurrence can provide important clues in determining the cause and help with treatment optimisation.<\/jats:p>\n                  <jats:p>This case report highlights the management of severe mixed dyskinesia in a critically ill PD patient admitted to the intensive care unit (ICU). The patient experienced debilitating motor complications, requiring intensive monitoring and personalised levodopa-carbidopa dose adjustments. Following the optimisation of her regimen, which included increasing the frequency of lower doses and the addition of another agent, her motor complications improved. This report underscores the need for individualised treatment strategies in advanced PD and the benefit of ICU-level close monitoring to optimise PD therapy in patients with severe dyskinesias.<\/jats:p>","DOI":"10.1136\/bcr-2024-264300","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T05:45:20Z","timestamp":1747806320000},"page":"e264300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Levodopa-carbidopa related severe mixed dyskinesia in a patient with advanced Parkinson\u2019s disease admitted to the intensive care unit"],"prefix":"10.1136","volume":"18","author":[{"given":"Mahsa","family":"Movahedan","sequence":"first","affiliation":[{"name":"Critical Care, St Paul\u2019s Hospital, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Shah","sequence":"additional","affiliation":[{"name":"Surrey Memorial Hospital, Surrey, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"McDermid","sequence":"additional","affiliation":[{"name":"Surrey Memorial Hospital, Surrey, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"2025082703334261000_18.5.e264300.1","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00702-018-1900-6","article-title":"Levodopa-induced dyskinesia: clinical features, incidence, and risk factors","volume":"125","author":"Tran","year":"2018","journal-title":"J Neural Transm (Vienna)"},{"key":"2025082703334261000_18.5.e264300.2","first-page":"S25","article-title":"Classification of fluctuations in patients with Parkinson\u2019s disease","volume":"51","author":"Quinn","year":"1998","journal-title":"Neurology (ECronicon)"},{"key":"2025082703334261000_18.5.e264300.3","first-page":"191","article-title":"Factors contributing to fluctuations of the dopaminergic nigro-striatal feedback system in Parkinson\u2019s disease","volume":"27","author":"Riederer","year":"1988","journal-title":"J Neural Transm Suppl"},{"key":"2025082703334261000_18.5.e264300.4","first-page":"759","article-title":"Drug-induced dyskinesia, part 1: treatment of levodopa-induced dyskinesia","volume":"76","author":"Vijayakumar","year":"2016","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025082703334261000_18.5.e264300.5","unstructured":"Dolhun R , The Michael J . 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LiverTox: clinical and research information on drug-induced liver injury. In: Adverse drug reaction probability scale (Naranjo) in drug-induced liver injury. 2019."},{"key":"2025082703334261000_18.5.e264300.11","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.58.9.1385"},{"key":"2025082703334261000_18.5.e264300.12","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(18)30405-8"},{"key":"2025082703334261000_18.5.e264300.13","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1111\/imj.13398","article-title":"Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia","volume":"47","author":"Williams","year":"2017","journal-title":"Intern Med J"},{"key":"2025082703334261000_18.5.e264300.14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/aian.AIAN_44_18","article-title":"Parkinson\u2019s disease in intensive care unit: an observational study of frequencies, causes, and outcomes","volume":"22","author":"Paul","year":"2019","journal-title":"Ann Indian Acad Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:34:03Z","timestamp":1756290843000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,21]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bcr-2024-264300"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264300","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}