Anxiety & Dyskinesia

My wife was first diagnosed about 10 years ago and has been taking Sinemet for about 5 years which has kept her Bradykesia in check and allowed her to live a reasonably normal life.

Of late though she has started to experience random short attacks of involuntary and uncontrollable movements of her body mainly in her feet and legs (dyskinesia) that occur without rhyme or reason at any time of the day and in the evening.

Her Parkinson’s nurse first felt that his might be because her Sinemet medication was beginning to lose its effectiveness or that the attacks might have been around the times she took her dosage.

As a consequence she prescribed Sinemet PR (slow release) before bed time to complement her exiting medication regime and this seems to have reduced, though not eradicated the frequency of when my wife experiences occurrences of dyskinesia

Her nurse is now of the opinion that the dyskinesia is being caused by anxiety/stress and tiredness though my wife is adamant she does not experience this She is quite an active person and is trying to balance activity and relaxation periods during the day and go to bed earlier.

I have noticed though that if she has social interactions (via WhatsApp /Zoom or face to face) with friends or family that she sometimes gets an attack and the last couple of times we have been to do the weekly shop it has occurred.

Does anyone else have similar experiences as my wife and are there drugs you could recommend that have helped you to address anxiety that could be added to her medication regime which is as follows.

Sinemet Plus 25mg/100mg 56 tablets to be taken daily at 7.00am
Sinemet Plus 12.5/50mg 280 tablets to be taken 4 times a day (11.00am, 13.30pm, 16.30pm, 19.30pm)
Razagaline 1mg 56 tablets to be taken daily
Spiroco 8mg 56 tablets to be taken daily
Cocareldopa 12.5mg/50mg 280 tablets to be taken 4 times a day (11.00am, 13.30pm, 16.30pm, 19.30pm)
Half Sinemet CR 25mg/100mg 60 tablets to be taken at 22.00pm

I’ll of course talk to her nurse before we adjust her regime.


Yes anxiety/stress and tiredness do in my opinion bringing on episode’s of dyskinesia. I too like your wife do not recognise anxiety or stress in myself, my wife on the other hand would say I do suffer with both at times especially after a challenging days work. Tiredness I agree is a precursor and despite some people thinking that they get enough sleep it is about the quality of the sleep.

My latest readings off my smartwatch show that last night though I slept for 5 hours and 30 minutes the percentage of deep sleep was 9% (range should be 20 to 60%) REM sleep 5% (10 to 30%) and light sleep was 86% (less than 55%). Which along with the variety of meds some the same as your wife I feel fatigued most days.

The issue with adding more meds us more side effects which might not balance the scales the right way. I wish I could say Eureka here is the solution but I can’t. I am still trying to solve my issues with dyskinesia as is my care team. All I can say is I wish you both well and good luck in finding the right solution for your wife. :sunglasses:

Hi, I hope your wife will recognize some features in the information below that will help start to clear up the confusion. Drug-induced movements disorders are caused by drugs. They can be exacerbated by stress & fatigue. One subtype of tardive dyskinesia is called akathisia. It is often misdiagnosed as anxiety and/or restless leg.

Parkinson’s UK could help prevent much suffering by providing an information page for patients specifically on Akathisia as they have done for Restless Leg and by including links to it in other areas such as levodopa side effects, dyskinesias, nonmotor symptoms ,pain, sleep, anxiety etc . Or, of course, they could choose to continue to ignore it. (for more on akathisia:

Drug-Induced Dyskinesia, Part 1: Treatment of Levodopa-Induced Dyskinesia. Vijayakumar D, Jankovic J. Drugs. 2016 May;76(7):759-77.
Dyskinesias encompass a variety of different hyperkinetic phenomenologies, particularly chorea, dystonia, stereotypies, and akathisia.
Levodopa-induced dyskinesia (LID) is one of the main types of drug-induced dyskinesia, occurring in patients with Parkinson’s disease (PD) who have been treated with levodopa for long time, but this side effect may be encountered even within a few weeks or months after initiation of levodopa therapy.

Distinguishing akathisia and tardive dyskinesia: a review of the literature M R Munetz, C L Cornes J Clin Psychopharmacol. 1983 Dec;3(6):343-50.
Akathisia and tardive dyskinesia, both side effects of neuroleptic drugs, should be easily distinguishable. Akathisia is fundamentally a subjective disorder characterized by a desire to be in constant motion resulting in an inability to sit still and a compulsion to move. Tardive dyskinesia is an involuntary movement disorder characterized by repetitive purposeless movements which typically involve the buccolingual masticatory areas but which can include choreoathetoid limb movement.

The two syndromes are recognized as distinct, but it is not uncommon for misdiagnosis to occur, since strict criteria are not often applied. Some drugs… have been reported to cause both akathisia and RLS.
The subjective symptoms
In DIA, there is a sense of inner restlessness in the mind or the body, particularly the legs.
This is in contrast to RLS, in which the characteristic complaint is of sensory symptoms in the legs.
Paraesthesiae can occur in DIA, but they are uncommon.
RLS patients may experience paraesthesiae in the arms as well, which would be extremely unusual in DIA.
DIA may also be experienced as inner tension, apprehension, irritability, impatience or general unease and may give rise to ‘paradoxical behavioural reactions’ (exacerbation of psychosis, violence, suicide, sexual torment, etc).
This is unusual for RLS, which is recognized as a sensorimotor sleep disorder without a cognitive or affective component, although patients may secondarily develop frustration, anxiety, anger or depression.

Motor manifestations (intentional)
The characteristic intentional movements of DIA are fidgetiness, crossing/uncrossing and pumping up and down of legs, inverting/everting of feet, tapping of toes, shifting body while sitting, rocking, shifting weight from foot to foot while standing, marching in place and pacing.
The typical movements of RLS are rubbing of legs, stretching of muscles, leg flexions, deep knee bends, tossing and turning in bed and pacing the floor.
The DIA patient moves to relieve the inner restlessness, while the RLS patient moves to relieve the paraesthesiae.
Body rocking, marching in place, shifting body position in a chair, and crossing/uncrossing of legs, movements characteristic of DIA, are not commonly seen in RLS, although they do occur intermittently.
The movements in RLS are usually successful in relieving the symptoms after a few minutes, but the akathisic patient gets little sustained relief.
The classic ‘inability to sit’, although present in only a proportion of DIA patients, is not typical of RLS, and the pacing of the RLS patient has a quantitatively different basis.

Exacerbating and relieving features
The symptoms of RLS are worst at night-time and when the limbs are at rest. They typically become most distressing when the individual goes to bed, and in mild cases may appear only at this time.
The symptoms of DIA do not show a definite diurnal pattern, although they may fluctuate either in relation to neuroleptic administration or for no apparent reason. They are worst when the person maintains a posture, either sitting or standing, for a prolonged period.
RLS patients may obtain relief from the application of heat or cold to the legs, which is not the case in DIA.
Overall, sleep has a marked ameliorating effect on movements in akathisia.
Sleep is significantly disturbed in RLS, with increased sleep latency, reduced sleep efficiency, multiple awakenings at nigh tand daytime somnolence. Polysomnography reveals increased sleep latency, reduced slow-wave sleep, reduced REM sleep and increased stage 1 and 2 sleep.
While sleep disturbance may be seen in DIA, it is relatively mild in comparison…Some increase in sleep latency,