Cell transplants are being developed for patients with Parkinson disease (PD) who have insufficient benefit with standard medical treatment. We describe the clinical features of five patients who developed persistent dyskinesias after fetal dopaminergic tissue transplantation. All had levodopa-induced dyskinesias preoperatively. We implanted fetal mesencephalic dopaminergic tissue into the putamina bilaterally in 34 patients with advanced PD. They were not immunosuppressed. Five of 34 patients (15%) developed troublesome choreic or dystonic dyskinesias that persisted despite lowering or discontinuing medications. Attempts to treat the involuntary movements with amantadine, clozapine, anticholinergics, dopamine depletors and other medicines had limited success. Metyrosine eliminated dyskinesias but led to the parkinsonian “off” state. Increasing the dose of levodopa worsened the dyskinesias. Three patients required placement of pallidal stimulators, bilaterally in two and unilaterally in one patient who had only contralateral dyskinesias. The two with the bilateral stimulators had improvement in dyskinesias. The patient with the unilateral pallidal stimulator had a substantial reduction of the dyskinesias, but attempts to treat residual “off” symptoms with levodopa were limited by worsening dyskinesias. Although the number of patients developing these persistent dyskinesias was small, these five patients had dramatic improvement after transplant. As a group, they had milder Parkinson signs at baseline and improved to the point of having minimal parkinsonism, with reduction or elimination of levodopa therapy prior to developing persistent dyskinesias. These involuntary movements establish the principle that fetal dopaminergic tissue transplants can mimic the effects of levodopa, not only in reducing bradykinesia, but also in provoking dyskinesias.

正在为患有帕金森病（PD）的患者提供细胞移植，这些患者在标准药物治疗中获益不足。我们描述了五名胎儿多巴胺能组织移植后发生持续性运动障碍的患者的临床特征。术前均患有左旋多巴诱发的运动障碍。我们将34例晚期PD患者的胎儿中脑多巴胺能组织双边植入到了Putamina中。他们没有被免疫抑制。34例患者中有5例（15％）出现了麻烦的舞蹈性或肌张力障碍性运动障碍，尽管降低或停用了药物仍持续存在。尝试用金刚烷胺，氯氮平，抗胆碱能药，多巴胺耗竭剂和其他药物治疗非自愿运动的成功有限。甲硫氨酸消除了运动障碍，但导致帕金森氏症处于“关闭”状态。左旋多巴剂量的增加会使运动障碍加重。3例患者需要放置苍白刺激物，其中2例是双侧双侧，而对侧运动障碍的则是1侧单侧。带有双侧刺激器的两个患者的运动障碍有所改善。具有单侧苍白刺激物的患者运动障碍明显减少，但通过增加运动障碍限制了用左旋多巴治疗残余“关闭”症状的尝试。尽管发生这些持续性运动障碍的患者人数很少，但是这五名患者在移植后有了显着改善。作为一个整体，他们在基线时具有较轻的帕金森症候群，并改善为具有最小的帕金森氏症的程度，并在发展为持续性运动障碍之前减少或消除了左旋多巴疗法。