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Monthly monitoring is advocated at the beginning of methotrexate treatment, followed by 3-monthly monitoring comprising complete blood counts, liver function tests and calculation of the Fib-4 fibrosis score

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Previous metabolomics studies have reported LID-specific alterations of glycerophospholipids and endocannabinoid signalling in dyskinetic rodent models 20 and significant dysregulation in glycosphingolipid metabolism in plasma and cerebrospinal fluid (CSF) samples from LID patients, correlating closely with the severity of dyskinetic movements 21