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Continuous levodopa for advanced Parkinson’s disease

By Christofer Lundqvist

Abstract

Parkinson’s disease is characterized by the progression of the disease from the early stages where it still has little functional consequence for afflicted patients, to an advanced stage disease with large consequences in terms of function, quality of life and individual and societal costs. Motor fluctuations and symptoms of levodopa overdosage may occur in parallel with increasing Parkinsonian symptoms. This leads to a narrower therapeutic window which causes problems with traditional oral medication. Various ways of optimizing oral treatment should be tried but often have limited effects. In addition to the previous alternatives of neurosurgery (especially deep brain stimulation of the subthalamic nuclei) and continuous apomorphine treatment there is now also the alternative of continuous enteral levodopa administration via a trans-abdominal tube. The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment. In the present article, the challenges to treatment of Parkinson’s disease in these phases are described as well as the various treatment alternatives available. Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel. The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed

Topics: Expert Opinion
Publisher: Dove Medical Press
OAI identifier: oai:pubmedcentral.nih.gov:2654791
Provided by: PubMed Central
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    Citations

    1. (2006). A randomized trial of deep-brain stimulation for Parkinsons disease.
    2. (2001). A randomized, double-blind, placebo-controlled trial of subcutaneously injected apomorphine for Parkinsonian off-state events.
    3. (2005). A. Promising new technology for Parkinsons disease.
    4. (1992). Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological Study of 100 cases.
    5. (2001). An algorithm (decision tree) for the management of Parkinsons disease (201): Treatment Guidelines.
    6. (2001). Apomorphinterapi versus tiefe hirnstimulation.
    7. (2005). Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up.
    8. (2002). Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD.
    9. (2006). Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease.
    10. (2006). Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinsosn’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus.
    11. (2005). Clinical studies with transdermal rotigotine in early Parkinsons disease.
    12. (2005). Comment on: subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years.
    13. (1988). Comparison between levodopa and lisuride intravenous infusions: A clinical study. Mov disord,
    14. (2003). Continuous apomorphine infusion and neuropsychiatric disorders: a controlled study in patients with advanced Parkinson’s disease. Neurol Sci,
    15. (2004). Continuous dopaminergic stimulation in early and advanced Parkinson’s disease.
    16. (1988). Continuous duodenal infusions of levodopa: plasma concentrations and motor fl uctuations in Parkinson’s disease.
    17. (1989). Continuous levodopa infusions to treat complex dystonia in Parkinson’s disease.
    18. (1998). Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson’s disease.
    19. (2001). Continuous transdermal dopaminergic stimulation in advanced Parkinsons disease. Clin Neuropharmacol,
    20. (1984). Control of on/off phenomenon by continuous intravenous infusion of levodopa.
    21. (1998). Costs of drug treatment in Parkinsons disease. Mov disord,
    22. (2003). Deep brain stimulation for Parkinson’s Disease. Curr Opin Neurobiol,
    23. (2003). Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: a therapy approaching evidence-based standards.
    24. (1993). Double-blind, placebo-controlled, cross-over study of duodenal infusion of levodopa/carbidopa in Parkinson’s disease patients with “on-off ” fl uctuations.
    25. (1988). Duodenal and gastric delivery of levodopa in Parkinsonism.
    26. (1986). Duodenal delivery of levodopa for on-off fl uctuations in Arkinsonism: preliminary observations.
    27. (2001). Duodenal levodopa infusion in Parkinson’s disease—long-term experience.
    28. (2005). Duodenal levodopa infusion monotherapy vs oral polypharmay in advanced Parkinson disease.
    29. (2006). Eidence based medical review update: pharmacological and surgical treatments of Parkinsons disease:
    30. (2007). Enteral levodopoda/carbidopa infusion in advanced Parkinson’s disease: long term exposure. Clin Neuropharmacol.
    31. (1989). Experience with continuous enteral levodopa infusions in the treatment of 9 patients with advanced Parkinsons disease.
    32. (2002). Global Parkinson’s disease survey steering committee.
    33. (2001). Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease: impact of motor fl uctuations and dyskinesias.
    34. (2005). Intermittent vs. continuous levodopa administration in patients with advanced Parkinson’s disease.
    35. (2006). International multicenter pilot study of the fi rst comprehensive selfcompleted nonmotor symptoms questionnaire for Parkinsons disease: the NMSQuest Study. Move disord (E-pub ahead of print).
    36. (1993). Intraduodenal infusion of a water-based levodopa dispersion for optimisation of the therapeutic effect in severe Parkinson’s disease.
    37. (1992). Intravenous boluses and continuous infusion of L-dopa methyl ester in fl uctuating patients with Parkinson’s disease. Mov disord,
    38. (2004). Levodopa in the treatment of Parkinson’s disease: current controversies. Mov disord,
    39. (2002). Levodopa-induced dyskinesias and continuous subcutaneous infusions of apomorphine: results of a two-year, prospective follow-up. Mov Disord,
    40. (2005). Long-term 24 hour duodenal infusion of levodopa: outcome and dose requirements.
    41. (1988). Long-term duodenal infusion of levodopa for motor fl uctuations in Parkinsonism. Ann Neurol,
    42. (1998). Long-term intraduodenal infusion of a water based levodopa-carbidopa dispersion in very advanced Parkinson’s disease.
    43. (1991). Nighttime levodopa infusions to treat motor Fluctuations in advanced Parkinsosn disease: preliminary observations.
    44. (2006). Non-motor symptoms of Parkinson’s disease: diagnosis and management.
    45. (1984). On-off fl uctuations in Parkinson’s disease. a clinical and neuropharmacological study.
    46. (1975). On-off response. Clinical and biochemical correlations during oral and intravenous levodopa administration in Parkinsonian patients.
    47. (2005). Optimising levodopa therapy for the management of Parkinsons disease.
    48. (2003). Optimizing levodopa pharmacokinetics: intestinal infusion versus oral sustained-release tablets. Clin Neuropharmacol,
    49. (2006). Outcome prediction of enteral levodopa/carbidopa infusion in advanced Parkinsons disease. Parkinsonism Relat Disord (E-pub ahead of print ).
    50. (1993). Pharmacokinetics of apomorphine in Parkinsonian patients. Fundam Clin Pharmacol,
    51. (1988). Pharmacokinetics of lisuride after subcutaneous infusion.
    52. (2006). Practice parameter: treatment of Parkinson disease with motor fl uctuations and dyskinesia (an evidencebased Review): Report of the Quality Standards Subcommittee of the American Academy of Neruology.
    53. (2000). Predictors of nursing home placement in Parkinsons disease: a population-based prospective study.
    54. (2005). Retrospective evaluation of cardio-pulmonary fi brotic side effects in symptomatic patients from a group of 234 Parkinsons disease patents treated with cabergoline.
    55. (2004). Severe multivalvular heart disease: a new complication of the ergot derivative dopamine agonists. Mov disord,
    56. (2003). Strategies to modify levodopa treatment.
    57. (1990). Subcutaneous apomorphine in the treatment of Parkinson’s disease.
    58. (2001). Subcutaneous continuous apomorphine infusion in fl uctuating patients with Parkinson’s disease: long-term results. Neurol Sci,
    59. (1991). Subcutaneous lisuride infusion in Parkinson’s disease: response to chronic administration in 34 patients.
    60. (2004). Subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years.
    61. (2004). Suicide after successful deep brain stimulation for movement disorders.
    62. (1993). Suppression of dyskinesias in advanced Parkinson’s disease. I. Continuous intravenous levodopa shifts dose response for production of dyskinesias but not for relief of Parkinsonism in patients with advanced Parkinson’s disease.
    63. (1990). Sustained enteral aministration of levodopa increases and interrupted infusion decreases levodopa dose requirements.
    64. (1998). Ten years experience with enteral levodopa infusions for motor fl uctuations in Parkinson’s disease. Mov disord,
    65. (1984). The “on-off” phenomenon in Parkinsons disease. Relation to levodopa absorption and transport.
    66. (1992). The clinical use of apomorphine in Parkinson’s disease.
    67. (2005). The cost-effectiveness of continuous duodenal delivery of levodopa (Duodopa) in patients with severe Parkinsons disease [abstract]. Mov disord, 20(Suppl 10):S80.
    68. (1985). The effect of carbidopa on the pharmacokinetics of intravenously administered levodopa: the mechanism of action in the treatment of Parkinsonism.
    69. (2005). The effect of deep brain stimulation on quality of life in movement disorders.
    70. (1989). The effects of oral protein on the absorption of intraduodenal levodopa and motor performance.
    71. (2003). The Parkinson study group.
    72. (1986). The pharmacokinetics of intravenous and oral evodopa in patients with Parkinson’s disease who exhibit on-off fl uctuations.
    73. (2004). Transdermal apomorphine permeation from microemulsions: A new treatment in Parkinson’s disease. Mov disord,
    74. (2005). Transdermal iontophoresis of the dopamine agonist 5-OH-DPAT in human skin in vitro.
    75. (2004). Treatment of Parkinsons disease with pergolide and relation to restrictive valvular heart disease.
    76. (2003). Two-year follow-up of subthalamic deep brain stimulation in Parkinson’s disease. Mov Disord,
    77. (2004). Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD.
    78. (2000). What contributes to quality of life in patients with Parkinsons disease.

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