Clinical implications of sustained dopaminergic stimulation

F. Stocchi, P. N. Patsalos, A. Berardelli, L. Barbato, A. Bonamartini, M. Manfredi, S. Ruggieri

Research output: Contribution to journalArticle

Abstract

Fluctuations in motor performance are the major problems in chronic management of Parkinson's disease. Most of these fluctuations reflect the decline of levodopa availability. As a consequence, levodopa dosage might be increased and the interdose interval progressively shortened. The postsynaptic dopamine receptors at this point are exposed to a nonphysiologic shift in dopamine level, which may induce changes at the receptor site and contribute to the appearance of 'on-off' phenomena and dyskinesias. We compared a group of 18 patients treated for 60 consecutive months with continuous subcutaneous lisuride infusion with a group of 20 patients treated with conventional oral levodopa treatment. The clinical evaluations performed during the study showed in the lisuride group only a worsening of dyskinesias, whereas the other symptoms remained unchanged. In the other group the evaluation scores showed a significant worsening of all long-term treatment complications. The slow-release preparations of levodopa may ensure a more continuous dopaminergic stimulation than standard formulations. However, the use of these compounds is difficult in severely fluctuating patients because the lack of a plasma peak level usually leads to a very long delay before patients turn 'on.' We studied the pharmacokinetic and clinical effects of the two slow-release preparations of levodopa [Madopar HBS and Sinemet controlled-release (CR)] and a combination of Sinemet CR plus standard Sinemet in 13 fluctuating parkinsonian patients. The results of this study show that the combination of standard Sinemet and Sinemet CR ensures a more prolonged clinical effect with a very short latency to the 'on' phase.

Original languageEnglish
JournalClinical Neuropharmacology
Volume17
Issue numberSUPPL. 2
Publication statusPublished - 1994

Keywords

  • 'On-off' phenomena
  • Levodopa
  • Motor performance
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Pharmacology (medical)
  • Neuroscience(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

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    Stocchi, F., Patsalos, P. N., Berardelli, A., Barbato, L., Bonamartini, A., Manfredi, M., & Ruggieri, S. (1994). Clinical implications of sustained dopaminergic stimulation. Clinical Neuropharmacology, 17(SUPPL. 2).