Continuous dopaminergic delivery in Parkinson's disease

Angelo Antonini, Giulia Ursino, Daniela Calandrella, Laura Bernardi, Mauro Plebani

Research output: Contribution to journalArticlepeer-review

Abstract

Motor fluctuations and dyskinesias occur in the majority of patients with Parkinson's disease (PD) and are likely to result from changes in dopamine production, storage and release, occurring as consequences of the nigrostriatal degenerative process. All studies comparing levodopa versus dopamine agonist early therapy indicate that initiation with agonists is associated with a reduced risk of motor complications - in particular, dyskinesias - possibly because agonists' longer half-lives provide continuous dopaminergic delivery. In advanced PD patients, switching from a pulsatile to continuous dopaminergic delivery may widen patients' therapeutic window. Currently, this can be accomplished only with subcutaneous apomorphine or duodenal levodopa infusions. Apomorphine is a highly soluble agonist whose effect is similar to dopamine. Conversely, replacing whole oral therapy with levodopa infusion bypasses gastric emptying and avoids peaks and troughs in plasma by releasing levodopa in the duodenum/jejunum.

Original languageEnglish
JournalJournal of Neurology
Volume257
Issue numberSUPPL. 2
DOIs
Publication statusPublished - Nov 2010

Keywords

  • Apomorphine
  • Dopamine agonists
  • Duodenal levodopa
  • Dyskinesia
  • Infusion
  • Motor complications
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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