Device-Aided Treatment Strategies in Advanced Parkinson's Disease
Timpka, Jonathan LU ; Nitu, Bianca ; Datieva, Veronika ; Odin, Per LU
and Antonini, Angelo
(2017)
In International Review of Neurobiology
132.
p.453-474
- Abstract
With peroral levodopa treatment, a majority of patients develop motor fluctuations and dyskinesia already within a few years of therapy. Device-aided Parkinson (PD) therapies refer to deep brain stimulation (DBS), levodopa-carbidopa intestinal gel infusion (LCIG), and subcutaneous infusion of the dopamine agonist apomorphine and represent effective strategies counteracting motor fluctuations and dyskinesia. These three therapy options seem to be similarly effective in reducing "time with PD symptoms (off time)" by at least 60%-65%. The use of advanced therapy also leads to a significant reduction of dyskinesia. Recent studies also indicate that these therapies can improve a number of nonmotor symptoms in advanced PD. Altogether this... (More)
With peroral levodopa treatment, a majority of patients develop motor fluctuations and dyskinesia already within a few years of therapy. Device-aided Parkinson (PD) therapies refer to deep brain stimulation (DBS), levodopa-carbidopa intestinal gel infusion (LCIG), and subcutaneous infusion of the dopamine agonist apomorphine and represent effective strategies counteracting motor fluctuations and dyskinesia. These three therapy options seem to be similarly effective in reducing "time with PD symptoms (off time)" by at least 60%-65%. The use of advanced therapy also leads to a significant reduction of dyskinesia. Recent studies also indicate that these therapies can improve a number of nonmotor symptoms in advanced PD. Altogether this results in an improved health-related quality of life in most treated patients. The side effects and complications are quite different between the three; for DBS, serious adverse events include intracranial bleeding and infection, LCIG complications relate to the infusion equipment and the establishment of the percutaneous endoscopic gastrostomy, while for apomorphine infusion the most common side effect is a formation of noduli (local inflammation) at the point of infusion. The device-aided therapies are all indicated for the treatment of motor fluctuations and/or dyskinesia when peroral/transdermal PD medications cannot be further optimized. However, the choice of device-aided therapy is made on basis of indications/contraindications, but also the patients' symptom profile and his/her personal preferences. Therefore, it is important these treatments are discussed early, well before motor and nonmotor symptoms have deteriorated excessively.
(Less)
- author
- Timpka, Jonathan
LU
; Nitu, Bianca
; Datieva, Veronika
; Odin, Per
LU
and Antonini, Angelo
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Advanced Parkinson, Apomorphine, Deep brain stimulation, Drug delivery system, Levodopa, Parkinson disease
- in
- International Review of Neurobiology
- volume
- 132
- pages
- 453 - 474
- publisher
- Elsevier
- external identifiers
-
- scopus:85019044891
- pmid:28554418
- wos:000414256500017
- ISSN
- 0074-7742
- DOI
- 10.1016/bs.irn.2017.03.001
- language
- English
- LU publication?
- yes
- id
- 84e07d34-f3f9-4809-a38d-55b73fa84cb4
- date added to LUP
- 2017-06-01 15:18:54
- date last changed
- 2024-03-31 10:47:05
@article{84e07d34-f3f9-4809-a38d-55b73fa84cb4,
abstract = {{<p>With peroral levodopa treatment, a majority of patients develop motor fluctuations and dyskinesia already within a few years of therapy. Device-aided Parkinson (PD) therapies refer to deep brain stimulation (DBS), levodopa-carbidopa intestinal gel infusion (LCIG), and subcutaneous infusion of the dopamine agonist apomorphine and represent effective strategies counteracting motor fluctuations and dyskinesia. These three therapy options seem to be similarly effective in reducing "time with PD symptoms (off time)" by at least 60%-65%. The use of advanced therapy also leads to a significant reduction of dyskinesia. Recent studies also indicate that these therapies can improve a number of nonmotor symptoms in advanced PD. Altogether this results in an improved health-related quality of life in most treated patients. The side effects and complications are quite different between the three; for DBS, serious adverse events include intracranial bleeding and infection, LCIG complications relate to the infusion equipment and the establishment of the percutaneous endoscopic gastrostomy, while for apomorphine infusion the most common side effect is a formation of noduli (local inflammation) at the point of infusion. The device-aided therapies are all indicated for the treatment of motor fluctuations and/or dyskinesia when peroral/transdermal PD medications cannot be further optimized. However, the choice of device-aided therapy is made on basis of indications/contraindications, but also the patients' symptom profile and his/her personal preferences. Therefore, it is important these treatments are discussed early, well before motor and nonmotor symptoms have deteriorated excessively.</p>}},
author = {{Timpka, Jonathan and Nitu, Bianca and Datieva, Veronika and Odin, Per and Antonini, Angelo}},
issn = {{0074-7742}},
keywords = {{Advanced Parkinson; Apomorphine; Deep brain stimulation; Drug delivery system; Levodopa; Parkinson disease}},
language = {{eng}},
pages = {{453--474}},
publisher = {{Elsevier}},
series = {{International Review of Neurobiology}},
title = {{Device-Aided Treatment Strategies in Advanced Parkinson's Disease}},
url = {{http://dx.doi.org/10.1016/bs.irn.2017.03.001}},
doi = {{10.1016/bs.irn.2017.03.001}},
volume = {{132}},
year = {{2017}},
}