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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.

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author
organization
publishing date
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
  • 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
2018-01-16 13:20:01
@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},
  keyword      = {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},
  volume       = {132},
  year         = {2017},
}