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Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms

Mundt-Petersen, Ulrika LU and Odin, Per LU (2017) In Parkinson’s: The Hidden Face Management and the Hidden Face of Related Disorders 134. p.1019-1044
Abstract

Pump-based Parkinson (PD) therapies, including subcutaneous apomorphine infusion (CSA) and levodopa-carbidopa intestinal gel (LCIG), presently constitute the most effective pharmacological treatments available for advanced PD. These therapies are based on a more constant delivery of the dopaminergic drug resulting in a more continuous dopaminergic stimulation and a more stable treatment effect. This can be detected as reduction of time in off, reduction of dyskinesia frequency and severity, as well as increase of time in on without troublesome dyskinesias. A number of open-label studies now suggest that also the nonmotor PD symptomatology can improve under CSA and LCIG therapy. The most consistent improvements are seen concerning sleep,... (More)

Pump-based Parkinson (PD) therapies, including subcutaneous apomorphine infusion (CSA) and levodopa-carbidopa intestinal gel (LCIG), presently constitute the most effective pharmacological treatments available for advanced PD. These therapies are based on a more constant delivery of the dopaminergic drug resulting in a more continuous dopaminergic stimulation and a more stable treatment effect. This can be detected as reduction of time in off, reduction of dyskinesia frequency and severity, as well as increase of time in on without troublesome dyskinesias. A number of open-label studies now suggest that also the nonmotor PD symptomatology can improve under CSA and LCIG therapy. The most consistent improvements are seen concerning sleep, mood, and apathy, gastrointestinal symptoms, and urological symptoms. But also cardiovascular symptoms, perception, attention, and sexual function might show beneficial effects when moving from conventional therapies to pump treatment. Further there might be negative influences on some parts of the nonmotor symptomatology through side effects of CSA and LCIG therapy. In this chapter, we review the present knowledge about these aspects of the pump-based therapies. This information might be valuable when deciding on advanced therapy for individual patients.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Chapter in Book/Report/Conference proceeding
publication status
published
subject
keywords
Apomorphine, CSA, Dyskinesia, Infusional therapy, Levodopa-carbidopa intestinal gel (LCIG), Motor fluctuations, Motor symptoms, Nonmotor symptoms, Parkinson, Pharmacological treatment, Pump
in
Parkinson’s: The Hidden Face Management and the Hidden Face of Related Disorders
editor
Chaudhuri, Ray; Titova, Nataliya; and
volume
134
pages
1019 - 1044
publisher
Elsevier
external identifiers
  • scopus:85025432968
ISSN
0074-7742
ISBN
978-0-12-812603-5
DOI
10.1016/bs.irn.2017.05.036
language
English
LU publication?
yes
id
c7bbfbb2-eb2c-4fdc-8fe0-99c733e514dc
date added to LUP
2017-08-30 13:42:26
date last changed
2017-09-03 05:26:35
@inbook{c7bbfbb2-eb2c-4fdc-8fe0-99c733e514dc,
  abstract     = {<p>Pump-based Parkinson (PD) therapies, including subcutaneous apomorphine infusion (CSA) and levodopa-carbidopa intestinal gel (LCIG), presently constitute the most effective pharmacological treatments available for advanced PD. These therapies are based on a more constant delivery of the dopaminergic drug resulting in a more continuous dopaminergic stimulation and a more stable treatment effect. This can be detected as reduction of time in off, reduction of dyskinesia frequency and severity, as well as increase of time in on without troublesome dyskinesias. A number of open-label studies now suggest that also the nonmotor PD symptomatology can improve under CSA and LCIG therapy. The most consistent improvements are seen concerning sleep, mood, and apathy, gastrointestinal symptoms, and urological symptoms. But also cardiovascular symptoms, perception, attention, and sexual function might show beneficial effects when moving from conventional therapies to pump treatment. Further there might be negative influences on some parts of the nonmotor symptomatology through side effects of CSA and LCIG therapy. In this chapter, we review the present knowledge about these aspects of the pump-based therapies. This information might be valuable when deciding on advanced therapy for individual patients.</p>},
  author       = {Mundt-Petersen, Ulrika and Odin, Per},
  editor       = {Chaudhuri, Ray and Titova, Nataliya},
  isbn         = {978-0-12-812603-5 },
  issn         = {0074-7742},
  keyword      = {Apomorphine,CSA,Dyskinesia,Infusional therapy,Levodopa-carbidopa intestinal gel (LCIG),Motor fluctuations,Motor symptoms,Nonmotor symptoms,Parkinson,Pharmacological treatment,Pump},
  language     = {eng},
  pages        = {1019--1044},
  publisher    = {Elsevier},
  series       = {Parkinson’s: The Hidden Face Management and the Hidden Face of Related Disorders},
  title        = {Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms},
  url          = {http://dx.doi.org/10.1016/bs.irn.2017.05.036},
  volume       = {134},
  year         = {2017},
}