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Development of motor fluctuations and dyskinesia characterizes the transition from the early to the advanced Parkinson stage. Current oral therapeutic strategies aim at increasing the number of levodopa administrations and extending its benefit by the association of enzyme blockers (MAO- and COMT-inhibitors) and dopamine agonists. However, as disease progresses, mobility becomes progressively dependent on levodopa absorption and plasma bioavailability, resulting in disabling motor complications. If patients continue to experience off time with functional impact on activities of daily living after best oral medication adjustments, implementation of infusion therapies with apomorphine or levodopa, and surgical techniques should be considered. Compared with pulsatile oral therapy implementation of apomorphine and levodopa infusion determines more continuous striatal dopamine receptors stimulation resulting in significant reduction of off-time and dyskinesia, particularly peak-dose. However, long-term experience with these treatments shows that motor complications are not abolished by continuous receptor stimulation suggesting that synaptic plasticity and connectivity changes are not easily reversed once they are established. Early intervention ideally would target patients as soon as motor complications begin rather than at late stage. Preliminary evidence from early deep brain stimulation or early pump treatment suggests that this is feasible but before it is implemented in clinical practice it would require a detailed cost-benefit analysis.
This article was published in the following journal.
Name: Fortschritte der Neurologie-Psychiatrie
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An inhibitor of DOPA DECARBOXYLASE, preventing conversion of LEVODOPA to dopamine. It is used in PARKINSON DISEASE to reduce peripheral adverse effects of LEVODOPA. It has no antiparkinson actions by itself.
A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl.
A group of disorders which feature impaired motor control characterized by bradykinesia, MUSCLE RIGIDITY; TREMOR; and postural instability. Parkinsonian diseases are generally divided into primary parkinsonism (see PARKINSON DISEASE), secondary parkinsonism (see PARKINSON DISEASE, SECONDARY) and inherited forms. These conditions are associated with dysfunction of dopaminergic or closely related motor integration neuronal pathways in the BASAL GANGLIA.
Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.
An inhibitor of DOPA DECARBOXYLASE that does not enter the central nervous system. It is often given with LEVODOPA in the treatment of parkinsonism to prevent the conversion of levodopa to dopamine in the periphery, thereby increasing the amount that reaches the central nervous system and reducing the required dose. It has no antiparkinson actions when given alone.
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