Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T15:19:25.258Z Has data issue: false hasContentIssue false
  • English
  • Français

Deep Brain Stimulation or Duodenal Levodopa/Carbidopa Infusion: Choosing the Right Therapy for Individual Patients

Published online by Cambridge University Press:  07 November 2014

Jens Volkmann
Get access Rights & Permissions [Opens in a new window]

Extract

Parkinson's disease is a progressive neurodegenerative disorder with prominent motor features. The cardinal motor signs, bradykinesia, rigidity, and tremor, are treated effectively by dopaminergic therapies. Levodopa is standard, and often initial, therapy for patients with this condition. However, with continued treatment, and as the disease progresses, the response to oral dopaminergic drugs becomes unstable and motor fluctuations emerge, including off periods (when medication effects wear off) and dyskinesia (dystonic or choreatic movements) (Slide 1). Risk factors for motor complications include younger age at disease onset, longer disease duration, higher levodopa dosage, and more severe motor symptoms.

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 13 , Issue S7: Managing Parkinson's Disease with Continuous Dopaminergic Stimulation , April 2008 , pp. 8 - 10
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Moro, E. Esselink, RJ. Xie, J, Hommel, M, Benabid, AL, Pollak, P. The impact on Parkinson's disease of electrical parameter settings in STN stimulation. Neurology. 2002;59:706–713.Google Scholar
2.Manson, AJ, Hanagasi, H, Turner, K, et al.Intravenous apomorphine therapy in Parkinson's disease: clinical and pharmacokinetic observations. Brain. 2001,124(Pt 2):331–340.Google Scholar
3.Stocchi, F, Ruggieri, S, Vacca, L, Olanow, CW. Prospective randomized trial of lisuride infusion versus oral levodopa in patients with Parkinson's disease. Brain. 2002;125(Pt 9):2058–2066.Google Scholar
4.Stocchi, F, Vacca, L, Ruggieri, S, Olanow, CW. Intermittent vs continuous levodopa administration in patients with advanced Parkinson disease: 3 clinical and pharmacokinetic study. Arch Neurol. 2005;62(6):905–910.CrossRefGoogle Scholar
5.Volkmann, J. Update on surgery for Parkinson's disease. Curr Opin Neurol. 2007;20(4):465–469.Google ScholarPubMed
6.Moro, E, Esselink, RJ, Xie, J, Hommel, M, Benabid, AL, Pollak, R. The impact on Parkinson's disease of electrical parameter settings in STN stimulation. Neurology. 2002;59:706–713.CrossRefGoogle ScholarPubMed
7.Volkmann, JDeep brain stimulation for the treatment of Parkinson's disease. J Clin Neurophysiot. 2004;21:6–17.Google Scholar
8.Bergman, H, Wichmann, T, DeLong, MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science. 1990;249:1436–1438.Google Scholar
9.Benazzouz, A, Gross, C, Feger, J, Boraud, T, Bioulac, B. Reversal of rigidity and improvement in motor performance by subthalamic high-frequency stimulation in MPTP-treated monkeys. Eur J Neurosci. 1993;5(4):382–389CrossRefGoogle ScholarPubMed
10.Kleiner-Fisman, G, Herzog, J, Fisman, DN, et al.Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006;21 (Suppl 14):290–304.Google Scholar
11.Schupbach, WM, Chastan, N, Welter, ML. et al.Stimulation of the subthalamic nucleus in Parkinson's disease: a 5 year follow up. J Neurol Neurosurg Psychiatry. 2005;76:1640–1644.CrossRefGoogle ScholarPubMed
12.Krack, PBatir, A, Van Blercom, N, et al.Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 2003;349:1925–1934.CrossRefGoogle ScholarPubMed
13.Rodriguez-Oroz, MC, Obeso, JA, Lang, AE, et al.Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. Brain. 2005;128(Pt 10):2240–2249.Google Scholar
14.Lagrange, E, Krack, P, Moro, E, et al.Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology. 2002;59:1976–1978.Google Scholar
15.Deuschl, G, Schade-Brittinger, C, Krack, P, et al.A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med. 2006;355:896–908.Google Scholar
16.Okun, MS, Tagliati, M, Pourfar, M, et al.Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol. 2005;62:1250–1255.CrossRefGoogle ScholarPubMed
17.Welter, ML, Houeto, JL, Tezenas du, Montcel S, et al.Clinical predictive factors of subthalamic stimulation in Parkinson's disease. Brain. 2002;125:575–583.CrossRefGoogle ScholarPubMed
18.Nyholm, D, Nilsson Remahl, AI, Dizdar, N, et al.Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease. Neurology. 2005;64:216–223.CrossRefGoogle ScholarPubMed
19.Nilsson, D, Nyholm, D, Aquilonius, SM. Duodenal levodopa infusion in Parkinson's disease--long-term experience. Acta Neurol Scand. 2001;104:343–348.Google Scholar
20.Nyholm, D. Enteral levodopa/carbidopa gel infusion for the treatment of motor fluctuations and dyskinesias in advanced Parkinson's disease. Expert Rev Neurother. 2006;6:1403–1411.Google Scholar
21.Antonini, A. Continuous dopaminergic stimulation--from theory to clinical practice. Parkinsonism Relat Disord. 2007;13(Suppl):24–28.Google Scholar
22.Morgante, L, Morgante, F, Moro, E, et al.How many parkinsonian patients are suitable candidates for deep brain stimulation of subthalamic nucleus? Results of a questionnaire. Parkinsonism Relat Disord. 2007;13(8):528–531.Google Scholar
23.Russmann, H, Ghika, J, Villemure, JG, et al.Subthalamic nucleus deep brain stimulation in Parkinson disease patients over age 70 years. Neurology. 2004;63:1952–1954.CrossRefGoogle ScholarPubMed