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The Importance of Steady-State Plasma Dopa Levels in Reducing Motor Fluctuations in Parkinson's Disease
Published online by Cambridge University Press: 07 November 2014
Extract
When levodopa (L-dopa) is administered intravenously to patients with severe Parkinson's disease, a therapeutic response may be seen within a 1/2 hour. However, when the drug is administered orally in lower doses to less disabled patients, a delay of 1–2 weeks often occurs before motor deficits start to improve. Recent data from the Early versus Late Levodopa study suggest that maximum improvement at a fixed dosage may take ≤3 months to develop. A nonspecific feeling of well-being and reduced tiredness are often the first benefits to occur, followed by greater alacrity and less stiffness. Rest tremor is slower to improve, but may eventually disappear altogether and remain well controlled throughout the rest of the course of the malady. Gait, balance, and speech may also improve, but the effect is usually more modest and a decline is common after several years of sustained treatment.
- Type
- Expert Roundtable Supplement
- Information
- CNS Spectrums , Volume 13 , Issue S7: Managing Parkinson's Disease with Continuous Dopaminergic Stimulation , April 2008 , pp. 4 - 7
- Copyright
- Copyright © Cambridge University Press 2008
References
1.Birkmayer, W, Hornykiewicz, O. The L-3,4-dioxyphenylalanine (DOPA)-effect in Parkinson-akinesia. Wien Klin Wochenschr. 1961;73:787–788.Google ScholarPubMed
2.Fahn, S, Oakes, D, Shoulson, I, et al.Levodopa and the progression of Parkinson's disease. N Engl J Med. 2004;351(24):2498–2508.Google Scholar
3.Schultz, W. Behavior-related activity of primate dopamine neurons. Rev Neurol (Paris). 1994;150(8–9):634–639.Google Scholar
4.Shoulson, I, Glaubiger, GA, Chase, TN. On-off response. Clinical and biochemical correlations during oral and intravenous levodopa administration in parkinsonian patients. Neurology. 1975;25(12):1144–1148.Google Scholar
5.Hardie, RJ, Lees, AJ, Stern, GM. On-off fluctuations in Parkinson's disease. A clinical and neuropharmacological study. Brain. 1984;107(Pt2):487–506.Google Scholar
6.Lees, AJ, Shaw, KM, Kobout, LJ, et al.Deprenyl in Parkinson's disease. Lancet. 1977;2(8042):791–795.Google Scholar
7.Quinn, N, Parkes, JD, Marsden, CD. Control of on/off phenomenon by continuous intravenous infusion of levodopa. Neurology. 1984;34(9):1131–1136.Google Scholar
8.Nutt, JG, Woodward, WR, Hammerstad, JP, Carter, JH, Anderson, JL. The “on-off” phenomenon in Parkinson's disease. Relation to levodopa absorption and transport. N Engl J Med. 1984;310(8):483–488.CrossRefGoogle Scholar
9.Marion, MH, Stocchi, F, Quinn, NP, Jenner, P, Marsden, CD. Repeated levodopa infusions in fluctuating Parkinson's disease: clinical and pharmacokinetic data. Clin Neuropharmacol. 1986;9(2):165–181.CrossRefGoogle ScholarPubMed
10.Sage, JI, Trooskin, S, Schuh, L, et al.Isolated jejunal pouches for levodopa delivery in parkinsonian patients with “on-off.” Successful experimental model in dogs. Clin Neuropharmacol. 1988;11(3):212–220.Google Scholar
11.Kurlan, R, Nutt, JG, Woodward, WR, et al.Duodenal and gastric delivery of levodopa in parkinsonism. Ann Neurol. 1988;23(6):589–595.CrossRefGoogle ScholarPubMed
12.Sage, JI, Sonsalla, PK, McHale, DM, Heikkila, RE, Duvoisin, RC. Clinical experience with duodenal infusions of levodopa for the treatment of motor fluctuations in Parkinson's disease. Adv Neurol. 1990;53:383–386.Google ScholarPubMed
13.Frankel, JP, Kempster, PA, Bovingdon, M, Webster, R, Lees, AJ, Stern, GM. The effects of oral protein on the absorption of intraduodenai levodopa and motor performance. J Neurol Neurosurg Psychiatry. 1989;52(9):1063–1067.CrossRefGoogle ScholarPubMed
14.Nutt, JG. Continuous dopaminergic stimulation: Is it the answer to the motor complications of Levodopa? Mov Disord. 2007;22(1):1–9.CrossRefGoogle Scholar