Continuous dopaminergic stimulation: Is it the answer to the motor complications of Levodopa?
Continuous dopaminergic stimulation (CDS) is a treatment strategy hypothesized to avoid or reduce the motor complications of long-term levodopa therapy, motor fluctuations, and dyskinesia, by preventing or reversing sensitization induced by pulsatile dopaminergic stimulation. The CDS hypothesis is itself based on several hypotheses. First, tonic dopaminergic stimulation is physiological. Second, sensitization is undesirable and should be reversed. Third, reduction of off time and dyskinesia can be induced simultaneously. Finally, clinical studies substantiate the CDS hypothesis. The evidence for these hypotheses is reviewed, and the need for randomized clinical trials that rigorously test the CDS hypothesis is emphasized.
Nutt
John G
JG
Parkinson Center of Oregon, Oregon Health & Science University, Portland, Oregon 97239-3098, USA. nuttj@ohsu.edu
D000818:Animals; D004298:Dopamine / Q000378:metabolism*; D015259:Dopamine Agents / Q000008:administration & dosage / Q000009:adverse effects*; D020820:Dyskinesias / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects*; D010300:Parkinson Disease / Q000188:drug therapy; D020551:Pulse Therapy, Drug
D015259:Dopamine Agents; D007980:Levodopa; D004298:Dopamine