Treatment of levodopa-induced motor complications.
Chronic levodopa treatment for Parkinson's disease patients is frequently associated with the development of motor complications such as end-of-dose wearing-off and dyskinesias. In this review, we provide an overview of the strategies available for dealing with these problems. Medical management includes manipulation of levodopa dosing to establish the optimum treatment schedule, improving levodopa absorption, catechol-O-methyl transferase-inhibition (COMT), Monoamine oxidase-B (MAO-B) inhibition, dopaminergic agonists, amantadine, and continuous dopaminergic infusions. Surgical procedures and particularly deep brain stimulation are also reviewed. It should be noted that none of these treatments has been shown to provide anti-parkinsonian efficacy that is greater than what can be achieved with levodopa. We highlight the importance of initiating therapy with a treatment strategy that reduces the risk that a Parkinson's disease patient will develop motor complications in the first place. Key Words: Advanced PD, dyskinesias, motor fluctuations, levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors.
Stocchi
Fabrizio
F
IRCCS San Raffaele, Via della Pisana 235, Roma, Italy. fabrizio.stocchi@fastwebnet.it
Tagliati
Michele
M
Olanow
C Warren
CW
D000327:Adsorption; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D065098:Catechol O-Methyltransferase Inhibitors; D046690:Deep Brain Stimulation; D018491:Dopamine Agonists / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D007980:Levodopa / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D009043:Motor Activity / Q000187:drug effects / Q000502:physiology; D009069:Movement Disorders / Q000209:etiology* / Q000628:therapy*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D012449:Safety
D000978:Antiparkinson Agents; D065098:Catechol O-Methyltransferase Inhibitors; D018491:Dopamine Agonists; D004791:Enzyme Inhibitors; D008996:Monoamine Oxidase Inhibitors; D007980:Levodopa