title: When the going gets tough: how to select patients with Parkinson's disease for advanced therapies.
abstract: Levodopa-induced motor complications of Parkinson's disease, including motor fluctuations and dyskinesias, become increasingly frequent as the disease progresses, and are often disabling. Oral and transdermal therapies have limited efficacy in controlling these problems. Advanced device-aided therapies, including continuous infusion of apomorphine, deep brain stimulation and levodopa-carbidopa intestinal gel can all ameliorate these complications. This review summarises the principles of each of these therapies, their modes of action, efficacy and adverse effects, and gives advice on timely identification of suitable patients and how to decide on the most appropriate therapy for a given patient.
authors.affiliation: Department of Neurology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK. paul.worth@nnuh.nhs.uk
authors.forename: Paul F
authors.initials: PF
authors.lastname: Worth
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001058:Apomorphine / Q000627:therapeutic use; D002230:Carbidopa / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D004338:Drug Combinations; D016503:Drug Delivery Systems; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D010300:Parkinson Disease / Q000628:therapy*; D018579:Patient Selection
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine
keywords: PARKINSON-S DISEASE