title: Advanced Parkinson's disease: clinical characteristics and treatment. Part II.
abstract: BACKGROUND
  Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa.
  
  
  OBJECTIVE
  To define the indications and results for the 3 available therapies for advanced PD.
  
  
  METHODS
  Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease.
  
  
  CONCLUSIONS
  Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique.
authors.affiliation: Servicio de Neurologia, Hospital Sant Pau, Barcelona, España. Electronic address: JKulisevsky@santpau.cat.
authors.forename: J
authors.initials: J
authors.lastname: Kulisevsky
authors.forename: M R
authors.initials: MR
authors.lastname: Luquin
authors.forename: J M
authors.initials: JM
authors.lastname: Arbelo
authors.forename: J A
authors.initials: JA
authors.lastname: Burguera
authors.forename: F
authors.initials: F
authors.lastname: Carrillo
authors.forename: A
authors.initials: A
authors.lastname: Castro
authors.forename: J
authors.initials: J
authors.lastname: Chacón
authors.forename: P J
authors.initials: PJ
authors.lastname: García-Ruiz
authors.forename: E
authors.initials: E
authors.lastname: Lezcano
authors.forename: P
authors.initials: P
authors.lastname: Mir
authors.forename: J C
authors.initials: JC
authors.lastname: Martinez-Castrillo
authors.forename: I
authors.initials: I
authors.lastname: Martínez-Torres
authors.forename: V
authors.initials: V
authors.lastname: Puente
authors.forename: A
authors.initials: A
authors.lastname: Sesar
authors.forename: F
authors.initials: F
authors.lastname: Valldeoriola-Serra
authors.forename: R
authors.initials: R
authors.lastname: Yañez
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001058:Apomorphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D046690:Deep Brain Stimulation; D018450:Disease Progression; D006801:Humans; D007262:Infusions, Intravenous; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D011618:Psychotic Disorders / Q000209:etiology / Q000628:therapy
chemical_list: D000978:Antiparkinson Agents; D001058:Apomorphine
keywords: Advanced Parkinson's disease; Deep brain stimulation; Enfermedad de Parkinson avanzada; Estimulación cerebral profunda; Infusión de apomorfina; Infusión intestinal de levodopa-carbidopa; Intestinal levodopa-carbidopa infusion; Subcutaneous apomorphine infusion