Continuous dopaminergic stimulation achieved by duodenal levodopa infusion.

Continuous dopaminergic stimulation is the ideal approach for the management of Parkinson's disease (PD); this goal can be partially reached with dopamine agonists, but the need for a therapeutic strategy providing a strong and constant dopaminergic stimulation also in the advanced phase of the disease remains unmet. The application of levodopa/carbidopa-gel suspension directly in the duodenum (Duodopa) allows a continuous delivery by a portable pump, resulting in smoother levodopa plasmatic concentrations, and consequently in a physiologic continuous receptor stimulation. Clinical studies have demonstrated that duodenal infusion was associated with significantly better outcome compared to conventional treatment regarding global functioning, ability to walk, "off" time and motor fluctuations. A retrospective analysis of the long-term clinical experience with Duodopa evidenced that daily dose of levodopa decreased by 5% during follow-up. The profile of pharmacological adverse events of Duodopa was similar to that observed with oral administration; dislocation of the intestinal tube to the stomach was the most common technical problem.