Neha Prakash1, Tanya Simuni2. 1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA. prakash@uchc.edu. 2. Parkinson's Disease and Movement Disorders Center, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
PURPOSE OF REVIEW: Advanced Parkinson's disease (APD) is marked by significant motor and non-motor complications affecting the patient's quality of life. Optimization of standard oral therapies (SOT) at some point fails to provide adequate relief. Among the available device-aided therapies, infusion therapies (IT) work on the rationale that continuous striatal dopaminergic stimulation can significantly reduce the motor fluctuations and smoothen the treatment response. This review serves to familiarize readers with available IT for APD with a focus on motor and non-motor effects, and safety. RECENT FINDINGS: Several recent longitudinal studies have demonstrated a reduction in OFF and an equivalent increase in ON time with the use of levodopa-carbidopa intestinal gel infusion (LCIG). Additionally, the benefit is noted on dyskinesia and non-motor symptoms. Similarly, backed by long-term clinical experience and open-label studies, a recent double-blind trial validates the efficacy of continuous subcutaneous apomorphine infusion (CSAI). Both IT are accompanied by a high rate of mild to moderate adverse events (AE) that can influence patient selection and clinical utility. While device and procedure-related AE are common for LCIG, infusion site reactions dominate the CSAI AE. IT are a viable and superior alternative for APD over SOT. Both therapies provide meaningful improvement of the motor fluctuations with a positive impact on the quality of life.
PURPOSE OF REVIEW: Advanced Parkinson's disease (APD) is marked by significant motor and non-motor complications affecting the patient's quality of life. Optimization of standard oral therapies (SOT) at some point fails to provide adequate relief. Among the available device-aided therapies, infusion therapies (IT) work on the rationale that continuous striatal dopaminergic stimulation can significantly reduce the motor fluctuations and smoothen the treatment response. This review serves to familiarize readers with available IT for APD with a focus on motor and non-motor effects, and safety. RECENT FINDINGS: Several recent longitudinal studies have demonstrated a reduction in OFF and an equivalent increase in ON time with the use of levodopa-carbidopa intestinal gel infusion (LCIG). Additionally, the benefit is noted on dyskinesia and non-motor symptoms. Similarly, backed by long-term clinical experience and open-label studies, a recent double-blind trial validates the efficacy of continuous subcutaneous apomorphine infusion (CSAI). Both IT are accompanied by a high rate of mild to moderate adverse events (AE) that can influence patient selection and clinical utility. While device and procedure-related AE are common for LCIG, infusion site reactions dominate the CSAI AE. IT are a viable and superior alternative for APD over SOT. Both therapies provide meaningful improvement of the motor fluctuations with a positive impact on the quality of life.
Authors: Lacramioara Perju-Dumbrava; Maria Barsan; Daniel Corneliu Leucuta; Luminita C Popa; Cristina Pop; Nicoleta Tohanean; Stefan L Popa Journal: Exp Ther Med Date: 2021-12-17 Impact factor: 2.447