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Medical and surgical management of advanced Parkinson's disease
Author(s) -
Antonini Angelo,
Moro Elena,
Godeiro Clecio,
Reichmann Heinz
Publication year - 2018
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.27340
Subject(s) - levodopa , dyskinesia , apomorphine , medicine , parkinson's disease , pallidotomy , deep brain stimulation , carbidopa , rotigotine , movement disorders , benserazide , dopamine , pharmacology , physical medicine and rehabilitation , disease , dopaminergic
Advanced Parkinson's disease is characterized by the presence of motor fluctuations, various degree of dyskinesia, and disability with functional impact on activities of daily living and independence. Therapeutic management aims to extend levodopa benefit while minimizing motor complications and includes, in selected cases, the implementation of drug infusion and surgical techniques. In milder forms of motor complications, these can often be controlled with manipulation of levodopa dose and the introduction of supplemental therapies such as catechol‐O‐methyl transferase inhibitors, monoamine oxidase B inhibitors, and dopamine agonists including apomorphine. Clinical experience and evidence from published studies indicate that when these agents cannot satisfactorily control motor complications, patients should be assessed and considered for device‐aided therapies. This review article summarizes some of the newer available therapeutic opportunities such as use of enzyme inhibitors like opicapone and safinamide, adenosine A 2A receptor antagonists, apomorphine and levodopa/carbidopa intestinal gel infusion, deep brain stimulation including the role of closed‐loop and adaptive stimulation, and MRI‐guided focused ultrasound. © 2018 International Parkinson and Movement Disorder Society