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Review
. 2020;10(s1):S65-S73.
doi: 10.3233/JPD-202104.

The Choice Between Advanced Therapies for Parkinson's Disease Patients: Why, What, and When?

Joke M Dijk  1 , Alberto J Espay  2 , Regina Katzenschlager  3 , Rob M A de Bie  1
Affiliations
Review

The Choice Between Advanced Therapies for Parkinson's Disease Patients: Why, What, and When?

Joke M Dijk et al. J Parkinsons Dis. 2020.

Abstract

When oral dopaminergic medication falls short in the treatment of Parkinson's disease, patients are left with motor response fluctuations and dyskinesias that may have a large impact on functioning in daily life. They may benefit from one of the currently available advanced treatments, namely deep brain stimulation, continuous levodopa-carbidopa intestinal gel, and continuous subcutaneous apomorphine infusion. The indication, choice between the separate advanced treatments and the timing can be challenging and will be discussed against the background of the progressive nature of the disease, the heterogeneity of disease manifestation and variable patient characteristics.

Keywords: Parkinson’s disease; apomorphine; carbidopa; deep brain stimulation; external infusion pumps; levodopa drug combination; parenteral infusions; review literature.

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Conflict of interest statement

JM Dijk has received unconditional grant support from ZonMW (the Netherlands Organisation for Health Research and Development), Medtronic, Stichting Parkinson Nederland (Foundation for Parkinson’s disease the Netherlands), all paid to the institution.

AJ Espay has received grant support from the NIH and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, Neurocrine, Amneal, Adamas, Acadia, Acorda, In Trance, Sunovion, Lundbeck, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from USWorldMeds, Acadia, and Sunovion.

R Katzenschlager has received research grants from Britannia, Stada, Zambon, and personal compensation as a consultant/scientific advisory board member or speaker from AbbVie, AOP Orphan, Bial, Britannia, Ever Pharma, Gruenenthal, Stada, UCB, and Zambon.

RMA de Bie has received unconditional grant support from ZonMW (the Netherlands Organisation for Health Research and Development), Medtronic, Lysosomal Therapeutics, Stichting Parkinson Nederland (Foundation for Parkinson’s disease the Netherlands), all paid to the institution.

References

    1. de Bie RMA, Clarke CE, Espay AJ, Fox SH, Lang AE (2020) Initiation of pharmacological therapy in Parkinson’s disease: When, why, and how. Lancet Neurol 19, 452–461. - PubMed
    1. Santos-Garcia D, de Deus Fonticoba T, Suarez Castro E, Aneiros Diaz A, McAfee D, Catalan MJ, Alonso-Frech F, Villanueva C, Jesus S, Mir P, Aguilar M, Pastor P, Garcia Caldentey J, Esltelrich Peyret E, Planellas LL, Marti MJ, Caballol N, Hernandez Vara J, Marti Andres G, Cabo I, Avila Rivera MA, Lopez Manzanares L, Redondo N, Martinez-Martin P, Group CS, McAfee D (2020) Non-motor symptom burden is strongly correlated to motor complications in patients with Parkinson’s disease. Eur J Neurol doi: 10.1111/ene.14221. - DOI - PubMed
    1. Kim HJ, Mason S, Foltynie T, Winder-Rhodes S, Barker RA, Williams-Gray CH (2020) Motor complications in Parkinson’s disease: 13-year follow-up of the CamPaIGN cohort. Mov Disord 35, 185–190. - PMC - PubMed
    1. Bestetti A, Capozza A, Lacerenza M, Manfredi L, Mancini F (2017) Delayed gastric emptying in advanced Parkinson disease: Correlation with therapeutic doses. Clin Nucl Med 42, 83–87. - PubMed
    1. Fasano A, Bove F, Gabrielli M, Petracca M, Zocco MA, Ragazzoni E, Barbaro F, Piano C, Fortuna S, Tortora A, Di Giacopo R, Campanale M, Gigante G, Lauritano EC, Navarra P, Marconi S, Gasbarrini A, Bentivoglio AR (2013) The role of small intestinal bacterial overgrowth in Parkinson’s disease. Mov Disord 28, 1241–1249. - PubMed

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