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Review
. 2018 Jul;33(6):900-908.
doi: 10.1002/mds.27340. Epub 2018 Mar 23.

Medical and surgical management of advanced Parkinson's disease

Angelo Antonini  1 , Elena Moro  2 , Clecio Godeiro  2   3 , Heinz Reichmann  4
Affiliations
Review

Medical and surgical management of advanced Parkinson's disease

Angelo Antonini et al. Mov Disord. 2018 Jul.

Abstract

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 A2A 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.

Keywords: MR focused ultrasound; apomorphine; deep brain stimulation; dyskinesia; inhaled levodopa; levodopa infusion gel; motor complications; opicapone; safinamide; wearing-off.

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