Systematic review of apomorphine infusion, levodopa infusion and deep brain stimulation in advanced Parkinson's disease
Published: February 2010
Levodopa is the mainstay of treatment for individuals with Parkinson’s disease (PD), but the effectiveness of oral levodopa in the late stages of PD is limited by its short half-life, and the resulting pulsatile dopaminergic stimulation leads to complex motor fluctuations and dyskinesia.
Several treatments provide more continuous/less pulsatile dopaminergic stimulation by modifying the pharmacokinetics of levodopa or dopamine; however, patients with advanced PD can be refractory to these treatments. In such cases, infusion therapies (apomorphine [a dopamine agonist] and intraduodenal levodopa) and neurosurgery (deep brain stimulation [DBS]) may be used. Although DBS does not cure PD, by sending high frequency electrical impulses into specific areas of the brain, it can mitigate symptoms, and/or directly diminish the side effects induced by PD medications, subsequently helping to improve the patient’s quality of life.
This systematic review assesses the evidence for apomorphine infusion, levodopa infusion and DBS in advanced PD. Studies identified for levodopa infusion and DBS supported a significant benefit of these therapies compared with best medical management. But, there is still an absence of direct comparative data, and consequently treatment choices for advanced PD are still determined by clinical judgement and patient preference. There is a real need for well-designed clinical trials to generate reliable data to better inform the clinical management of advanced PD patients – a difficult-to-treat subgroup of PD patients.
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