Objective: Physiopathological and therapeutic discussion of motor complications and dyskinesias in patients treated with continuous dopaminergic stimulation

Background: Levodopa -induced motor complications remain an important source of disability for many patients with PD. Continuous dopaminergic therapies in PD include the transdermal rotigotine and infusion therapies with subcutaneous apomorphine and Intrajejunal Levodopa. These therapies are based on a more constant delivery of the dopaminergic drug. Continuos dopaminergic stimulation in PD has several advantages over conventional oral pulsatile, no continuous, stimulation.

Method: We report 2 patients (1 male and 1 female; age: 70 and 69 years) with advanced Parkinson´s disease (more than 10 years of evolution, stage III/V of Hoehn and Yahr). With habitual therapeutic scheme (oral pulsatil dopaminergic stimulation) the patients presented fluctuations, chorea on and severe frezzing-off. Continuous subcutaneous apomorphine (“pump”) treatment was indicated.

Results: Patient 1: 70 year-old man with PD of 10 years of evolution presented motor fluctuations and moderate chorea on. Treatment with subcutaneous apomorphine infusion, “pump”,was indicated (6 mg/h, from 8 to 23 h/day) with good initial response. After 8 months the patient developped again motor fluctuations and dyskinesias (chorea on). After various treatment adjustments over a period of weeks, it was finally indicated 7 mg/h from 8 to 17 hours and 8 m g/h from 17 to 23 h, with improvement (stable motor response without dyskinesias).

Patient 2: 69 years-old woman with advanced PD developped severe fluctuations and dyskinesias. Treatment with subcutaneous apomorphine infusion pump improved motor complications for several years but finally the patient developped motor fluctuations and afternoon complex dyskinesias (Repetitive Anormal Movements in legs). The infusion rate was maintained in the morning- 6 mg/h from 8 to 17 h- and increased in the afternoon – 7 mg/h). Stable motor response was achieved without dyskinesias.

Conclusion: Several drugs and delivery systems are now available for CDS. Our patients with advanced PD had motor complications despite continuous dopaminergic stimulation and required different infusion rates to achieve a stable motor status. This clinical observation reflects not only pharmacokinetic, but also pharmacodynamic changes involved in motor response patterns in advanced PD.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-dopaminergic-stimulation-cds-different-infusion-rates/