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Rapid treatment of "wearing off" in Parkinson's disease.
Neurology. 2004 Mar 23; 62(6 Suppl 4):S27-31.Neur

Abstract

Patients with advanced Parkinson's disease (PD) may develop a variety of motor complications associated with levodopa therapy. Motor fluctuations, such as early morning akinesia and "wearing-off," may respond to individualized medical management with titrated combinations of levodopa, dopamine agonists, COMT inhibitors and amantadine. Often with disease progression, dyskinesias and unpredictable, rapid "off" periods will also emerge. These motor complications are less amenable to traditional anti-parkinson therapy manipulation. This manuscript reviews approaches for "rescue" therapy in PD patients with "wearing off," sudden "offs," early morning akinesia, and variable response to individual doses of oral medications. Strategies for preparing and administering liquid levodopa are discussed within the context of gastric emptying, intestinal absorption, and active transport across the blood brain barrier. In addition other levodopa preparations in early development, including the orally administered levodopa methyl ester and the potential for a subcutaneously administered levodopa ethyl ester are reviewed. Furthermore, practical guidelines regarding the dosing, administration, use of the antiemetic trimethobenzamide (Tigan), time to "on," duration of benefit, and potential side effects associated with subcutaneously injected apomorphine are provided.

Authors+Show Affiliations

Department of Neurology, Loma Linda University, Loma Linda, California 92354, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15037669

Citation

Swope, David M.. "Rapid Treatment of "wearing Off" in Parkinson's Disease." Neurology, vol. 62, no. 6 Suppl 4, 2004, pp. S27-31.
Swope DM. Rapid treatment of "wearing off" in Parkinson's disease. Neurology. 2004;62(6 Suppl 4):S27-31.
Swope, D. M. (2004). Rapid treatment of "wearing off" in Parkinson's disease. Neurology, 62(6 Suppl 4), S27-31.
Swope DM. Rapid Treatment of "wearing Off" in Parkinson's Disease. Neurology. 2004 Mar 23;62(6 Suppl 4):S27-31. PubMed PMID: 15037669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid treatment of "wearing off" in Parkinson's disease. A1 - Swope,David M, PY - 2004/3/24/pubmed PY - 2004/4/30/medline PY - 2004/3/24/entrez SP - S27 EP - 31 JF - Neurology JO - Neurology VL - 62 IS - 6 Suppl 4 N2 - Patients with advanced Parkinson's disease (PD) may develop a variety of motor complications associated with levodopa therapy. Motor fluctuations, such as early morning akinesia and "wearing-off," may respond to individualized medical management with titrated combinations of levodopa, dopamine agonists, COMT inhibitors and amantadine. Often with disease progression, dyskinesias and unpredictable, rapid "off" periods will also emerge. These motor complications are less amenable to traditional anti-parkinson therapy manipulation. This manuscript reviews approaches for "rescue" therapy in PD patients with "wearing off," sudden "offs," early morning akinesia, and variable response to individual doses of oral medications. Strategies for preparing and administering liquid levodopa are discussed within the context of gastric emptying, intestinal absorption, and active transport across the blood brain barrier. In addition other levodopa preparations in early development, including the orally administered levodopa methyl ester and the potential for a subcutaneously administered levodopa ethyl ester are reviewed. Furthermore, practical guidelines regarding the dosing, administration, use of the antiemetic trimethobenzamide (Tigan), time to "on," duration of benefit, and potential side effects associated with subcutaneously injected apomorphine are provided. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/15037669/Rapid_treatment_of_"wearing_off"_in_Parkinson's_disease_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15037669 DB - PRIME DP - Unbound Medicine ER -