A comparative clinical investigation of the therapeutic effect of levodopa alone and in combination with a decarboxylase inhibitor (carbidopa) in cases of Parkinson's disease.

The therapeutic effect of the combination of levodopa and carbidopa ("Sinemet") was compared with that of levodopa alone in 21 patients with Parkinson's disease. Eighteen parameters of the clinical condition and of functional impairment were determined quantitatively and the results satistically evaluated. Changing over from levodopa to the combination preparation resulted in an average improvement of 51.9% within 2 weeks. No relationship was found to exist between the degree of improvement and the severity or the progression of the disease. By the use of the combination preparation, the daily dosage of levodopa could be reduced by 77%. Side-effects connected with the gastro-intestinal tract occurred much less frequently, while hyperkinesia increased. No arrhythmogenic effect was found with the combination product. From the clinical standpoint, combination therapy appeared to be qualitatively superior. By selective maintenance of freshly formed dopamine, it should be possible to assure a directed influence on the disturbed equilibrium of the functional systems of the brain.     

Levodopa/benserazide ('Madopar') combination therapy in elderly patients with parkinsonism.

A clinical evaluation was carried out in 20 elderly patients with parkinsonism to assess the effectiveness and acceptability of treatment with a combination preparation of levodopa and benserazide over a period of 9 months. Mean daily maintenance dosage was 612.5 mg levodopa and 140 mg benserazide. The effects of treatment on clinical features and activities of daily living were monitored at monthly intervals. Significant improvement occurred in the first month and optimal improvement was usually reached by the end of 3-months' treatment. Akinesia and rigidity were abolished or improved in the majority of patients but the effect on tremor was less satisfactory. The preparation was well tolerated and side-effects were not troublesome.     

Therapeutic strategies to prevent and manage dyskinesias in Parkinson’s disease

Introduction: Chronic treatment with levodopa is associated with the development of motor fluctuations and dyskinesias particularly in young Parkinson patients. In some cases, dyskinesias become so severe that they interfere with normal movement and negatively impact quality of life.

Areas covered: In this review, we discuss benefits and limits of available therapeutic approaches aimed at delaying or managing dyskinesias as well as new strategies that are currently under investigation.

Expert opinion: Among available treatments, monotherapy with dopamine agonists in the early phases of the disease reduces the risk for dyskinesias compared with levodopa. Nevertheless, dopamine agonists are unable to prevent dyskinesias once levodopa is added, which is always required once disease severity progresses. Convincing evidence of dyskinesia improvement has been shown only for deep brain stimulation and to some extent also for duodenal levodopa infusion and subcutaneous apomorphine. These approaches are expensive, have restrictive inclusion criteria and can cause potentially serious side effects. Alternative therapies include drugs targeting nondopaminergic neurotransmitter systems. Amantadine improves dyskinesias but its long-term effect is often unsatisfactory. Glutamatergic and gabaergic compounds have been tested in clinical trials, with promising results. By contrast, adrenergic drugs, fipamezole and idazoxan, did not show antidyskinetic effect.     

天麻钩藤颗粒联合左旋多巴治疗帕金森病的疗效观察

目的观察天麻钩藤颗粒联合左旋多巴治疗帕金森病的临床疗效。方法选取2015年7月—2016年6月监利县人民医院收治的帕金森患者88例,随机分为对照组和治疗组,每组各44例。对照组口服左旋多巴片,125 mg/次,2次/d,每周调整药物用量,逐渐增量至250 mg/次,3次/d,每日总剂量不超过6 g;治疗组在对照组的基础上口服天麻钩藤颗粒,5 g/次,3次/d。两组均治疗3个月。治疗后,观察两组的临床疗效,比较两组日常生活能力和运动能力评分和不良反应情况。结果治疗后,对照组和治疗组的总有效率分别为61.36%、72.27%,两组比较差异有统计学意义(P0.05)。治疗后,两组日常生活能力和运动能力评分均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。两组不良反应发生率比较差异无统计学意义。结论天麻钩藤颗粒联合左旋多巴治疗帕金森病,临床疗效确切,症状改善明显,值得临床推广。     

盐酸曲马多与硫酸镁注射液在氯化钠注射液中的配伍稳定性研究

目的 考察盐酸曲马多注射液与硫酸镁注射液配伍的稳定性,为临床用药安全提供依据。方法 模拟临床用药方案,观察盐酸曲马多与硫酸镁注射液在0.9%氯化钠注射液配伍后,在168 h内的外观、pH值及不溶性微粒变化,并采用高效液相色谱法测定盐酸曲马多质量浓度的变化。结果 配伍液在室温条件下外观、pH值及不溶性微粒均无明显变化,两药配伍后盐酸曲马多相对质量浓度>99%。结论 盐酸曲马多注射液与硫酸镁注射液在0.9%氯化钠注射液配伍后,在室温条件下168 h可保持稳定。     

Clinical drug monitoring by microdialysis: application to levodopa therapy in Parkinson's disease

1 We describe the first application of microdialysis to monitor the pharmacokinetics of a drug in the blood of man.
2 The aims of the study were to ascertain patient acceptability and tolerability of a new microdialysis probe and to assess its accuracy in determining the pharmacokinetics of levodopa and its principal plasma metabolite 3-O-methyldopa (3-OMD).
3 Eight patients with parkinsonism on chronic levodopa therapy were investigated.
4 After an overnight fast, a flexible microdialysis probe, perfused with isotonic saline, was inserted into a forearm vein and a blood sampling cannula was inserted in a forearm vein of the other arm. After ingestion of a levodopa preparation (Madopar Dispersible^}}rm), dialysate was collected over 5 or 10  min periods and blood samples were taken every 15 or 30  min for 2–6  h.
5 Dialysate drug profiles were similar to those of plasma, and levodopa and 3-OMD concentrations exhibited significant ( P <0.001) correlation with those observed in the corresponding plasma samples.
6 The mean (±s.d.) blood dialysate concentrations for levodopa and 3-OMD were 36.1±9.2% and 43.4±8.4% respectively of the plasma content.
7 The tolerability of the probe was excellent, and all eight patients found it preferable to conventional blood sampling.
8 Microdialysis of blood is less invasive than frequent intermittent direct blood sampling, and can readily be used to continuously monitor levodopa pharmacokinetics. In a clinical setting, a combination of drug monitoring by this technique together with clinical evaluation of motor function can be used to optimize levodopa treatment in patients with Parkinson's disease.     

Naturalistic evaluation of entacapone in patients with signs and symptoms of L-dopa wearing-off

ABSTRACT

Objective: To evaluate the effectiveness of entacapone in the management of levodopa wearing-off in Parkinson's disease (PD) in a naturalistic, real-life setting.

Research design and methods: This prospective, open-label, observational study included patients with idiopathic PD. Patients were eligible for inclusion if they had been taking 3–5 doses of levodopa per day for ≥2 months and had shown signs of levodopa wearing-off for ≥1 month. Subjects received entacapone (recommended dose: 1 × 200 mg tablet with each levodopa dose) for 28 days. Patients were asked to complete a wearing-off questionnaire and the eight-question Parkinson's Disease Questionnaire Quality of Life assessment (PDQ-8). Activities of daily living (both in the on and off states) were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) part II. Clinical Global Impression (CGI) of severity of PD-related symptoms was assessed using a modified CGI tool. Patient global assessment of severity of PD symptoms was also obtained.

Results: A total of 341 patients were enrolled by 68 physicians across Canada. At Day 28, 56.9% of the subjects indicated improvement compared to baseline on the modified CGI of change (CGI-C); 21.4% reported no change. Improvements were also observed on the UPDRS II and the PDQ-8. Benefit from entacapone appeared to be relatively uniform across subgroups (e.g., number of daily levodopa doses, use of other anti-PD medications).

Study limitations: The results of this study may be biased due to factors inherent in open-label, community-based trials (e.g., compliance). This is, however, reflective of everyday clinical practice.

Conclusions: In this naturalistic, real-life study, the addition of entacapone to levodopa therapy provided benefits in quality of life and activities of daily living for a substantial proportion of PD patients experiencing wearing-off.     

A noninterventional study evaluating the effectiveness of rotigotine and levodopa combination therapy in younger versus older patients with Parkinson’s disease

Background: PD0013 was a 6-month noninterventional study in clinical practice comparing effectiveness/tolerability of rotigotine+levodopa in younger (<70 years) vs. older (≥70 years) Parkinson’s disease (PD) patients.

Methods: Patients previously received levodopa for ≥6 months as monotherapy/in combination with another dopamine-agonist (DA). Primary variable: Unified PD Rating Scale (UPDRS) Part-II change from baseline to end-of-observation-period (EOP).

Results: 91 younger/99 older patients started rotigotine; 68 younger/62 older patients completed the study. Most switched from levodopa+another DA. Addition of rotigotine as first DA was more common in older patients (20.2% vs.15.4%). Mean ± SD rotigotine-exposure: 6.1 ± 3.4 mg/24h younger vs. 4.9 ± 2.4 mg/24h older. Eleven patients changed levodopa dose.

At EOP, improvement in mean UPDRS-II was greater in younger patients (p = 0.0289). UPDRS-II responder-rate (≥20% decrease in UPDRS-II score) was higher in younger patients (42.3% vs. 25.9%). Improvement across age groups was similar on PD Sleep Scale-2 and Clinical Global Impressions-Improvement Scale. Adverse drug reactions (ADRs), and discontinuations because of ADRs, were more common among older patients. There were no new safety signals.

Conclusions: Despite low rotigotine doses, when added to levodopa/switched from levodopa+another DA, rotigotine led to greater improvement in UPDRS-II in younger patients (<70 years). Individual patient data revealed clinically meaningful improvements in UPDRS-II in both groups.     

New and emerging medical therapies in Parkinson’s disease

Introduction: Parkinson’s disease (PD) is one of the most challenging neurodegenerative disorders to treat as it manifests with a large variety of troublesome, and often disabling, motor and non-motor symptoms. Despite limitations, such as motor and other complications, levodopa remains the most effective drug in the treatment of PD.

Areas covered: In this review, we focus on phase 2 and 3 studies describing new and emerging medical therapies in PD. We discuss new formulations of levodopa, medications that prolong levodopa response and ameliorate levodopa-induced dyskinesias, and innovative delivery methods that are currently being evaluated in clinical trials or are in development with the promise of better efficacy and tolerability. We also describe novel non-dopaminergic drugs that have been identified for treatment of motor and non-motor symptoms. A specific section is designated for potential disease modifying therapies.

Expert Opinion: Alternative formulations of levodopa appear to be promising especially to help with the motor fluctuations either by providing sustained benefits with controlled released formulations or ameliorate sudden OFF by formulations such as inhaled levodopa. Several different medications affecting non-dopaminergic pathways are being evaluated which may aide levodopa. As the understanding of the disease grows further, numerous novel neuroprotective or disease modifying therapies have been suggested. This along with development of medications to treat various non-motor symptoms will help improve quality of life of patients with PD.     

Intraduodenal infusion of a water-based levodopa dispersion for optimisation of the therapeutic effect in severe Parkinson's disease

Summary Motor performance of five patients with advanced Parkinson's disease was investigated during their optimum oral therapy (conventional tablets and/or depot capsules) and during a continuous duodenal infusion of levodopa. Due to the low water solubility of the drug, conventional tablets of levodopa + carbidopa (Sinemet^®) were milled and dispersed in a 1.8% aqueous methylcellulose solution. The dispersion was delivered nasoduodenally by a portable pump. The effect of levodopa in the two dosing regimens was estimated optico-electronically every 15 min and was also evaluated from videorecordings every 30 min and plasma levels of levodopa was regularly measured. Each dosage regimen the was studied twice, at a 2–4 day interval.Duodenal infusion improved motor function in all five patients and the fluctuations were reduced when compared to the oral therapy. Variation in plasma levodopa concentrations was 3–10 fold during oral therapy, while during the infusion a stable concentration was obtained. The therapeutic concentration varied from 0.3–3 g ml^–1 between patients. The relative bioavailability of levodopa in the solid preparation compared to the dispersion was in all patients 100%.Our results encourage further development of a duodenal infusion system with a levodopa dispersion for clinical use in parkinsonian patients who show severe fluctuation.     

吡贝地尔联合左旋多巴治疗帕金森病的Meta分析

目的 系统评价吡贝地尔联合左旋多巴治疗帕金森病（Parkinson’s disease,PD）的有效性与安全性。方法 检索Cochrane library、PubMed、ScienceDirect英文数据库和CNKI、WanFang、VIP中文数据库,检索时间从建库至2015年9月,收集吡贝地尔联用左旋多巴治疗PD的随机对照试验（randomized controlled trial,RCT）。由2名研究者严格按照纳入与排除标准独立筛选文献、提取资料并评价质量,使用RevMan5.3软件进行Meta分析。结果 最终纳入9个随机对照试验,共计697例PD患者。Meta分析结果显示,吡贝地尔联合左旋多巴在改善统一帕金森病评定量表（unified Parkinson’s disease rating scale,UPDRS）总评分、UPDRS运动评分、UPDRS日常活动评分方面优于左旋多巴联合安慰剂或左旋多巴单药治疗,差异具有统计学意义[UPDRS总评分：MD=-9.20,95% CI（-11.28,-7.12）,P<0.000 01;UPDRS运动评分：随访时间≤6月,MD=-3.04,95% CI（-4.92,-1.16）,P=0.002;随访时间>6个月,MD=-10.81,95% CI（-14.76,-6.86）,P<0.000 01;UPDRS日常活动评分：MD=-1.28,95% CI（-2.31,-0.26）,P=0.01];在胃肠道不良反应发生率方面,左旋多巴联合安慰剂或左旋多巴单药治疗优于吡贝地尔联合左旋多巴,其差异有统计学意义[OR=1.86,95% CI（1.04,3.31）,P=0.04]。结论 吡贝地尔联用左旋多巴治疗PD,可显著改善UPDRS总评分、UPDRS运动评分、UPDRS日常活动评分,同时应重视其胃肠道不良反应。     

Levodopa in Parkinson's disease: from the past to the future

Importance of the field: Levodopa is the mainstay of symptomatic treatment for Parkinson's disease (PD). Although other treatments have been developed in the last 30 years, most patients use levodopa in view of its superior efficacy in controlling PD symptoms. Unfortunately, levodopa is associated with long-term motor complications (motor fluctuations and dyskinesias). The main causes of these undesirable effects are the narrowing of the therapeutic window with the natural progression of the disease, pulsatile dopaminergic stimulation due to the short half-life of the drug and erratic absorption. Several studies suggest that PD control could be enhanced by changing the mode of levodopa delivery so as to ensure continuous and stable supply of the drug to the brain. The objective of this text is to review the ascertained strengths and limitations of levodopa in PD, starting from its history, and propose novel modes of usage designed to cover currently unmet medical needs.

Areas covered in this review: Medline literature search (from 1973 to date).

What the reader will gain: A perspective on the evolution of PD pharmacological treatment.

Take home message: Levodopa still is the best treatment for PD. Truly stable and controlled formulations that ensure clinical response should be developed to reduce the undesirable effects that restrict its efficacy.     

Inhaled levodopa for intermittent treatment of OFF episodes in patients with Parkinson’s disease

ABSTRACT

Introduction: Many patients with advanced Parkinson’s disease (PD) have inadequate control of motor symptoms despite optimized treatment. Predictable and unpredictable OFF periods severely interfere with the quality of life. A drug that easily and rapidly reverts the OFF state is still needed. Subcutaneous apomorphine, the only approved drug for this indication, although efficacious, is not widely used probably due to its potential side effects and complicated administration.

Levodopa is the most efficacious drug for the treatment of PD motor symptoms. However, issues related to the oral route and intestinal absorption in later disease stages render this route lengthy and inefficacious.

Areas covered: Literature on the development of an inhaled formulation of levodopa has been reviewed. Significant advances in the field of pulmonary delivery systems and in dry powders have enabled the development of a new formulation of levodopa that can be inhaled and adequate blood levels rapidly achieved, bypassing intestinal absorption. Several clinical trials have reported efficacy, safety, and tolerability data. Some pulmonary-related adverse events have been reported but are mostly mild.

Expert opinion: This new way of administering levodopa is likely to be very welcome and may fill a gap for OFF rescue treatments, at least for some patients.     

依达拉奉联合多巴丝肼片治疗血管性帕金森综合征疗效研究

目的 观察多巴丝肼片联合依达拉奉治疗血管性帕金森综合征的临床疗效,以期为血管性帕金森综合征的治疗提供借鉴。方法 以入榆林市星元医院就诊的血管性帕金森综合征患者为研究治疗对象,将患者随机分为观察组与对照组,对照组以多巴丝肼片治疗,观察组在对照组基础上予以依达拉奉治疗,治疗20 d,观察治疗前后临床症状与体征,采用帕金森病评定量表（UPDRS）评价临床疗效。结果 共搜集患者60例,每组各30例,各组在年龄、性别、分级、UPDRS评分、危险因素等方面具有可比性。观察组患者显效17例,有效11例,无效2例,总有效率为93.33%;对照组患者显效12例,有效10例,无效8例,总有效率为73.33%。有效率比较,差异有显著性意义（P<0.05）,说明观察组有效率明显高于对照组;两组患者治疗后的精神情绪行为、日常生活活动评分和运动功能评分较治疗前均有所降低（P<0.05）,治疗后患者日常生活、行为精神情绪、运动检查等UPDRS评分的比较,差异有显著性（P<0.05）,观察组UPDRS评分改善明显高于对照组。所有患者治疗前后一般体格检查及血、尿常规,肝肾功能,心电图均在正常范围内,未出现严重不良反应。结论 依达拉奉联合多巴丝肼片治疗血管性帕金森综合征的临床疗效要优于单独使用多巴丝肼片,且具有良好的安全性。     

Recent important trials of pharmacotherapy in Parkinson's disease

Parkinson's disease (PD) affects approximately 1% of individuals > 60 years. Of these PD patients approximately 40% suffer dementia in later life. Levodopa is commonly used in the treatment of PD. Experimental evidence suggests that the dopamine synthesised from levodopa may contribute to the further degeneration of dopaminergic neurons. The results of the clinical outcome part of the Earlier Versus Later Levodopa Therapy in PD study suggest that levodopa slows the progression of PD. In contrast, the single photon emission-computed tomography imaging substudy was not conclusive but suggested that levodopa hastened the progression of PD. Thus, further studies of the effects of levodopa on the progression of PD are needed before it can be proved that levodopa does not have a detrimental effect on dopaminergic neurons. In a clinical trial of the anticholinesterase rivastigmine, a small improvement was observed in some patients suffering from dementia associated with PD. This small benefit has to be balanced against cholinergic side effects and a possible loss of efficacy of antimuscarinic agents used for motor control in PD.     

美托洛尔联合稳心颗粒治疗功能性早搏的疗效观察

目的 观察美托洛尔联合稳心颗粒治疗功能性早搏的临床疗效和安全性。方法 选择2011年4月-2013年3月到日照市人民医院就诊的功能性早搏患者90例,随机分成美托洛尔组、稳心颗粒组、联合治疗组,每组均为30例。美托洛尔组口服美托洛尔片12.5 mg/次,2次/d;稳心颗粒组口服稳心颗粒1袋/次,3次/d;联合治疗组口服美托洛尔片和稳心颗粒,用法用量同以上两组。3组均持续治疗4周。观察治疗后两组患者的症状疗效、动态心电图疗效,并对两组患者治疗前后血压、心率及心电图相关指标进行比较。结果 治疗后症状疗效美托洛尔组、稳心颗粒组、联合治疗组总有效率分别为76.6%、83.3%、96.7%;联合治疗组与另两组比较差异均有统计学意义（P<0.05）。动态心电图疗效美托洛尔组、稳心颗粒组、联合治疗组总有效率分别为53.3%、63.3%、76.6%,联合治疗组与另两组比较差异均有统计学意义（P<0.05）。结论 美托洛尔联合稳心颗粒治疗功能性早搏有较好疗效,其临床疗效明显优于单用稳心颗粒和美托洛尔,值得临床推广使用。     

Tolcapone,a Selective Catechol-O-Methyltransferase Inhibitor for Treatment of Parkinson's Disease

Tolcapone is a selective peripheral and central catechol-O-methyltransferase (COMT) inhibitor recently approved as adjunctive therapy in patients with idiopathic Parkinson's disease who are already being treated with a levodopa-peripheral dopa decarboxylase inhibitor (DDI) combination. Tolcapone potentiates and prolongs the effect of levodopa in the central nervous system (CNS) by enhancing levodopa's delivery to the CNS and slowing dopamine's central metabolism. A short terminal disposition half-life of 2 hours mandates dosing 3 times/day. Dosage adjustment is generally unnecessary in the presence of mild to moderate renal and hepatic impairment. Coadministration of tolcapone with levodopa-DDI results in significant amelioration of the wearing-off and on-off phenomena and frequently allows significant levodopa dosage reduction. In patients with stable disease, tolcapone improves ‘on’ time. As might be expected from its potentiation of levodopa effects, dopaminergic side effects are prominent with this agent. Although the main objective of drug treatment in Parkinson's disease remains clinical improvement with an optimum dose and frequency of levodopa administration, tolcapone may prove a useful adjunct to such therapy, especially in the presence of the wearing-off and on-off phenomena. The relative merits of this agent vis-a-vis dopamine receptor agonists are somewhat unclear at present. However, recent guidelines from the American Academy of Neurology suggest that a COMT inhibitor be added to levodopa-dopamine agonist therapy in patients with advanced disease.     

Safinamide in the treatment of Parkinson's disease

Importance of the field: Current therapy for Parkinson's disease (PD) is primarily directed at reversing the motor symptoms that are the consequence of dopamine deficiency and includes levodopa, dopamine agonists and monoamine oxidase (MAO) B inhibitors. New drugs offering both dopaminergic and non-dopaminergic actions could offer a significant advantage.

Areas covered in this review: This review surveys the current treatment strategies for PD. Defining unmet needs and how a new compound – safinamide, which has both dopaminergic and non-dopaminergic actions – might address these.

What the reader will gain: The reader will gain an understanding of safinamide and its mechanisms of action, including reversible MAOB inhibition and reduced dopamine reuptake with antiglutamatergic effects, and how it may potentially provide improvement of PD motor symptoms with an antidyskinetic effect through its effect on glutamate release. The clinical trial profile of safinamide is reviewed. Early results are promising in terms of improved motor function and reduced ‘OFF’ time. Additional Phase III trials are now in progress for this adjunctive indication. Finally, the reader will understand the potential role for safinamide in the selection and sequencing of drugs for PD.

Take home message: safinamide combines both dopaminergic and non-dopaminergic actions that may add a new dimension to PD treatment options as an adjunct to current drugs. Its efficacy is under active evaluation in Phase III clinical trials.     

四磨汤口服液联合阿米替林治疗功能性胃肠病的疗效观察

目的探究四磨汤口服液联合盐酸阿米替林片治疗功能性胃肠病的临床疗效。方法选取2016年1月—2017年1月在徐州市中心医院消化内科收治的功能性胃肠病患者140例作为研究对象,所有患者随机分为对照组和治疗组,每组各70例。对照组口服盐酸阿米替林片,1片/次,2次/d。治疗组在对照组基础上口服四磨汤口服液,20 m L/次,3次/d。两组患者均连续治疗6周。观察两组的临床疗效,比较两组的消化道症状积分情况。结果治疗2、4、6周后,对照组总有效率分别为52.86%、62.86%、65.71%,治疗组总有效率分别为61.43%、78.57%、85.71%,两组同期比较差异统计学意义(P0.05)。治疗2、4、6周后,两组消化道症状积分均明显下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组消化道症状积分明显低于同期对照组,两组比较差异具有统计学意义(P0.05)。结论四磨汤口服液联合盐酸阿米替林片治疗功能性胃肠病具有较好的临床疗效,能改善消化道症状,安全性较好,具有一定的临床推广应用价值。     

Carbidopa levodopa enteral suspension

Introduction: The search for consistent, effective treatments in Parkinson’s disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains.

Areas covered: An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall “on” time compared with oral immediate release formulation of carbidopa/levodopa.

Expert opinion: The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.