Pulsatile stimulation of dopamine receptors and levodopa-induced motor complications in Parkinson's disease: implications for the early use of COMT inhibitors
Olanow CW, Obeso JA.
Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA
Date: Jun 1, 2000Neurology [SP]
Increasing laboratory and clinical evidence indicates that pulsatile stimulation of dopamine receptors contributes to the development of levodopa-related motor complications in PD. In keeping with this concept, clinical trials have demonstrated that initiating therapy with a long-acting dopamine agonist reduces the risk of inducing motor complications in comparison to levodopa.
However, the introduction of levodopa is associated with the development of motor complications even in the presence of a long-acting dopamine agonist in both PD patients or MPTP treated monkeys. Administration of levodopa with a catechol-O-methyl transferase (COMT) inhibitor increases its plasma half-life, smoothes out peaks and troughs, and delivers levodopa to the brain in a more continuous fashion. We hypothesize that the risk of developing motor complications in PD patients when levodopa is introduced can be reduced if the levodopa is coupled with a COMT inhibitor so as to provide more continuous dopaminergic stimulation of dopamine receptors.
A proposed algorithm for the treatment of the early PD patient is to initiate therapy with a dopamine agonist, and supplement with levodopa coupled with a COMT inhibitor when the dopamine agonist cannot provide satisfactory clinical benefits.
CITATION Neurology. 2000;55(11 Suppl 4):S72-7; discussion S78-81
you maybe interested
The Clínica is the greater private hospital with technological equipment of Spain, all in a single center.
The professionals of the Clínica perform continuous research and training, always to the benefit of the patient.
Learn why we are different from other healthcare centers. Quality, speed, comfort and results.