Continuous dopamine-receptor stimulation in advanced Parkinson's disease
Nutt JG, Obeso JA, Stocchi F.
Dept of Neurology, Oregon Health Sciences University, Portland 97201, USA.
Intermittent or pulsatile dopamine-receptor stimulation is postulated to induce plastic changes in motor systems that are responsible for the development of the motor fluctuations and dyskinesia that complicate long-term L-dopa therapy of Parkinson's disease. As a corollary to this hypothesis, continuous dopamine-receptor stimulation can avoid or reverse these complications.
Such continuous stimulation is unlikely to mimic completely the normal function of the dopaminergic system, but should avoid the supra-physiological swings in extracellular dopamine that accompany intermittent L-dopa dosing. The concern is that this continuous stimulation might induce tolerance rather than sensitization to some effects of L-dopa.
Open clinical trials support the value of continuous dopaminergic stimulation in Parkinson's disease with established motor complications, but rigorous studies, although experimentally difficult, are needed.
CITA DEL ARTÍCULO Trends Neurosci. 2000 Oct;23(10 Suppl):S109-15