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Continuous dopaminergic stimulation aims to avoid fluctuations in plasma levels of antiparkinsonian drugs in Parkinson’s disease. There are limited possibilities for translating this concept into practice with standard oral therapies: subcutaneous infusions of apomorphine (and in the near future most probably also of levodopa) and intestinal infusions of levodopa/carbidopa (LD/CD). Both allow the maintenance of stable drug levels in blood and hence a sustained stimulation of dopamine receptors. The magnitude of the effect is more or less similar between techniques, with a reduction in OFF time, an improvement in ON time, and at least for infusions of LD/CD, documented reduction in dyskinesias. The effect is apparently greater with the intestinal and subcutaneous levodopa infusions given that they were compared with oral LD/CD in their pivotal studies whereas apomorphine was compared with placebo. As of yet, subcutaneous apomorphine and intestinal LD/CD infusions are positioned at the same level of efficacy as surgical treatment of PD and are alternatives for the treatment of patients with motor fluctuations not controlled with conventional treatment.
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