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Age-related Neurodegenerative Disease Parkinson’s Disease
i.e. sleep, ‘off’, ‘on’ and ‘on’ with troublesome dyskinesia. A diary over restricted to that sole intake, i.e. increasing the drug dosage or
three consecutive days provides a good period of observation to obtain changing the time of administration, for example a few minutes earlier
pertinent information. In the most difficult cases, brief hospitalisation may or sometimes longer before a meal. The presence of regular motor
help, and medical staff can fill in a similar hourly diary. A levodopa fluctuations requires treatment optimisation, such as the introduction
challenge is a useful complement (and is also particularly useful to analyse of levodopa–carbidopa–entacapone. Currently, the recommended
method is a day-to-day switch from conventional levodopa to
levodopa–carbidopa–entacapone. Each intake of conventional
levodopa is changed to levodopa–carbidopa–entacapone with the
Levodopa–carbidopa–entacapone is an
corresponding dosage of levodopa. To reduce the risk of an increase
effective and well-tolerated treatment
of dopaminergic adverse effects, careful titration of the levodopa dose
may be necessary in cases where increased exposure to levodopa is
option in Parkinson’s disease patients
expected. Caution is mandatory in patients suffering from dyskinesia,
suffering from motor fluctuations.
as the switch may result in a worsening of the complication. When
dyskinesia is severe, levodopa first needs to be reduced (even if this
leads to a worsening of the motor fluctuation), before the switch to
levodopa–carbidopa–entacapone is made.
dyskinesia).
35
A levodopa challenge provides information on the severity of
the morning ‘off’ period, the time of effect and the duration of levodopa Conclusion
(the dosage is the levodopa equivalent of the morning dosage of the first Levodopa–carbidopa–entacapone is an effective and well-tolerated
intake of antiparkinsonian drugs +50mg, given in liquid levodopa while the treatment option in PD patients suffering from motor fluctuations.
patient fasts and after overnight withdrawal of antiparkinsonian drug). Early detection of fluctuation is important for prompt treatment,
which in turn will improve the quality of life of the patients. Moreover,
Treating Motor Fluctuations addressing levodopa-related motor fluctuations early may also
If the patient is suffering from isolated fluctuations, such as the lack or be beneficial for basal ganglia function, which, ultimately, will benefit
the poor efficacy of a given intake of treatment, the correction will be the patient. ■
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