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Continuous Dopaminergic Stimulation in Parkinson’s Disease


provide stable and more prolonged synaptic levels of striatal DA compared with standard levodopa administration along with a sustained motor response.


Discussion


To our knowledge, there are no PET studies that have directly tested whether currently available drug approaches, which provide more sustained levodopa delivery, also provide stable and more prolonged synaptic levels of striatal DA along with a sustained motor response. However, it is clear that PET has a great potential in this specific research field and could provide valuable insight on the pharmacokinetics and pharmacodynamics of new agents and therapeutic strategies in PD. First, the entacapone and tolcapone experience clearly indicates that quantitative 18F-dopa PET may be useful in assessing pharmacological manipulations of levadopa delivery into the brain. Late imaging can be informative if central COMT inhibition needs to be demonstrated. More importantly, sequential 11C-raclopride PET scans can be used to compare the effects of intermittent and continuous dopaminergic delivery directly on striatal DA levels in PD patients. The same paradigm may also be useful to examine whether pulsatile and continuous dopaminergic stimulation have different long-term effects on pre-synaptic function and on the ability of the striatum to release DA in the synaptic cleft following an acute levodopa challenge. n


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David J Brooks is the Hartnett Professor of Neurology and Head of the Centre for Neuroscience in the Department of Medicine at Imperial College London. He is also a Senior Neurologist in Medical Diagnostics at GE Healthcare PLC. His research involves the use of positron-emission tomography and magnetic resonance imaging to diagnose and study the progression of Alzheimer’s and Parkinson’s disease and their validation of biomarker therapeutic trials. To


date, he has published over 300 reports in peer-reviewed journals, including Nature. Professor Brooks’ research is supported by grants from the UK Medical Research Council, the Alzheimer’s Research Trust, the UK Parkinson’s Disease Society, the Michael J Fox Foundation and industry. He has been an active member of the research advisory panels and boards for many of the leading Parkinson’s disease and neurology societies and is on the Editorial Boards of Brain, the Journal of Neural Transmission, Synapse, Molecular Imaging and Biology, Neurotherapeutics and Current Trends in Neurology. He is a Fellow of the UK’s Academy of Medical Science and has been the invited keynote speaker at several prestigious international scientific meetings.


Nicola Pavese is a Senior Investigator Scientist based at the Medical Research Council – Neurology PET Group in London and an Honorary Senior Lecturer at Imperial College London. His research activity has focused on the neuropharmacology and neurochemistry of movement disorders and he is investigating pathogenetic mechanisms underlying non-motor symptoms of Parkinson’s disease by using functional imaging techniques.


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EUROPEAN NEUROLOGICAL REVIEW


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