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Psychiatria Danubina, Vol.23. No.1. March 2011. -

Motor fluctuations and dyskinesia in later stages of Parkinson-s disease PD are caused by pharmacokinetic as well as

pharmacodynamic factors, intermittent dopaminergic stimulation being one of the most important. In the healthy brain, dopamine

neurons in the substantia nigra pars compacta fire tonically at a steady rate of about 4 cycles-second. In later stages of PD, steady

firing is replaced by pulsatile stimulation which causes molecular and physiologic changes in the basal ganglia. Continuous

dopaminergic stimulation has been shown to dramatically improve motor fluctuations and dyskinesia by modifications of oral

treatment dopamine agonists, smaller, more frequent levodopa doses, controlled-release formulation of levodopa, addition of agents

that slow down the catabolism of dopamine, such as inhibitors of catechol-O-methyl transferase and monoamine oxidase,

transdermal delivery rotigotine, infusion therapies intravenous levodopa, subcutaneous application of apomorphine and lisuride,

duodenal infusion of levodopa and deep brain stimulation of the subthalamic nucleus.

Parkinson-s disease; continuous dopaminergic stimulation; levodopa; neuronal firing; basal ganglia



Author: Zvezdan Pirtošek - ; Department of Neurology, University Medical centre, Ljubljana, Slovenia

Source: http://hrcak.srce.hr/



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