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Controlled-Release Levodopa for the Treatment of Rapid Motor Fluctuations in Parkinson's Disease Subjects with Subthalamic Nucleus Deep Brain StimulationFunding None.
Objectives We aimed to investigate the efficiency of controlled-release levodopa/benserazide (Madopar HBS) use during daytime in our pilot study on advanced-stage Parkinson's disease (PD) subjects with deep brain stimulation of the subthalamic nucleus (STN-DBS) therapy.
Methods We have evaluated all PD subjects with STN-DBS who had admitted to our outpatient polyclinic between February 2022 and March 2022. Among these patients, those who were taking levodopa therapy at least five times throughout the day and the efficiency of levodopa lasted less than 3 hours were detected. The standard levodopa therapy was switched to Madopar HBS in all patients who accepted the therapy chance and the clinical evaluation of the patients on Madopar HBS therapy was performed in the second month of the therapy.
Results Ultimately, the follow-up of all four patients in whom the levodopa therapy was changed to Madopar HBS yielded a significant reduction in the “off” periods and improvement in the PSQ-39 scores.
Conclusion We suggest the use of Madopar HBS in PD patients with STN-DBS surgery suffering from motor fluctuations, particularly in the subgroup with milder dyskinesias. Future study results of a large number of PD subjects with STN-DBS therapy are warranted to confirm our observations. The results of these studies may provide critical applications in clinical practice.
Keywordscontrolled-release levodopa - rapid motor fluctuations - short-duration response - Parkinson's disease - STN-DBS
The consent form has been obtained from the patient and his spouse.
HO conceptualized and designed the study. SC supervised the study. HO, SK, and SC helped in providing material. HO and SC helped in data collection and/or processing and analysis and/or interpretation. HO helped in literature search and manuscript writing. SC helped in critical review.
Article published online:
16 June 2023
© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Poewe W. The role of COMT inhibition in the treatment of Parkinson's disease. Neurology 2004; 62 (1, Suppl 1): S31-S38
- 2 Iansek R, Danoudis M. A single-blind cross over study investigating the efficacy of standard and controlled release levodopa in combination with entacapone in the treatment of end-of-dose effect in people with Parkinson's disease. Parkinsonism Relat Disord 2011; 17 (07) 533-536
- 3 Hauser RA, Panisset M, Abbruzzese G, Mancione L, Dronamraju N, Kakarieka A. FIRST-STEP Study Group. Double-blind trial of levodopa/carbidopa/entacapone versus levodopa/carbidopa in early Parkinson's disease. Mov Disord 2009; 24 (04) 541-550
- 4 Jansen EN, Meerwaldtt JD. Madopar HBS in nocturnal symptoms of Parkinson's disease. Adv Neurol 1990; 53: 527-531
- 5 Lees AJ. A sustained-release formulation of L-dopa (Madopar HBS) in the treatment of nocturnal and early-morning disabilities in Parkinson's disease. Eur Neurol 1987; 27 (Suppl. 01) 126-134
- 6 Yeh KC, August TF, Bush DF. et al. Pharmacokinetics and bioavailability of Sinemet CR: a summary of human studies. Neurology 1989; 39 (11, Suppl 2): 25-38
- 7 Da Prada M, Kettler R, Zürcher G, Schaffner R, Haefely WE. Inhibition of decarboxylase and levels of dopa and 3-O-methyldopa: a comparative study of benserazide versus carbidopa in rodents and of Madopar standard versus Madopar HBS in volunteers. Eur Neurol 1987; 27 (Suppl. 01) 9-20
- 8 Dupont E, Andersen A, Boas J. et al. Sustained-release Madopar HBS compared with standard Madopar in the long-term treatment of de novo parkinsonian patients. Acta Neurol Scand 1996; 93 (01) 14-20
- 9 Poewe WH, Lees AJ, Stern GM. Treatment of motor fluctuations in Parkinson's disease with an oral sustained-release preparation of L-dopa: clinical and pharmacokinetic observations. Clin Neuropharmacol 1986; 9 (05) 430-439
- 10 Rinne UK, Rinne JO. Treatment of early Parkinson's disease with controlled-release levodopa preparations. Neurology 1989;39(11, Suppl 2):78–81, discussion 95
- 11 Olanow CW, Nakano K, Nausieda P. et al. An open multicenter trial of Sinemet CR in levodopa-naive Parkinson's disease patients. Clin Neuropharmacol 1991; 14 (03) 235-240
- 12 Baek JS, Choo CC, Qian C, Tan NS, Shen Z, Loo SC. Multi-drug-loaded microcapsules with controlled release for management of Parkinson's disease. Small 2016; 12 (27) 3712-3722
- 13 MacMahon DG, Sachdev D, Boddie HG, Ellis CJ, Kendal BR, Blackburn NA. A comparison of the effects of controlled-release levodopa (Madopar CR) with conventional levodopa in late Parkinson's disease. J Neurol Neurosurg Psychiatry 1990; 53 (03) 220-223
- 14 Pezzoli G, Tesei S, Ferrante C, Cossutta E, Zecchinelli A, Scarlato G. Madopar HBS in fluctuating parkinsonian patients: two-year treatment. Mov Disord 1988; 3 (01) 37-45
- 15 Chase TN, Baronti F, Fabbrini G, Heuser IJ, Juncos JL, Mouradian MM. Rationale for continuous dopaminomimetic therapy of Parkinson's disease. Neurology 1989;39(11, Suppl 2):7–10, discussion 19
- 16 Schaeffer E, Vaterrodt T, Zaunbrecher L. et al. Effects of levodopa on quality of sleep and nocturnal movements in Parkinson's disease. J Neurol 2021; 268 (07) 2506-2514
- 17 Li J, Mei S, Jia X, Zhang Y. Evaluation of the direct effect of bilateral deep brain stimulation of the subthalamic nucleus on levodopa-induced on-dyskinesia in Parkinson's disease. Front Neurol 2021; 12: 595741
- 18 Liu Y, Li F, Luo H. et al. Improvement of deep brain stimulation in dyskinesia in Parkinson's disease: a meta-analysis. Front Neurol 2019; 10: 151
- 19 Obeso JA, Rodriguez-Oroz M, Marin C. et al. The origin of motor fluctuations in Parkinson's disease: importance of dopaminergic innervation and basal ganglia circuits. Neurology 2004; 62 (1, Suppl 1): S17-S30
- 20 Poewe W, Antonini A, Zijlmans JC, Burkhard PR, Vingerhoets F. Levodopa in the treatment of Parkinson's disease: an old drug still going strong. Clin Interv Aging 2010; 5: 229-238
- 21 Heetun ZS, Quigley EM. Gastroparesis and Parkinson's disease: a systematic review. Parkinsonism Relat Disord 2012; 18 (05) 433-440
- 22 deSouza RM, Moro E, Lang AE, Schapira AH. Timing of deep brain stimulation in Parkinson disease: a need for reappraisal?. Ann Neurol 2013; 73 (05) 565-575