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CONy 2021 | Continuous dopaminergic stimulation to prevent motor complications in Parkinson’s disease

Angelo Antonini, MD, PhD, University of Padua, Padua, Italy, discusses whether continuous dopaminergic stimulation should replace pulsatile once motor fluctuations develop. Evidence suggests that continuous delivery of dopaminergic stimulation delays the development of wearing-off and dyskinesias. Although at the moment continuous dopaminergic stimulation is not feasible, infusion systems that allow levodopa to be delivered subcutaneously early in the process might be available soon. However, there are some questions about whether it would be sufficient to prevent the occurrence of motor fluctuations as they are driven by the loss of dopamine terminals, so unless a neuroprotective agent is added, the number of neurons available to transform levodopa into dopamine won’t change. But the difference we might see is in the development of dyskinesias since they are the consequence of abnormal dopamine production and release. Prof. Antonini concludes that all attempts should try to prolong and maximize the benefit of levodopa. Making the delivery more continuous benefits Parkinson’s disease patients and may limit the risk and severity of motor complications, particularly dyskinesias. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy).