In the more advanced person with Parkinson’s who already is experiencing motor complications, it is believed that providing a more continuous stimulation may reverse the development of motor complications, enabling the person to enjoy more stable benefits from therapy.
According to neourologist Professor Per Odin, continuous dopaminergic stimulation (CDS) is a treatment strategy hypothesised to avoid or reduce the motor complications of longterm levodopa therapy, motor fluctuations, and dyskinesia. CDS achieves this by preventing or reversing sensitisation induced by pulsatile dopaminergic stimulation. The CDS hypothesis is itself based on several hypotheses. First, tonic dopaminergic stimulation is physiological. Second, sensitisation is undesirable and should be reversed. Third, reduction of “off” time and dyskinesia can be induced simultaneously. Finally, clinical studies substantiate the CDS hypothesis.
The infusion pump is a very good way in advanced, or even moderate Parkinson’s, to help people obtain a smoother plasma response and more continuous stimulation at the postsynaptic receptor site.
The plasma profile induced by the infusion is always higher than with oral treatment, but the trough levels during the day are much less.
The pharmacokinetic studies suggest that the key to CDS may be the elimination of trough levels, rather than delivering a constant concentration of a drug. High concentrations of levodopa may not be a problem if low trough levels are avoided.
