Management of motor complications in advanced Parkinson's disease.
Level 5 - mechanism / opinion, no new human data
Narrative review of mechanisms and clinical management without systematic review methodology.
PubMed 18175400 · doi:10.1002/mds.21680
What was done
This narrative review outlines the mechanistic subtypes of motor fluctuations (including "on"/"off", "wearing off", "delayed on", and "no-on" phenomena) in advanced Parkinson's disease and summarizes clinical and investigational management strategies based on the abstract.
What was found
The abstract reports no numerical data, effect sizes, or statistical comparisons. It identifies mechanisms such as loss of striatal dopamine storage and short levodopa half-life for "wearing off," and impaired oral absorption for "delayed on" and "no-on." Outlined interventions include fractionated levodopa dosing, alternative formulations (controlled-release, dispersible, soluble), oral/transdermal/subcutaneous dopamine agonists, MAO-B/COMT inhibitors, subthalamic deep brain stimulation, and investigational gene or stem cell therapies.
Why it matters
It provides a clinical framework linking specific physiological causes of motor complications in advanced Parkinson's disease to targeted therapeutic options.
Limits
The abstract presents a narrative overview without primary empirical data, sample sizes, systematic search methodology, or quantitative comparisons of efficacy and safety among the discussed treatments.
Cited by
- supports In Parkinson's disease progression, surviving dopaminergic neurons lose the capacity to properly store dopamine, contributing to the need for more frequent levodopa dosing.