Continuous Dopaminergic Stimulation in Parkinson's Disease

At this meeting, a number of critical groups confirmed and extended the original findings by J.A. Obeso and his colleagues. These authors found that continuous s.c. infusion of lisuride, a watersoluble dopaminergic 8- -aminoergoline with dopaminergic properties which can be injected or infused, can improve - sometimes quite considerably - motor function in severely disabled fluctuating Parkinsonian patients. The concurrent use of the peripheral dopamine antagonist domperidone attenuates or prevents side effects related to the stimulation of "peripheral" dopamine receptors, including the chemoreceptor trigger zone and some areas of the hypothalamus outside the blood-brain barrier. The clinical results discussed in this volume may not only be a basis for further improvements in our knowledge and therapeutic strategies in Parkinsonism, they point to the so far neglected importance of different ways of stimulating neurological or other systems, e.g. discontinous, oscillatory effects caused by frequent oral application vs. continuous stimulation as described here with the lisuride s.c. infusion. Similar concepts have to be discussed and investigated in neurological disorders. In this respect, this multidisciplinary meeting and its publication may offer new ideas and concepts for therapy in general, in addition to its potential application in the treatment of the complications of Parkinson's disease.

Contenu

Continuous dopaminergic stimulation in Parkinson's disease.- Pathogenetic studies of motor fluctuations in Parkinson's disease.- The case for and concerns about continuous dopamine stimulation in Parkinson's disease.- Subcutaneous administration of lisuride in the treatment of complex motor fluctuations in Parkinson's disease.- Subcutaneous lisuride infusion in Parkinson's disease: clinical results using different modes of administration.- Chronic s. c. Lisuride in Parkinson's disease-motor-performance and avoidance of psychiatric side effects.- Continuous subcutaneous lisuride infusions in Parkinson's disease.- A combined regimen of subcutaneous lisuride and oral madopar HBS in Parkinson's disease.- Pharmacokinetics of lisuride after subcutaneous infusion.- Treatment of Parkinson's disease with subcutaneous lisuride infusions.- Lisuride infusion pump in Parkinson's disease. A report of two cases.- Discussion.- Complications in treatment.- Psychiatric side effects during the treatment of Parkinson's disease.- Applications of new drug delivery technologies to Parkinson's disease and dopaminergic agents.- Discussion.- Continuous dopaminergic stimulation experimental studies.- Continuous intracerebroventricular infusion of dopamine and dopamine agonists through a totally implanted drug delivery system in animal models of Parkinson's disease.- Receptor changes during chronic dopaminergic stimulation.- Effect of chronic subcutaneous minipump infusion of lisuride upon locomotor activity of rats.- Discussion.- Biochemical basis of diagnostic and therapeutic problems.- Factors contributing to fluctuations of the dopaminergic nigro-striatal feedback system in Parkinson's disease.- Agonist and antagonist actions of lisuride on dopamine neurons: electrophysiological evidence.- Pharmacokinetic studies with sustained-release formulations of levodopa in healthy volunteers.- Parkinson's disease and PET tracer studies.- Mapping dopamine receptors in the human brain.- Discussion.- Present state and future developments.- Discussion.- Continuous dopaminergic stimulation: state of the art and outlook.- Listed in Current Contents.