علاج مرض باركنسون عند استمرار التقلبات الحركية رغم العلاج الفموي

References

• Invasive procedures should be considered when levodopa-dependent motor fluctuations persist despite optimizing oral/transdermal therapy.
• Four pump therapies (Continuous subcutaneous Apomorphine infusion (CSAI), Levodopa-Carbidopa Intestinal Gel (LCIG), Levodopa/Entacapone/Carbidopa intestinal Gel (LECIG) and Foslevodopa/Foscarbidopa-Infusion (CSFLI)) have been approved for the treatment of motor fluctuations that cannot be adequately treated conservatively.
• Subthalamic nucleus (STN) Deep Brain Stimulation (DBS) should be offered to patients with PD with motor fluctuations with and without dyskinesia that cannot be adequately treated with oral medication and at least 33% improvement in PD motor symptoms using a standardized levodopa test, taking into account the contraindications such as cognitive decline and severe psychiatric symptoms or other severe comorbidities.
• STN DBS should be preferred over Globus Pallidus internus (GPi) DBS for PD patients with motor fluctuations (with and without dyskinesias).

DOI: 10.1186/s42466-024-00325-4