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The on-off phenomenon.

¹National Hospital for Nervous Diseases, London UK.

Journal of Neurology, Neurosurgery, and Psychiatry

|June 1, 1989

Summary

This summary is machine-generated.

Parkinson's disease patients on levodopa treatment often experience the "on-off" phenomenon. This study suggests improved levodopa handling, not dopamine terminal storage, is key to managing motor fluctuations.

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Area of Science:

Neurology
Pharmacology

Background:

Sustained levodopa treatment for Parkinson's disease (PD) frequently leads to the "on-off" phenomenon, characterized by alternating immobility and motor fluctuations.
Both pharmacokinetic and pharmacodynamic factors contribute to the pathogenesis of this phenomenon.

Purpose of the Study:

To investigate the underlying mechanisms of the on-off phenomenon in Parkinson's disease.
To evaluate the significance of levodopa handling versus dopamine terminal storage capacity in motor fluctuations.

Main Methods:

Review of evidence regarding levodopa pharmacokinetics and pharmacodynamics in PD patients.
Analysis of factors influencing levodopa handling and dopamine storage.

Main Results:

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Evidence suggests that levodopa handling, rather than a progressive reduction in nigrostriatal dopamine terminal storage capacity, is underestimated in the pathogenesis of on-off fluctuations.

Dosage adjustments, dietary protein restriction, and certain medications (selegiline, bromocriptine) may offer temporary relief.

Conclusions:

Optimizing levodopa administration strategies is crucial for managing motor oscillations in Parkinson's disease.
Emerging treatments like subcutaneous apomorphine and continuous levodopa administration show promise for improved patient management.