Motor Complications in Parkinson’s Disease: A Comprehensive Review of Emergent Management Strategies
Susana Marques de Sousa and João Massano
Affiliation: Movement Disorders and Functional Surgery Unit, Department of Neurology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-139 Porto, Portugal.
Motor complications (dyskinesias and motor fluctuations) are a common and disabling problem of
dopaminergic therapy in Parkinson’s disease, which are often difficult to treat with the current therapeutic strategies. It
has been proposed that continuous dopaminergic delivery could reduce the emergence of motor complications, which has
been tried with levodopa intestinal infusion or subcutaneous apomorphine infusion. In selected refractory cases, surgical
approaches such as deep brain stimulation should be considered. Ongoing clinical and preclinical research tried to lead the
field into the discovery of other therapeutic targets and strategies that might prevent or reduce motor complications. These
include drugs targeting non-dopaminergic systems (e.g. glutamatergic, serotonergic, noradrenergic, adenosinergic and
cholinergic systems), gene therapy for delivering neurotrophic factors or critical enzymes for dopamine synthesis, and cell
therapy. These studies found variable results, some of them promising, with the possibility of new therapeutic
armamentarium in the management of Parkinson’s disease in the near future.
Keywords: Levodopa, motor complications, motor fluctuations, Parkinson disease, peak-dose dyskinesia.
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